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Telehealth Services Coverage

Medicare and Medicaid Introduce New Expansion of Coverage for Telehealth Services

The use of telehealth for delivering healthcare services expanded in recent years, an innovation that owes much to the decision by the Centers for Medicare and Medicaid Services (CMS) to cover selected telehealth services. Even before the COVID-19 pandemic, the expansion of telehealth services coverage helped providers reach mobility-challenged patients, who found it difficult to leave their homes to receive the healthcare services they needed. It also helped expand access, making it possible for patients to receive services from providers sometimes well outside of their geographic area.

In California, for example, the County of Lasson uses GrandCare’s HIPAA-compliant telehealth capabilities to provide therapy visits. And in Ohio, LADD, a Cincinnati-based non-profit, created a smart home for disabled men, which uses GrandCare and other ground breaking innovations in accessibility, lighting and sensory control. This home is built from the ground up to enable the residents to live safer, more independent and happier lives. According to said Brian Hart, Chief Strategy Officer at LADD, “We have been working on this for a long time and our partnership with GrandCare enables us to provide a safe, scalable and affordable service model.” Reimbursement through Medicaid for these services is possible, because Medicaid has expanded its definition of assistive technology to include support for remote supports, such as reminders and prompts for daily activities, and even video calls to receive remote support from caregivers. 

With the advent of the pandemic, the importance of telehealth became even more apparent, when it allowed patients to receive services safely, even as they sheltered at home. This was especially critical for our nation’s seniors, who were at the highest risk for the most severe forms of the disease. Those in congregate living were often under quarantine, and unable to safely leave their communities for needed care. The pandemic resulted in a dramatic increase in the use of remote telehealth services.

“Before the COVID-19 public health emergency (PHE), only 15,000 fee-for-service beneficiaries each week received a Medicare telemedicine service. Since the beginning of the PHE, CMS has added 144 telehealth services,” according to CMS. In the 7-month time period between mid-March and mid-October of 2020, over 24.5 million people received a Medicare-covered telehealth service. 

“Telehealth has long been a priority. We started paying for short virtual visits in rural areas long before the pandemic struck. But the pandemic accentuated just how transformative it could be.” – Seema Verma, CMS Administrator

In recent months, Network Health, a Wisconsin-based insurance company, started a new program for its Medicare Advantage members in Wisconsin, using GrandCare in member homes to provide virtual visits with care managers and providers, and reduce loneliness and isolation. They will continue to roll out telehealth and medication management solutions to offer a better member experience.

This year’s Physician Fee Schedule (PFS) final rule once again expands CMS coverage for telehealth services. Although one category of new covered services is designed to be temporary, remaining on the list through the end of the declared public health emergency, others are permanent additions to the list of covered services. It’s part of a strategy, according to CMS, to “create a healthcare system that results in better accessibility, quality, affordability, empowerment, and innovation.”

“Telehealth has long been a priority,” said CMS Administrator Seema Verma. “We started paying for short virtual visits in rural areas long before the pandemic struck. But the pandemic accentuated just how transformative it could be.”

Among the many additional to this year’s schedule is a welcome broadening of the coverage for remote monitoring services. In addition, CMS has created new codes for coverage of online assessments, making it possible for qualified non-physician health care professionals to perform these services. “Medicare beneficiaries will now be able to receive dozens of new services via telehealth, and we’ll keep exploring ways to deliver Americans access to healthcare in the setting that they and their doctor decide makes sense for them,” said HHS Secretary Alex Azar.

Telehealth Services Expanding Under Medicare

Exciting news! The Centers for Medicare and Medicaid Services (CMS) issued a new ruling last week that adds telehealth benefits to Medicare Advantage plans. Previously, certain telehealth benefits were only available to seniors in Original Medicare, and only if they lived in remote, rural areas.

“Today’s policies represent a historic step in bringing innovative technology to Medicare beneficiaries.”

These new changes, starting in 2020, mean that patients will have the option to use telehealth to receive medicare care, and have it covered. What does this mean for GrandCare? Instead of being required to go to a healthcare facility for every service, seniors will be able to use GrandCare’s one -touch, HIPAA-compliant video chat on their GrandCare system to connect with their healthcare and clinical providers. It also means expanded access to telehealth services from providers who may practice in other parts of the country, and may not otherwise be reachable by the senior patient. This also enables medical homecare providers, such as the visiting nurses, to better access patients using telehealth monitoring tools and virtual check ins, without having the excess “windshield” time and cost of transport.

“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.”

With geographical restrictions lifted, CMS is ensuring that seniors in all parts of the country will have access to telehealth and telemedicine services. According to CMS, “These policies continue the agency’s efforts to modernize the Medicare Advantage and Part D programs, unleash innovation and drive competition to improve quality among private Medicare health and drug plans.”

GrandCare’s easy-to-use, HIPAA-compliant video chat feature has always allowed seniors an easy face-to-face chat with healthcare providers. GrandCare also uses Bluetooth wireless technologies for remote monitoring of vitals and biometric readings, and offers better medication management and compliance monitoring. With the new CMS ruling, GrandCare users will enjoy a new convenience, better and faster access to care, while being covered by Medicare.