Budget Pact Boosts Medicare Coverage for Telehealth Services

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By Mike Stankiewicz

Medicare managed care coverage for telehealth services, such as digitally connecting a patient at home to a doctor, is receiving a boost under a two-year spending bill, which became law Feb. 9.

Currently, Medicare pays only for certain telehealth services under Part B, normally in the form of face-to-face video conferencing. Under the new law, Medicare can pay for telehealth benefits, such as telemonitoring and medication therapy management, under private Medicare Advantage plans starting in 2020.

MA plans are currently allowed to provide telehealth services, other than those covered in the traditional Medicare program, but those additional services are not paid for separately by Medicare and plans must pay for them in other ways as a supplemental benefit. UnitedHealth Group Inc., the most popular insurer in the MA market, which comprises 25 percent of enrollments, and Humana Inc., the second largest, did not respond to Bloomberg Law’s request for comment.

The law also removes geographical limitations on Medicare reimbursement for stroke-related telehealth services, known as telestroke. Advocates say expanding access to telehealth would increase convenience and reduce medical costs, especially in rural areas, where doctors are few and far between.

Not everyone, however, has been supportive of expanding coverage for such services. Members of the Medicare Payment Advisory Commission, the main Medicare payment advisers to Congress, have cautioned that covering more telehealth services could lead to misuse and that such services might actually increase overall Medicare costs.

What’s Next

The ball is now in the Medicare agency’s court on when it decides to move and on what services should be covered.

Seema Verma, administrator of the Centers for Medicare & Medicaid Services, said during a Feb. 6 conference that telehealth coverage provisions will be included in this year’s Medicare payment rules, which are expected in the spring.

Reaction to the law’s telehealth provisions was mostly positive. A Medicare patient advocacy group, however, slammed the law for only expanding coverage to MA plans.

“On the one hand, these provisions have the potential of improving services and care for people enrolled in MA plans,” David A. Lipschutz, senior policy attorney for the Center for Medicare Advocacy, told Bloomberg Law Feb. 9. “On the other hand, this is unfair for the majority of Medicare beneficiaries, who are in traditional Medicare, and once again favors MA over traditional Medicare.”Ken Wood, senior vice president of health plan development at the San Francisco office of Evolent Health, a health plan consulting company, said the expansion could eventually lead to greater telehealth coverage under traditional Medicare.

“This is a much bigger step than I imagined they’d take,” he told Bloomberg Law Feb. 9. “There is a slow but growing understanding that this is a legitimate form of care delivery and I’m looking forward to seeing it covered more.”

To contact the reporter on this story: Mike Stankiewicz in Washington at mstankiewicz@bloomberglaw.com

To contact the editor responsible for this story: Brian Broderick at bbroderick@bloomberglaw.com

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