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Another day, another telehealth coverage battle

We’re starting a slow clap for CMS for proposing a new rule that would expand behavioral telehealth coverage through end of 2023 (and we’re hoping beyond!) for MA patients.

And the telehealth saga continues.

As we’ve said before, the COVID-19 pandemic opened many doors (even apps) for telehealth. Specifically, being able to provide patients access to care without going into the doctor’s office or hospital, when doing so was particularly dangerous for certain vulnerable populations, like Medicare patients. And it’s also not surprising to us that many payors are now looking to pull back on those added benefits.

Now, per a Becker’s Hospital Review article, a new Biden-proposed rule, unveiled by the Centers for Medicare & Medicaid Services (CMS) on July 13, includes suggested payment rates to providers for various telehealth services. CMS: we applaud you! For stepping up, stepping in, and making moves to extend telehealth coverage through the end of 2023.

According to the article, CMS says this will allow “a glide path to evaluate whether the services should be permanently added to the telehealth list following the COVID-19 [public health emergency].”

This move comes at a time where hospitals and payors are at a stalemate on this the telehealth parity situation. Hospitals are advocating for assured coverage and reimbursement for telehealth and behavioral health services, but payors continue to push back, often attempting to avoid providing the added coverage.

But if you’re not on Medicare, why should you care? Often, CMS and government-run health plans are the trendsetters in health insurance. When they jump, it’s not unexpected for private carriers to follow suit.

So does this finally represent a tipping of the scale? We’ll be sure to keep a close eye until September 13, the deadline for stakeholders to “speak now or forever hold their peace” about the proposed ruling.

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