The Center for Medicare and Medicaid Services released its 1,425-page Managed Care Final Rule, a long-awaited update to CMS bylaws which, according to CMS, “aligns key rules with those of other health insurance coverage programs, modernizes how states purchase managed care for beneficiaries, and strengthens the consumer experience and key consumer protections.”
In part, the rule opens the door for more telemedicine reimbursement. The rule passes to the states the duty of establishing “network adequacy standards”, or standards that ensure all Medicaid beneficiaries have reasonable access to all the types of care they might need. In the past, these standards required that services be accessible in-person, but, after it was suggested in public comments, CMS has amended the final rule to allow states to consider telemedicine options as well.
“We agree with commenters that such services and technological solutions could impact the needs of enrollees in a particular area and could change the manner and extent to which other network providers are needed and utilized,” CMS wrote in the Federal Register. “We encourage states to consider how current and future technological solutions could impact their network adequacy standards. Therefore, we agree with adding these criteria to the list of elements that states should consider when developing network adequacy standards. We are modifying the regulatory text to adopt this recommendation.”
The rule now reads, in part, “States developing network adequacy standards consistent with paragraph (b)(1) of this section must consider, at a minimum, the following elements: … The availability of triage lines or screening systems, as well as the use of telemedicine, evisits, and/or other evolving and innovative technological solutions.”
“Past standards have focused on ‘old school’ physical proximity, how many days to appointment, etc,” American Telemedicine Association Chief Policy Officer Gary Capistrant told MobiHealthNews in an email. “For many services, telehealth is a great way for patients to get quick and convenient service. It is important to update laws and regulations to accommodate the benefits of telehealth.”
In addition, the National Association of Insurance Commissioners released a model legislation for states which, if adopted, would codify telehealth as an acceptable component of meeting network adequacy standards for each state.