RISE summarizes recent regulatory headlines.

Guidance clarifies how plans can provide audio-only telehealth in compliance with HIPAA

The U.S. Department of Health and Human Services (HHS), through its Office for Civil Rights (OCR), issued guidance this week on how covered health care providers and health plans can use remote communication technologies to provide audio-only telehealth services under HIPAA, including when the OCR’s Notification of Enforcement Discretion for Telehealth is no longer in effect.

HHS said in an announcement that the guidance will help individuals to continue to benefit from audio-only telehealth by clarifying how covered entities can provide these services in compliance with the HIPAA Rules and by improving public confidence that covered entities are protecting the privacy and security of their health information.

While telehealth can significantly expand access to health care, HHS noted that certain populations may have difficulty accessing or be unable to access technologies used for audio-video telehealth due to limited financial resources, limited English proficiency, disability, or lack of internet access, availability of sufficient broadband, and cell coverage in the geographic area. Audio-only telehealth, especially using technologies that do not require broadband availability, can help address the needs of some of these individuals.

“Audio telehealth is an important tool to reach patients in rural communities, individuals with disabilities, and others seeking the convenience of remote options. This guidance explains how the HIPAA Rules permit health care providers and plans to offer audio telehealth while protecting the privacy and security of individuals’ health information,” OCR Director Lisa J. Pino said in the announcement.

OIG: Inaccuracies in Medicare’s race, ethnicity data hamper ability to assess health disparities

The Office of Inspector General (OIG) urged the Centers for Medicare & Medicaid Services (CMS) to improve its race and ethnicity data to assess disparities and advance health equity, a top priority of the Biden administration.

The ability to assess health disparities hinges on the quality of the underlying race and ethnicity data, according to OIG. Researchers analyzed the race and ethnicity data in Medicare’s enrollment database, the only source of this information for all enrolled beneficiaries. They assessed the accuracy of the data for different groups by comparing them to self-reported data for a subset of beneficiaries in nursing homes. Self-reported data for race and ethnicity are considered the most accurate.

The OIG found the data is less accurate for some groups, such as those who identify as American Indian/Alaska Native, Asian/Pacific Islander, or Hispanic. Analysts also determined that Medicare's enrollment data on race and ethnicity are inconsistent with federal data collection standards, which inhibits the work of identifying and improving health disparities within the Medicare population.

OIG recommended that CMS take four steps to improve its race and ethnicity data:

  • Develop its own source of race and ethnicity data
  • Use self-reported race and ethnicity information to improve data for current beneficiaries
  • Develop a process to standardize the data
  • Educate beneficiaries about CMS' efforts to improve the race and ethnicity information

CMS did not concur with the first recommendation and concurred with the other three recommendations.

CMS FAQ offers guidance on agent and broker compensation for special enrollment periods

The Centers for Medicare & Medicaid Services (CMS) has issued the guidance last week after it became aware that some issuers in the individual market, who commonly use agents and brokers as part of their marketing and sales channels, have reduced or eliminated commissions and other forms of compensation to agents and brokers for enrollments during a special enrollment period (SEP). The frequently asked questions clarify that paying differential compensation to agents and brokers for coverage in the same benefit year based on whether the enrollment is completed during an SEP or during open enrollment periods is prohibited under federal law. These practices violate the guaranteed availability protections afforded to these individuals under the Affordable Care Act.

Survey: Most Medicare Advantage beneficiaries satisfied with their plans

A new report published by eHealth, a licensed broker of Medicare insurance plans, found that a “striking majority” of the 2,800 Medicare Advantage enrollees surveyed in late May are satisfied with their plans. “Many find in it precisely the affordable, comprehensive, all-in-one coverage they value and need. In fact, most feel that Medicare Advantage offers a commendable example of cooperation between government and private enterprise,” the report said.

Here are five highlights from the report:

  • Eighty-eight percent of enrollees express satisfaction with their Medicare Advantage plan and 86 percent would recommend Medicare Advantage to family or friends.
  • Few were denied coverage based on formulary or provider network limitations. Overall, 13 percent say they have had a claim or pre-authorization request denied. However, 15 percent of those who had a claim or pre-authorization request initially denied say it was eventually paid by their insurer.
  • Nearly 60 percent of beneficiaries previously enrolled in Medigap say they are “more satisfied” with their Medicare Advantage plan.
  • Two thirds (67 percent) of those who chose Medicare Advantage over Medigap did so because Medigap was too expensive.
  • If forced to look for similar coverage elsewhere, 73 percent of Medicare Advantage enrollees say they could afford monthly premiums of no more than $50.