Payer lobbies cheer new bipartisan bill allowing audio-only telehealth in MA

Dive Brief:

  • Payer groups are coming out in support of a new bipartisan bill that would allow for audio-only telehealth services to be reimbursed through Medicare Advantage after the COVID-19 public health emergency ends.
  • The bill, originally introduced in July last year and reintroduced in the House of Representatives earlier this week, would allow providers to offer medical services and consults over the telephone to MA enrollees and require MA plans to reimburse for audio-only services as if they were in-person visits, unless the plans and providers jointly decide on a different arrangement.
  • In a statement in support of the bill, health plan lobby America’s Health Insurance Plans stressed phone calls are sometimes the only option for seniors needing to receive care in the home, especially if they live in rural or low-income areas with poor broadband access.

Dive Insight:

Early last year the federal government loosened many regulations restricting telehealth use, resulting in skyrocketing utilization of virtual care nationwide, including among Medicare patients. The relaxations included allowing diagnoses from telehealth encounters to be used in the MA risk adjustment program, but required encounters to include a video component for inclusion.

That’s not an option for all patients, as many seniors and other at-risk populations might have physical limitations or little tech know-how to set up video conferencing capabilities at home. Similarly, despite recent efforts to invest in U.S. broadband infrastructure, certain regions of the U.S. don’t have strong enough internet to support a video visit.

A pair of studies published in JAMA in August found more than a fourth of Medicare beneficiaries didn’t have access to a computer with high-speed internet access at home or a smartphone with a wireless data plan, making it impossible to have a real-time video visit with a clinician.

And an estimated 13 million seniors — 38% of all older adults in America — said they weren’t prepared for video visits, mostly due to inexperience with technology.

Those problems with access translate to the privately run MA program, too.

In a letter sent earlier this month to the sponsors of the new bill, called the Ensuring Parity in MA and PACE for Audio-Only Telehealth Act, America’s Physician Groups noted 40% of MA beneficiaries earn less than $25,000 a year and may not be able to afford video-enabled technology like a smartphone or laptop, or have stable internet access.

Additionally, many seniors struggle with video platforms, APG said in the letter signed by 10 other health groups, including AHIP and the BlueCross BlueShield Association.

Research from the Better Medicare Alliance, a group including privately-run plans like Aetna and UnitedHealth, but also patient and professional groups, found 34% of MA beneficiaries living under the federal poverty line reported no internet usage at all, complicating video telehealth access and suggesting the importance of ensuring continuous access to medical services delivered over the phone.

If audio-only access is slashed post-COVID-19, that could result in a medical cliff for low-income and needy MA beneficiaries, payer groups said.

“Lawmakers have recognized the importance of telehealth, and this important legislation recognizes that for many seniors, a phone call is their only option for health care at home,” AHIP CEO Matt Eyles said in a Wednesday statement. BMA CEO Allyson Schwartz called the bill “sensible” and “sorely needed” in a Thursday statement.

Though there’s general support in Congress for wider telehealth access and reimbursement after the pandemic, there are warring ideas on Capitol Hill about what form exactly those permanent flexibilities should take. In a House subcommittee panel on telehealth earlier this month, lawmakers seemed to agree audio-only telehealth should be allowed after the national emergency expires, but raised concerns it’s insufficient to address many health needs and — if paid at parity — could result in overutilization of health services.

The bill was introduced by Rep. Terri Sewell, D-Ala., and Rep. Gus Bilirakis, R-Fla., and supported by a half-dozen bipartisan cosponsors.

Clarification: This article has been updated to more accurately describe BMA.

Posted in Law