Senators Introduce Bipartisan Bill to Expand Telehealth Access for Medicare Advantage Enrollees

Jan. 28, 2021
Sens. Catherine Cortez Masto and Tim Scott on Jan. 26 introduced into the Senate a bill previously introduced into the House of Representatives to expand coverage to audio-based care for Medicare Advantage enrollees

On Wednesday, Jan. 26, the offices of one Democratic and one Republican senator announced that they will introduce bipartisan legislation to expand access to telehealth-based care for Medicare Advantage enrollees, including for audio-only care encounters.

As shared in a press release on Tuesday, “U.S. Senators Catherine Cortez Masto (D-Nev.) and Tim Scott (R-S.C.) will introduce bipartisan legislation, the Ensuring Parity in Medicare Advantage for Audio-Only Telehealth Act of 2021, to facilitate Medicare Advantage enrollees’ access to telehealth during the pandemic, even if they can only make an audio connection to providers.” The press release quoted Sen. Cortez Masto as stating that “Many of Nevada’s seniors have been following guidance to rely on telehealth services during the coronavirus pandemic. They should not be penalized if, as in many cases, their access to video services is limited, either by the availability of broadband in their area or by their budgets. I’m glad to support this bipartisan bill that will modernize the payment rules and make sure Nevadans can get the care they need safely.”

And it quoted Sen. Scott as stating that “The coronavirus pandemic has highlighted the necessity of modernizing our telehealth laws to reflect the real challenges we face with technology and medicine. This bipartisan bill will ensure that Medicare payments will cover virtual consultations, which are key to slowing the spread and treating millions of seniors, especially those in low income and rural areas. Updating our laws is a commonsense and practical approach to making sure we do everything we can to combat the pandemic.”

As noted in the press release, “Senator Cortez Masto first introduced this legislation in the 116th Congress. The Ensuring Parity in Medicare Advantage for Audio-Only Telehealth Act would require the Center for Medicare and Medicaid (CMS) to consider diagnoses from audio-only telehealth visits for risk adjustment payments in Medicare Advantage plans to ensure that they are reimbursed as if they were in-person visits during the COVID-19 emergency, unless both parties have agreed to a separate payment policy.”

Provider and payer associations praise the proposed legislation

Both provider and payer associations in healthcare praised the senators’ planned action. On the provider side, the Los Angeles-based America’s Physician Groups (APG), which represents several hundred physician groups involved in value-based contracting, released a statement on Wednesday, Jan. 27. In the statement, APG president and CEO Don Crane said that “America’s Physician Groups (APG) applauds Senators Catherine Cortez Masto (D-NV) and Tim Scott (R-SC) for their bipartisan bill, Ensuring Parity in Medicare Advantage for Audio-Only Telehealth Act of 2021. The bill would require the Center for Medicare & Medicaid Services (CMS) to consider diagnoses from audio-only telehealth visits for payment in Medicare Advantage (MA) plans as if they were in-person visits during the COVID-19 public health emergency.”

Indeed, Crane continued, “Appropriate recognition of audio-only telehealth services is critical to keeping seniors safe during this COVID-19 pandemic. Many older patients have difficulty in navigating the video technology included on video-equipped smartphones and similar devices while physicians have also made clear that the video component of telehealth services is unnecessary in providing care for certain chronic conditions. We need to address the barriers that discourage telehealth and prevent organizations from offering necessary care. Virtual audio-only consultations with doctors are a sensible approach to keeping seniors healthy.”

Crane went on to note that “APG has been a strong proponent of changes in telehealth regulations in Medicare, including adding ‘telephone without video capability’ coverage in both traditional Medicare and MA. APG also recommends that CMS lift its requirement that patients have a prior relationship with their doctor in order to use telehealth services, and allow licensed non-physicians (nurse practitioners, physician assistants, registered nurses, and respiratory therapists) to bill for telehealth. These additional flexibilities will assist in strengthening the continued response to the ongoing COVID-19 public health emergency.”

Also on Wednesday, the Washington, D.C.-based America’s Health Insurance Plans (AHIP), the nation’s umbrella association for private health plans, issued a statement in support of the senators’ “intent to reintroduce the Ensuring Parity in MA for Audio-Only Telehealth Act that would allow for audio-only telehealth services to count toward Medicare Advantage risk adjustment.”

In the statement, Matt Eyles, AHIP’s president and CEO, said, “Every American deserves access to the care they need, when they need it, in a way that is safe and convenient for them,” Eyles said in the statement. “Throughout the COVID-19 crisis, Americans have been relying on telehealth to continue to receive care and manage their chronic health conditions while reducing their risk of exposure to the virus. But while new flexibilities have encouraged the use of telehealth in Medicare Advantage, restrictions that require telehealth to include engagement through video mean that millions of Americans have been left behind.”

Further, Eyles said in the statement, “We applaud Senators Cortez Masto and Scott for taking this important step to make telehealth access more equitable for seniors and people with disabilities, especially those in rural America. Medicare Advantage delivers high-quality, affordable coverage for people on a low income, with about 40% of Medicare Advantage enrollees earning less than $25,000 a year. Many seniors in rural and urban communities still struggle with a lack of access to broadband Internet services. This bill recognizes that for many of these Americans, a phone call is their only option for health care at home. We also commend the inclusion of guardrails to defend against attempted fraud, which is essential to keeping health care more affordable for everyone. This bipartisan legislative action is a remarkable example of how we can work together for public-private solutions that improve affordability and access for every American. We encourage members of the House to follow suit to ensure stable access to telehealth for Americans in every one of our communities.”

The legislation introduced into the Senate by Cortez Masto and Scott moves forward legislation originally introduced into the House of Representatives on July 21, 2020 by U.S. Reps. Terri Sewell (D.-Ala.), Jackie Walorski (R-Ind.), Ron Kind (D.-Wis.), Tony Cárdenas (Calif.), and Brian Fitzpatrick (R.-Pa.). As a press release from Rep. Sewell’s office noted on that date, “Rep. Terri Sewell (AL-07), Jackie Walorski (IN-02), Ron Kind (WI-03), Tony Cárdenas (CA-29) and Brian Fitzpatrick (PA-01) introduced the Ensuring Parity in MA for Audio-Only Telehealth Act, bipartisan legislation to help ensure Medicare Advantage (MA) enrollees who cannot access the video component during telehealth visits are able to access care through audio visits during the COVID-19 pandemic.”

“Since the COVID-19 outbreak, an increasing number of Americans have been relying on telehealth services to access the care they need and deserve. Utilizing telehealth services helps reduce the risk of exposure for both patients and health care workers, mitigating the spread of COVID-19,” Rep. Sewell said on that date. “The Ensuring Parity in MA for Audio-Only Telehealth will allow those enrolled in Medicare Advantage to access audio as well as video telehealth services to ensure they are not forced to forego critical care during the pandemic, as many of our seniors live in rural areas without access to broadband speeds that support video connections.”

And Rep. Fitzpatrick said on that date, also contained in the press release, “During the COVID-19 pandemic, older Americans and enrollees in Medicare Advantage have been utilizing telehealth services to access care they need. In many instances, telehealth services can help to reduce the risk of exposure for both vulnerable patient populations, like seniors, and health care workers. I am proud to support this bipartisan legislation to make sure that seniors enrolled in Medicare Advantage, who may be limited to an audio-only telehealth visit, have more options and can continue to safely receive the care they deserve throughout this public health emergency.”

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