Bill Aims to Allow Audio-Only Telehealth for MA plans, PACE programs

A bipartisan group of representatives introduced a bill last week that would allow Medicare Advantage plans to count diagnoses from audio-only telehealth services toward risk adjustment for at least plan years 2020 and 2021 and allow clinicians to be reimbursed at the same rate for audio-only telehealth and in-person care during the public health emergency.

The Ensuring Parity in MA and PACE for Audio-Only Telehealth Act was introduced by Reps. Terri Sewell (D-AL) and Gus Bilirakis (R-FL) with a group of bipartisan cosponsors. It aims to make audio-only services more accessible to MA and Program of All-Inclusive Care for the Elderly beneficiaries and providers during the pandemic. The bill clarifies that only qualified diagnoses—those made during a plan year that match diagnoses made during one of the last three years—would count toward risk adjustment.

The bill is slightly different from one introduced last month in the Senate, as the Senate bill does not also apply to PACE

The Society has raised concerns about broadband availability for full implementation of telehealth. Audio-only options may allow facilities to provide greater access to clinicians in areas where broadband may be an issue and residents may not be comfortable with telehealth platforms.

During the public health emergency, several services are allowed to be billed using audio-only options including Advance Care Planning.