Medicare Advantage final rule expands telehealth coverage

CMS will expand coverage of telehealth services under Medicare Advantage effective January 1, 2020, according to a final rule published in the Federal Register April 16.

The final rule allows Medicare Advantage beneficiaries to receive telehealth services in their homes rather than requiring them to travel to a physician’s office or other healthcare facility. Expanding telehealth benefits will increase patients’ access to care by giving them more control over when, where, and how they receive care, according to the final rule.

The final rule also finalizes proposals aimed at improving the appeals process and coordination of benefits for certain beneficiaries who participate in Dual Eligible Special Needs Plans (D-SNP). The unified appeals and grievance process for D-SNAP beneficiaries creates a single pathway for appeal resolution by aligning timeframes and sets requirements for how Medicare Advantage plans track and resolve appeals. It also requires Medicare Advantage to incorporate existing law that provides continuation of benefits pending appeal for items and services covered under Medicare and Medicaid.

Organizations should review the final rule to determine how it may impact their specific operations and how they and their patient populations may benefit from the expanded telehealth benefits.