CMS finalizes rules to allow expansion of telehealth services

CMS finalized proposed rules this week that will allow Medicare Advantage plans to expand telehealth benefits covered in plans by 2020. Prior to this year, Medicare enrollees could receive only limited telehealth services and only if they lived in rural areas.

The Bipartisan Budget Act of 2018, sought to loosen these restrictions so as to encourage more cost effective care. In 2019 support of telehealth service increased as the Medicare Physician Fee Schedule and Quality Payment Program included some reimbursement for remote patient monitoring and virtual check-ins. The rules build on this flexibility.


Get the latest state-specific policy intelligence for the health care sector delivered to your inbox.


The new rules eliminate geographic restrictions for allowable telehealth services to allow both urban and rural members to take advantage of telehealth services as part of regular, not supplemental benefits, hopefully allowing for expanded access to care in other settings.

CMS Administrator Seema Verma explains, “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.”

In addition to the expansion of telehealth, the newly finalized rules allow for increased integration of Medicare and Medicaid Dual Eligible Special Needs Plans which typically cover beneficiaries with complex health needs. Currently, if enrollees have a complaint about their healthcare or about access to items and services, they have to coordinate between multiple organizations, one responsible for Medicare benefits and another responsible for Medicaid benefits, in order to file an appeal.

The new rule will consolidate the process into one across both Medicare and Medicaid, making it easier for enrollees to navigate. The rule will also requires plans to more seamless integration Medicare and Medicaid benefits across the two programs, to promote coordination of care for these patients.