Telehealth Rules Must Protect Continuous Care, AAFP Tells CMS

January 07, 2019 04:35 pm News Staff

The AAFP recently took advantage of an opportunity to respond a CMS proposed rule published in the Nov. 1 Federal Register(www.govinfo.gov) that would revise the Medicare Advantage program Part C regulations and Part D benefit regulations in 2020.  

[medicare advantage plan writing on the wall]

In a Dec. 20 letter(2 page PDF) to CMS Administrator Seema Verma, M.P.H., that was signed by AAFP Board Chair Michael Munger, M.D., of Overland Park, Kan., the AAFP focused on CMS' proposal to offer Medicare Advantage plans more flexibility regarding payment for telehealth benefits.

The letter made clear the AAFP's longstanding support for use of such technology.

"It is the policy of the AAFP to support expanded use of telehealth and telemedicine as an appropriate and efficient means of improving health when conducted within the context of appropriate standards of care," wrote the AAFP.

Furthermore, the AAFP stressed the importance of a patient's ability to maintain a "continuous relationship" with his or her primary care physician to ensure care coordination. "The most effective coordination is when the patient's primary care physician or practice performs the telemedicine service," wrote the AAFP.

The letter then highlighted the AAFP's stand on three specific sections of the proposed rule on which CMS had solicited comments.

First, the AAFP noted its support for a provision that would require a Medicare Advantage plan that covers a Part B service as an additional telehealth benefit to also provide enrollees access to such service through an in-person visit.

Doing so "would improve Medicare Advantage enrollees' access to telehealth within their homes" and would give plans "greater flexibility to offer clinically appropriate telehealth benefits that are not otherwise available," reasoned the AAFP.

However, the AAFP disagreed with CMS' proposal to allow telehealth health care professionals to be counted as part of a plan's network adequacy requirement, saying that doing so would not be appropriate unless these health care professionals also provide in-person care in the payer's network.

Those who are available to see a patient only virtually are not really available "to meet all potential care needs for a patient in the payer's network," said the AAFP. Rather, CMS should protect patients from "an encroachment of direct-to-consumer telemedicine not coordinated with the beneficiaries' usual source of primary care."

Lastly, regarding CMS' request for suggestions on how to implement additional telehealth benefits for Medicare Advantage beneficiaries, the AAFP noted that the appropriateness of a telemedicine service "should be dictated by the standard of care and not by arbitrary policies."

Furthermore, said the AAFP, "Available technology capabilities, as well as an existing physician-patient relationship, impact whether the standard of care can be achieved for a specific patient encounter type."

The letter reiterated that the best method of ensuring care coordination is to allow the patient's primary care physician -- or another clinician in the practice -- to perform the telemedicine service.

"It must also be noted that forwarding documentation by electronic means, including fax, is not acceptable for coordination of care with the primary care physician or medical home," said the letter.

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