September 02, 2020

Megan Herber Discusses Efforts to Change MA Telehealth Policy

Reprinted with AIS Health’s permission from the Sept. 3, 2020, issue of RADAR on Medicare Advantage.

In the article, “Plans, Providers Pursue Lasting Change to MA Telehealth Policy,” director Megan Herber described the efforts by Faegre Drinker Consulting and other organizations with regard to advocacy on the issue of Medicare Advantage (MA) telehealth policy.

RADAR on Medicare Advantage reports that while the Trump administration had already implemented or was taking steps to support the use of telehealth in the MA program prior to the COVID-19 pandemic, one remaining barrier for plan adoption of telehealth was the inability to collect diagnosis codes for risk adjustment purposes. According to the publication, CMS temporarily addressed this issue during the pandemic, but as providers anticipate telehealth to play a more permanent role in health care delivery, they are joining with plans to advocate for a permanent shift in MA telehealth policy.

But as plans were rolling out their benefits for 2020, it appeared that they weren’t fully embracing and adopting telehealth, Herber said.

“I was on the Hill before I joined the firm and helped work on the policy that allowed MA plans to include telehealth in the base bid rather than as a supplemental benefit and I was kind of looking at plans [last fall] asking, ‘Why aren’t you implementing this? What’s going on?’” Herber recalls.

“It’s a huge disincentive if you all of a sudden fully adopt and conduct more telehealth and you end up getting a bunch of your diagnoses over telehealth visits, and it’s not going to count toward your risk adjustment,” said Herber. “That’s a significant reason not to more fully adopt telehealth visits for a lot of different services. CMS has done a number of things to encourage telehealth, but I feel like this is the one big, outstanding barrier that they could and should address on a more permanent basis to make sure the MA plans can fully adopt.”

As a result, Faegre Drinker has convened a small group of industry players around advocacy on the issue. That includes telehealth provider Doctor On Demand, CVS Health Corp. and its Aetna subsidiary, Humana Inc., and Ochsner Health.

Alongside other organizations, Ochsner and Faegre Drinker are composing a letter to CMS requesting the permanent policy change, which would likely be accomplished via a second memo. Unlike other Medicare telehealth policies enacted during the pandemic that would require congressional authorization to continue, “We believe CMS has the authority to do this immediately through subregulatory guidance, as they already did for the April 10 memo,” says Herber. “Our most ideal outcome would be a second memo (plus updates to technical guides/manuals) that says the policy from [the] April 10, 2020, memo counts for all dates of service going forward rather than just 2019 and 2020.”


Meet the Authors

Faegre Baker Daniels
Michael S. Adelberg

Principal - Healthcare Providers & Plans Practice Lead - Faegre Drinker Consulting

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