CMS Proposed Ruling Gives Greater Access to Telehealth to Home Health Care Patients

Medicare Advantage members as of 2020 will have greater access to virtual care visits, according to a new proposed ruling from the Centers for Medicare and Medicaid Services (CMS) that was finalized in April.  The new ruling, if passed, will expand geographical areas covered and the way the services are paid for. This is good news for the home health care industry and its patients, who will have greater access to telehealth services.

Telehealth is defined as the “delivery and facilitation of health and health-related services including medical care, provider and patient education, health information services, and self-care via telecommunications and digital communication technologies.” It’s estimated that by 2025 the telehealth industry will surpass $16 billion in the U.S.

Currently, the CMS restricts telehealth reimbursement to clinical settings in rural areas, except for Alaska and Hawaii. According to Home Health Care News, “while that regulatory landscape has opened the door for telehealth use in skilled nursing facilities operating in sparsely populated, non-urban markets, it has mostly shut out the home health industry and slowed providers’ innovation pace.”

The new CMS proposed ruling gives Medicare Advantage plans greater flexibility to offer government-funded telehealth benefits to all enrollees, regardless of whether they live in rural or urban areas. The CMS proposal would also allow Medicare Advantage enrollees to receive telehealth services from home, rather than requiring them to go to a clinic, skilled nursing home or other health care facility.  Medicare Advantage is an increasingly prominent payer for home health agencies. These plans — offered by private insurers using government funds — also will be allowed to cover private duty home care services starting in 2019, according to Home Health Care  News.

“Today’s policies represent a historic step in bringing innovative technology to Medicare beneficiaries,” said CMS Administrator Seema Verma. “With these new telehealth benefits, Medicare Advantage enrollees will be able to access the latest technology and have greater access to telehealth. By providing greater flexibility to Medicare Advantage plans, beneficiaries can receive more benefits, at lower costs and better quality.”

Telehealth provides several benefits to patients, including better access to health care providers; cost reduction because of the lower costs involved for everything from less traveling time and shorter hospital stays to shared professional staffing and improved chronic disease management; and enhanced quality with better outcomes in terms of both care and patient satisfaction.

In the home health care industry, the increased opportunities for communication offered by telehealth allow professionals and caregivers alike to assess the status of patients when needed without repeated visits to the doctor’s office or hospital. This can include monitoring everything from medication taking and blood levels to telemonitoring vital signs, interacting with blood pressure cuffs and glucose monitors, and notifying caregivers about changes that may indicate illness. Additionally, telehealth offers increased security for wandering and elopement in people with dementia. The bottom line: Teleheath can serve to extend the reach of physicians, enable a constant relationship between patients and caregivers, and offer providers a continuous stream of real-time health data.

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