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Medicare Promotes More Home Monitoring, Telehealth

Federal Insider: December 2018

In a final rule setting payment for home healthcare in 2019, and in a proposed rule for Medicare Advantage plans in 2020, the Centers for Medicare and Medicaid Services (CMS) is adding new reimbursement for remote patient monitoring technology and expanding telemedicine options for providers. The home healthcare rule also implements a payment model that focuses on groups of patients with certain medical needs rather than the volume of services.

“Using new technology … will provide home health agencies and doctors what they need to give patients a personalized treatment plan that will result in better health outcomes,” said CMS Administrator Seema Verma.

Beginning in 2017, CMS allowed physicians to bill for services related to home monitoring, which includes devices that track and digitally share data on blood pressure, blood glucose, and other parameters. In 2019, however, home health agencies will be able to bill for the actual monitoring instruments and services themselves. This will foster adoption of emerging home monitoring and testing technologies, and encourage greater data sharing and coordination of care among patients and providers, according to CMS.

CMS also is focusing on home-based care in the Medicare Advantage proposed rule. Medicare Advantage, in which Medicare pays a single capitated payment for private managed care, has grown enrollment 71% since 2010, attracting more than a third of Medicare beneficiaries. The proposed telehealth benefits for 2020 would expand these services beyond narrowly defined situations like rural areas and special telehealth centers that fee-for-service Medicare traditionally allowed, making telehealth a part of core “basic benefits” under Medicare Advantage rules.

ACA Marketplace Plan Premiums Fall, But Could Have Been Lower

For the first time since the insurance exchanges established by the Affordable Care Act (ACA) were established in 2014, premiums for the lowest cost plans will drop in 2019, with an average reduction of 1.5%. According to the Centers for Medicare and Medicaid Services (CMS), average individual market premiums more than doubled from $2,784 per year in 2013 to $5,712 on in 2017, an increase of 105%.

In addition, many insurers had dropped out of the federal exchange, but this trend is reversing as well. Some 23 insurers have said they will add plans to the exchange, and the number of counties with only one insurer has dropped from 56% in 2018 to 39% in 2019.

However, a study by the Kaiser Family Foundation found that premiums would be significantly lower if not for changes made to private insurance markets since 2016. According to the Kaiser analysis, plans on the exchange will cost an average of 16% more than they otherwise would due to the loss of ACA cost-sharing reduction payments, the repeal of the individual mandate penalty, and the administration’s expansion of looser regulated plans.

Low-Income Adults Forgo Care in States Without Medicaid Expansion

A report from the Government Accountability Office (GAO) analyzed 2016 data from the National Center for Health Statistics and found that low-income adults in states without Medicaid expansion forgo care at about twice the rate of those who live in states with Medicaid expansion. The Affordable Care Act (ACA) allowed states to fill gaps in health insurance by offering Medicaid to families whose incomes fall below 138% of the federal poverty level.

The GAO report found that in states that expanded Medicare, 9% of low-income adults delayed medical care, compared to 20% in non-expansion states. The gap narrowed somewhat for specific preventive services. For example, 49% in expansion states received a blood cholesterol check within the last year versus 42% in non-expansion states. Low-income adults in expansion states were only slightly less likely to visit the emergency department, 27% versus 28%.

Overall, 5.6 million low-income adults were uninsured in 2016. Of these, an estimated 1.9 million resided in expansion states, compared with an estimated 3.7 million in non-expansion states.

Most people on Medicaid are children or people with a disability or who are elderly. Currently 31 states and the District of Columbia have expanded Medicaid eligibility under the ACA, and this new population now makes up 20% of the Medicaid rolls. Most work, with 16% unemployed across all states.