New Medicare Advantage Telehealth Rules Signal Growing Skilled Nursing Opportunity

New guidelines that could open up telehealth coverage under Medicare Advantage represent a serious opportunity for the industry, according to multiple technology providers — especially as the moves signal growing support for remote care from key federal officials.

Under a proposed rule released late last month, the Centers for Medicare & Medicaid Services (CMS) would include telehealth services as part of the basic, core offerings for which Medicare Advantage plans can receive government reimbursements.

The current structure forces Medicare Advantage plans to budget internally for telehealth services, according to Timothy Peck, co-founder and CEO of Call9, a platform that “embeds” emergency medical technicians in skilled nursing facilities and enables direct communication with remote doctors. So even if a plan determines that the use of Call9 or other telehealth technologies can produce savings in the short term, it’s forced to take on all of the financial risk.

But the new rule, set to take effect in calendar year 2020, would provide for the direct reimbursement of telehealth services under Medicare Advantage regardless of location; currently, traditional Medicare only covers remote health tech in rural facilities.