Better Medicare Alliance Touts Support for Audio-Only Telehealth

April 19, 2021 - The Better Medicare Alliance is touting support from more than 30 health systems and healthcare organizations for a bill that would establish Medicare coverage for audio-only telehealth services in Medicare Advantage and PACE programs.

Senate Bill 150 and its companion bill in the House, HR 2166, known as the Ensuring Parity in MA for Audio-Only Telehealth Act, would set coverage in MA plans for audio-only telehealth services for risk assessment. HR 2166 would also set coverage for those services in the roughly 135 Program of All-Inclusive Care for the Elderly (PACE) programs in the country. That coverage would last as long as the public health emergency is in place for the coronavirus pandemic.

PACE was created by the Centers for Medicare & Medicaid Services (CMS) for seniors who need long-term support services (LTSS), or a nursing home level of care. Developed as a capitated model of care for dual-eligible beneficiaries (ninety percent are dual eligible), it provides all necessary medical care, therapies, long term care and services, meals, socialization, transportation, day center services and activities.

The Better Medicare Alliance says providers can gain valuable information from members of these programs through a phone call.

“Allowing the use of this data will ensure that clinically accurate data on patients obtained during audio-only telehealth visits will be available during this public health emergency to fulfill Medicare Advantage and PACE requirements,” a letter sent last week to both bills’ sponsors reads. “It is essential that the collection of diagnoses required for risk adjustment be as complete and as accurate as possible. Action by Congress now will help avoid disruption and provide relief necessary for Medicare Advantage and PACE organization, allowing them to continue to provide high quality, affordable care to millions of Medicare beneficiaries.”

Along with the Better Medicare Alliance, the letter is signed by, among others, Ascension, Harvard Pilgrim Health Care, Northwell Health, the US Chamber of Commerce, the Visiting Nurse Associations of America and the UPMC Health Plan.

The lobbying effort comes as telehealth organizations and health systems struggle to define a strategy for telehealth and mHealth access and coverage that extends through and beyond the COVID-19 crisis. Groups like the Alliance for Connected Care and the American Telemedicine Association have been pushing Congress to develop and act on a plan that permanently extends some or all of the emergency measures put in place during the pandemic.

Telehealth advocates say Congress should act as soon as possible on a long-term plan to promote telehealth adoption. While many providers have launched connected health programs during the pandemic, they’re uncertain as to how those programs would be sustained if coverage disappears with the PHE, so they’re waiting for direction from Washington DC.

Congress has been slow to act on telehealth, however, and CMS has taken a conservative approach, asking for more proof that telehealth improves outcomes and reduces costs. Just last month, the Medicare Payment Advisory Commission urged lawmakers to move slowly on a long-term policy so that they could see how telehealth programs have worked during the pandemic.

With dozens of bills now before Congress calling for new telehealth coverage, groups like the Better Medicare Alliance are jockeying for attention, raising the profile for specific bills in hopes that they are are either passed or included in larger pieces of legislation.

With S 150 and HR 2166, they’re looking to establish telehealth coverage now so that both MA and PACE programs can prove value in the long run.

“Medicare Advantage is unique in requiring accurate health assessment of each beneficiary every year to determine their health conditions and ensure that risk adjusted payments are accurate and reflect a beneficiary’s current diagnoses and conditions,” the letter points out. CMS “has already taken action to permit using data obtained during audio-video telehealth visits to inform diagnoses for risk assessment; however, they are denying the use of audio-only telehealth visits for risk assessment purposes. This same limitation also applies to (PACE).”

“The data obtained through audio-only telehealth visits is necessary for accurate calculation of the following year’s benchmarks in Medicare Advantage, without which it will be difficult to keep out-of-pocket costs low for beneficiaries and meet expectations for use of supplemental benefits,” the letter concludes.