Congressional Budget Pact Includes Telehealth Sweetener

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.

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.

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

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