AHIP, others applaud House bill focused on audio-only telehealth for Medicare Advantage

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America’s Health Insurance Plans has praised the introduction of a bill that would improve access to audio-only telehealth for seniors in Medicare Advantage. The bill, which was originally introduced in July 2020, was revived by the U.S. House of Representatives this week.

According to the website of Representative Tony Cárdenas (D-Calif.), one of the bill’s cosponsors, the Ensuring Parity in MA and PACE for Audio-Only Telehealth Act would allow providers to offer audio-only telehealth services to MA enrollees. It would ensure that providers are adequately compensated by requiring MA plans to reimburse them for audio-only telehealth visits as if they were in-person visits – unless both parties have agreed to a separate payment policy.

WHAT’S THE IMPACT?

AHIP lauded the bill, saying that phone calls are often the only option for seniors seeking care at home. During the COVID-19 pandemic, this demographic in particular has increasingly relied on telehealth to safely access their care, but many seniors in rural and urban communities still struggle with a lack of broadband Internet services.

AHIP said the bill would reduce health disparities caused by unequal access to technology.

“The bipartisan legislation is another example of how the public and private sector can work together to improve healthcare affordability and access for all Americans,” AHIP wrote in a statement.

Joining in support of the bill was America’s Physician Groups, which said in a letter to the bill’s sponsors that telehealth services are essential for older Americans, especially those with a high risk of complications if they contract the coronavirus.

Telehealth, the group said, helps to reduce exposure and mitigates the spread of the virus and other illnesses.

To help facilitate the use of telehealth among MA patients, the Centers for Medicare and Medicaid Services loosened many previous restrictions regarding telehealth, including allowing diagnoses from telehealth encounters to be used in the MA risk adjustment program. 

But this guidance requires that the encounters include a video component, which is not an option for many patients. Seniors in rural and urban communities, in particular, may lack access to broadband Internet services.

In addition to the lack of access to broadband, 40% of MA enrollees earn less than $25,000 a year and may not be able to afford the technologies and infrastructure needed for video telehealth services, according to APG. 

At the same time, older seniors, or those with certain physical limitations and disabilities, often struggle to access video platforms. For these patients, an audio-only telehealth visit may be the only option other than foregoing needed care.

“Allowing diagnoses from audio-only telehealth services to count for MA risk adjustment helps to ensure that health costs are adequately covered while also providing coordinated care teams with the information necessary to assess and develop plans, deploy necessary resources, and inform approaches to manage patient care,” APG wrote.

“Without the accurate documentation of diagnoses, MA will see cuts during the middle of a global pandemic, leaving plans and providers with fewer resources necessary to care for patients.”

This outcome, the group said, could lead to fewer choices and higher premiums or potentially reduced benefits, especially for the plans whose enrollees have the least access to video telehealth.

THE LARGER TREND

While the increased use of telehealth during the pandemic allowed many patients to maintain access to care, reimbursement for a large portion of these visits may end with the public health emergency, creating challenges for low-income patients who rely on such services, according to a February study from RAND.

The study looked at data from billable outpatient primary care and behavioral health visits at 41 federally qualified health centers that operated at 534 locations in California from February 2019 to August 2020.

During the pandemic, the FQHCs experienced a rapid increase in telehealth usage as the clinics substituted in-person care for video and telephone visits. For primary care visits, 48.1% occurred in person, 48.5% via telephone and 3.4% via video. Comparatively, for behavioral health visits, 22.8% occurred in person, 63.3% via telephone and 13.9% via video.

Telephone visits peaked in April 2020, comprising 65.4% of primary care visits and 71.6% of behavioral health visits, according to the study.

The American Psychological Association is one of many organizations that support the bill.

“Allowing patients to receive mental health services by audio-only telephone is a matter of health equity for underserved populations, and APA applauds this important equalizer,” said APA CEO Arthur C. Evans Jr., Ph.D. “This bill will allow patients to receive services at home, no matter where they live − whether in rural, urban or suburban communities.”

Even without the bill, HHS expects to extend the public health emergency through the end of 2021, according to a letter it recently sent to governors.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com

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