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Telehealth Updates

Tuesday, May 7, 2019
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Overview

The Bipartisan Budget Act of 2018 (BBA) included legislation to enhance telehealth services. Section 50323 of the BBA created section 1852(m) of the Social Security Act (the Act) which allows an MA plan to have the ability to provide “additional telehealth benefits” to plan enrollees in the year 2020 and treat them as “basic benefits.” This means that the additional telehealth benefits will now be included in the capitation rate paid by Medicare to the MA Plan. Two expected benefits for enrollees from this new legislation are reduced travel time to and from providers and a reduction in premium costs.

Additional telehealth benefits are clinically appropriate services provided by in-network providers for benefits which are available under Part B and utilize electronic information and telecommunications technology (electronic exchange) when a physician or practitioner providing the service is not in the same location as the plan enroller. Electronic exchange is defined as electronic information and telecommunications technology and may include, though not limited to, secure messaging, store and forward technologies, telephone, videoconferencing, other internet-enabled technologies, and present or evolving technologies that are appropriate for non-face-to-face communications.

Infrastructure costs and investments relating to such benefits, such as start-up costs, are excluded from reimbursement.

Background

Historically, MA Plans have offered more telehealth services than Original Medicare (FFS) as a supplemental benefit. Before the enactment of the BBA, supplemental benefits were not covered in the capitation rate paid to the MA Plan that resulted in enrollees who received these benefits having to pay higher premium costs to the MA Plan they were enrolled with. Section 1834(m) of the Act generally limited the provision of telehealth services to the use of interactive audio and telecommunications systems that promoted real-time communications between a Medicare beneficiary and either a physician or specified other type of practitioner at an eligible originating site. The newly created section 1852 (m) loosens up some of the section 1834 (m) restrictions for MA plans.

What Has Changed

Now, MA Plans can offer telehealth services that expand beyond services offered by Original Medicare. For example, enrollees can have the option of receiving telehealth services from places like their home rather than having to go to a designated healthcare facility. In addition, telehealth services, limited for the most part to rural areas under Original Medicare, can be provided in urban areas also.

Section 50302 and 50325 of the BBA removed certain section 1834 (m) restrictions effective for the Calendar Year 2019 Physician Fee Schedule final rule including the limitations on geography and originating sites for certain services under Original Medicare. As an example, Original Medicare has started to pay for virtual check-ins across the country which allows patients to connect with their physicians by phone or video chat.

The Centers for Medicare and Medicaid Services allows MA plans to independently determine on an annual basis which services are clinically appropriate to furnish through electronic exchange as MA Plan additional telehealth benefits. Finally, MA plans must advise enrollees that they may receive these specified services either through an in-person visit or through electronic exchange.                                                                   

What You Can Do

This new legislation is a great opportunity for your organization to provide enhanced telemedicine services to your patient population. Contact your current MA providers to discuss how they can partner with your organization to provide enhanced telemedicine services.

For additional information, please contact:

Richard T. (Terry) Lang, FHFMA, CPA