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In final rule, CMS makes telehealth more widely available in Medicare Advantage plans


The Centers for Medicare and Medicaid Services today finalized requirements that will, among other measures, increase access to telehealth for seniors in Medicare Advantage plans.

CMS is giving MA plans more flexibility to count telehealth providers in certain specialty areas such as Dermatology, Psychiatry, Cardiology, Ophthalmology, Nephrology, Primary Care, Gynecology, Endocrinology, and infectious diseases, towards meeting CMS network adequacy standards.

This flexibility will encourage plans to enhance their benefits to give beneficiaries access to the latest telehealth technologies and increase plan choices for beneficiaries residing in rural areas, CMS said.

CMS is also finalizing proposals to enhance the MA and Part D Star Ratings system to further increase the impact that patient experience and access measures have on a plan’s overall star rating.

Additionally, CMS adopted a series of changes in the March 31 Interim Final Rule with Comment Period for the 2021 and 2022 Star Ratings to accommodate challenges arising from the COVID-19 public health emergency.

CMS today also finalized requirements to expand the types of supplemental benefits available for beneficiaries with an MA plan who have chronic diseases, provide support for more MA options for beneficiaries in rural communities, and expand access to MA for patients with end stage renal disease.

Today’s rule gives beneficiaries with end-stage renal disease more coverage choices in the Medicare program. Previously, beneficiaries with ESRD were only allowed to enroll in MA plans in limited circumstances. The rule implements the changes made by the 21st Century Cures Act to give all beneficiaries with ESRD the option to enroll in an MA plan starting in 2021.

This will give beneficiaries with ESRD access to more affordable Medicare coverage options that may include extra benefits such as health and wellness programs, transportation, or home-delivered meals that are not available in Medicare fee-for-service, CMS said.


Due to the upcoming June 1, MA and Part D bid deadlines for the 2021 plan year, CMS finalized a subset of the proposed policies before the MA and Part D plans’ bids are due.

CMS plans to address the remaining proposals for plans later in 2020 for the 2022 plan year.

“We understand that the entire healthcare sector is focused on caring for patients and providing coverage related to coronavirus disease 2019, and we believe this approach provides plans with adequate time and information to design the best coverage for Medicare beneficiaries,” CMS said.


CMS first expanded the use of telehealth when it offered Medicare Advantage plans more flexibility for its use in April 2019.

Under COVID-19, the agency has expanded the allowable uses for providers to use telehealth and get paid at in-person rates.

The provisions in the final rule result in an estimated $3.65 billion net reduction in spending by the federal government over ten years due to a finalized change to the Part C and D Star Rating methodology to remove outliers before calculating star ratings cut points, which offsets costs arising from the Medical Loss Ratio provisions and other refinements to the MA and Part D Quality Star Ratings system.


Teladoc Health, a large telehealth provider, said it is still reviewing the final rule. In a letter to CMS Administrator Seema Verma in April, Teledoc said it supported a number of policies in the proposed rule and asked for clarity on some points, including what constitutes a “face-to-face” encounter.

Teledoc urged CMS to broadly consider all telehealth visits as meeting “face-to-face” encounter requirements across the MA program.


“CMS’s rapid changes to telehealth are a godsend to patients and providers and allows people to be treated in the safety of their home,” said CMS Administrator Seema Verma. “The changes we are making will help make telehealth more widely available in Medicare Advantage and are part of larger efforts to advance telehealth.”

Twitter: @SusanJMorse
Email the writer: [email protected]


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