RISE reviews the latest headlines from the Centers for Medicare & Medicaid Services (CMS).

Feds finalize permanent expansion of Medicare telehealth services 

The Centers for Medicare & Medicaid Services (CMS) Tuesday released the annual Physician Fee Schedule final rule, which includes steps to further expand telehealth. Before the COVID-19 public health emergency (PHE), CMS said that only 15,000 fee-for-service beneficiaries each week received a Medicare telemedicine service. Since the beginning of the COVID-19 pandemic, the agency has added 144 telehealth services, such as emergency department visits, initial inpatient and nursing facility visits, and discharge day management services, that are covered by Medicare through the end of the PHE. As a result, CMS announced that preliminary data shows that between mid-March and mid-October 2020, more than 24.5 million out of 63 million beneficiaries and enrollees have received a Medicare telemedicine service. 

The final rule adds more than 60 services to the Medicare telehealth list that will continue to be covered beyond the end of the PHE. CMS said these additional services will allow beneficiaries in rural areas who are in a medical facility (like a nursing home) to continue to have access to telehealth services such as certain types of emergency department visits, therapy services, and critical care services. Medicare does not have the statutory authority to pay for telehealth to beneficiaries outside of rural areas or, with certain exceptions, allow beneficiaries to receive telehealth in their homes. However, CMS said this step will allow Medicare beneficiaries in rural areas to have more convenient access to health care. 

Despite this major step, industry experts told Modern Healthcare that without new legislation, the agency’s efforts to expand video-based telehealth will be sidelined by restrictions outside of CMS’ control. Those changes will require Congress to pass legislation to permanently allow more Medicare beneficiaries to receive telehealth services at home.  

Meanwhile in the CMS announcement, the agency said it has commissioned a study to explore new opportunities for telehealth services, virtual care supervision, and remote monitoring. 

CMS launches new model to boost regional value-based care in Medicare   

CMS on Thursday also announced the creation of the Geographic Direct Contracting Model, a voluntary payment model that will test an approach to improve health outcomes and reduce the cost of care for Medicare beneficiaries in multiple regions and communities across the country. The model will offer participants a direct incentive to improve care across entire geographic regions. Within each region, CMS said organizations with experience in risk-sharing arrangements and population health will partner with health care providers and community organizations to better coordinate care. 

Medicare beneficiaries in the model will keep all their Original Medicare benefits but may also receive enhanced benefits, such as additional telehealth services, easier access to home care, and access to skilled nursing care without having to stay in a hospital for three days.  

Model participants will coordinate care and clinical management for beneficiaries in Original Medicare in their region. This coordination may include care management services, telemedicine, as well as help for beneficiaries to understand which providers have a history of delivering better results and lower costs over the long-term.  

To help with delivering improved outcomes, participants may create a network of preferred providers. Participants and preferred providers may choose alternative payment arrangements, including prospective capitation and other value-based arrangements. Participants will also work to augment Medicare’s current program integrity efforts, reducing fraud, waste, and abuse in their region and decreasing costs for beneficiaries and taxpayers. 

CMS said organizations interested in participating in the model should submit a non-binding Letter of Interest by 11:59pm PT, December 21 through this link: Geographic Direct Contracting Model Letter of Interest. Letters of Interest will be used to determine the final regions in which CMS will solicit participants.