CMS Allows Medicare Advantage Plans to Expand Telehealth

The Centers for Medicare and Medicaid Services (CMS) announced on May 22, 2020 a final rule that provides for changes to telehealth coverage for Medicare Advantage (MA) plans in advance of the upcoming June 1, 2020 MA and Part D bid deadlines for the 2021 plan year. CMS is finalizing the proposed rule before the MA and Part D plans’ bids are due.

The proposed rule encourages MA plans to increase their telehealth benefits and increase plan options for beneficiaries living in rural areas. CMS is giving MA plans more flexibility to count telehealth providers in certain specialty areas (such as Dermatology, Psychiatry, Cardiology, Ophthalmology, Nephrology, Primary Care, Gynecology, Endocrinology and Infectious Diseases) towards meeting CMS network adequacy standards. CMS hopes that providing flexibility in the proposed rule with respect to telehealth “will encourage plans to enhance their benefits to give beneficiaries access to the latest telehealth technologies and increase plan choices for beneficiaries residing in rural areas.” This move is an extension of CMS’s continued expansion of telehealth flexibility to benefit individuals seeking medical care during this pandemic.

Hopefully the support of CMS in advancing the use of telehealth for those covered by MA plans will also signal wider expansion and adoption of telehealth solutions for those covered by commercial health insurance plans as the value of telehealth has been battle tested by the pandemic. White and Williams is continuing to monitor developments with respect to telehealth. A current summary of guidance can be found here. 

If you have questions or would like additional information, contact Lori Smith (smithl@whiteandwilliams.com; 212.714.3075), Andy Hamelsky (hamelskya@whiteandwilliams.com; 212.631.4406), Zaara Nazir (nazirz@whiteandwilliams.com; 973.604.5681) or another member of the Healthcare Group.

As we continue to monitor COVID-19, White and Williams lawyers are working collaboratively to stay current on developments and counsel clients through the various legal and business issues that may arise across a variety of sectors. Read all of the updates here.