{"id":6911,"date":"2019-05-13T10:58:10","date_gmt":"2019-05-13T10:58:10","guid":{"rendered":"http:\/\/tele.healthcare\/?p=6911"},"modified":"2019-05-13T10:58:10","modified_gmt":"2019-05-13T10:58:10","slug":"cms-issues-final-rule-for-telehealth","status":"publish","type":"post","link":"https:\/\/drmiltie.com\/at-home-testing\/cms-issues-final-rule-for-telehealth\/","title":{"rendered":"CMS Issues Final Rule for Telehealth"},"content":{"rendered":"\n<p>Monday, May 13, 2019\n\n\n\n\n\n\n\n<\/p>\n\n\n\n<p>Citing the use of telehealth as a care delivery option for Medicare Advantage (MA or Part C) enrollees with the potential to \u201cimprove access to and timeliness of needed care, increase convenience for patients, increase communication between providers and patients, enhance care coordination, improve quality and reduce costs related to in-person care,\u201d the Centers for Medicare &amp; Medicaid Services (CMS) issued a&nbsp;<a href=\"https:\/\/urldefense.proofpoint.com\/v2\/url?u=http-3A__gtlawinfo.com_collect_click.aspx-3Fu-3DjRYOrR8N39Sa3z407wcythHdT8W-2Bauck7A7TVm5cwHKBPvcz5JaNHq06YJ7Yn4p8-26rh-3Dff004a581d57945f7bc55b3ef449aaa0d1fbdf15&amp;d=DwMGaQ&amp;c=2s2mvbfY0UoSKkl6_Ol9wg&amp;r=0sja4ZcXlI82_7NqhplWwC4w5VIykUVWY3KF4t82mzU&amp;m=astjqh2NYt4H7o6Z2sIj4R-G2DZ5BiVH0HIzSSC8eZA&amp;s=iQ1nNvqTkATi4eSTS9HM3RLUMsKEUedh_MQDqE5Vf_Y&amp;e=\" target=\"_blank\" rel=\"noreferrer noopener\">final rule<\/a>&nbsp;on April 5, 2019, implementing several provisions from the Bipartisan Budget Act of 2018 (Public Law 115-123), including updating the MA program by allowing MA plans to include \u201cadditional telehealth benefits\u201d as part of the Medicare basic benefits. As a result, starting in plan year 2020, MA plans will be able to include such \u201cadditional telehealth benefits\u201d (i.e., telehealth benefits beyond what original Medicare allows) in their bids for the basic Medicare benefits.<\/p>\n\n\n\n<p>Traditionally, MA plans have been constrained in how they deliver telehealth services outside of the original Medicare telehealth benefit, limiting payment to specified services at eligible originating and distant sites within certain designated geographic locations. Because the government\u2019s capitation payment historically has only included hospital and physician\/outpatient services covered under original Medicare, most telehealth benefits offered by MA Plans have been offered as MA supplemental benefits, which are funded through the use of rebate dollars or supplemental premiums paid by enrollees. The new rule allows MA plans more flexibility to design their telehealth programs within the Medicare benefit package. While MA plans will still be able to offer MA supplemental benefits for those services that do not meet the requirements for coverage under original Medicare or the requirements for MA \u201cadditional telehealth benefits\u201d (described below), the new rule will allow MA plans to provide increased access to patient-centered care by giving enrollees more control to determine when, where, and how they access benefits.&nbsp;<\/p>\n\n\n\n<p>\u201cAdditional telehealth benefits\u201d are defined as services i) available under Medicare Part B, but not payable under the original Medicare telehealth benefit and ii) identified by the MA plan as clinically appropriate to furnish through electronic exchange when the physician or practitioner providing the services is not in the same location as the enrollee.&nbsp;<em>See<\/em>&nbsp;42 CFR 422.135(a); 42 CFR 410.78. CMS broadly defines \u201celectronic exchange\u201d as electronic information and telecommunications technology and permits MA plans to furnish such \u201cadditional telehealth benefits\u201d provided the plan meets the following requirements:<\/p>\n\n\n\n<ol class=\"wp-block-list\"><li>\nthe plan provides in-person access to the specified Part B services(s) at the election of the enrollee;\n<\/li><li>\nthe plan advises each enrollee that he\/she may receive the specified Part B services through an in-person visit or through electronic exchange;\n<\/li><li>\nthe plan complies with the Medicare provider selection and credentialing requirements and, when providing additional telehealth benefits, ensures through its contract with the provider that the provider meets and complies with applicable state licensing requirements and other applicable laws for the state in which the enrollee is located and receiving the services; and\n<\/li><li>\nthe plan makes information about coverage of additional telehealth benefits available to CMS upon request, including but not limited to statistics on use or cost, manner or method of electronic exchange, evaluation or effectiveness, and demonstration of regulatory compliance.\n<\/li><\/ol>\n\n\n\n<p><em>See<\/em>&nbsp;42 CFR 422.135(c).&nbsp;<\/p>\n\n\n\n<p>Additionally, an MA plan furnishing \u201cadditional telehealth benefits\u201d may only do so using contracted providers. CMS requires that the MA plan review and certify the qualifications and compliance of such providers to ensure that telehealth services are furnished in accordance with clinically appropriate standards of care and that all licensure and credentialing requirements are met. Coverage of benefits furnished by a non-contracted provider through electronic exchange may only be covered as a supplemental benefit.&nbsp;<em>See<\/em>&nbsp;42 CFR 422.135(d).<\/p>\n\n\n\n<p>If an MA plan fails to comply with the requirements of 42 CFR 422.135, the MA plan may not treat the benefits provided through electronic exchange as \u201cadditional telehealth benefits.\u201d (The plan may treat them as supplemental benefits, but subject to CMS approval.)<\/p>\n\n\n\n<p>Further, because CMS deems the delivery of a Part B service via electronic exchange as inherently different (e.g., in modality and required infrastructure) from in-person delivery, MA plans offering \u201cadditional telehealth benefits\u201d may maintain different cost-sharing for the specified Part B services furnished through an in-person visit versus furnished through electronic exchange.&nbsp;<em>See<\/em>&nbsp;42 CFR 422.135(f).<\/p>\n\n\n\n<p>Under this final rule, CMS envisions that MA enrollees will have additional opportunities to receive health care services from places like their homes, rather than being required to go to a health care facility. And MA plans will now have broader flexibility than is currently available in how they pay for telehealth benefits to meet the needs of their enrollees.\n\n\n\n\n\n\t\t\t\t\u00a92019 Greenberg Traurig, LLP. All rights reserved. <\/p>\n","protected":false},"excerpt":{"rendered":"<p>Monday, May 13, 2019 Citing the use of telehealth as a care delivery option for [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":5478,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_uag_custom_page_level_css":"","_uf_show_specific_survey":0,"_uf_disable_surveys":false,"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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