Regulatory roundup: New bill would allow audio-only telehealth services to count toward MA risk adjustment; MA satisfaction hits new high

Ilene MacDonald, Editorial Director | January 28, 2021

RISE reviews the latest headlines that impact Medicare, Medicare Advantage, and the Affordable Care Act marketplace.

Bipartisan bill would ease access to telehealth services

U.S. Senators Catherine Cortez Masto (D-Nev.) and Tim Scott (R-S.C.) announced plans to reintroduce bipartisan legislation, the Ensuring Parity in Medicare Advantage for Audio-Only Telehealth Act of 2021, to help improve Medicare Advantage (MA) enrollees’ access to telehealth during the pandemic, even if they can only make an audio connection to providers. 

The bill would require the Center for Medicare & Medicaid to consider diagnoses from audio-only telehealth visits for risk adjustment payments in MA plans to ensure that they are reimbursed as if they were in-person visits during the COVID-19 emergency, unless both parties have agreed to a separate payment policy. 

“Many of Nevada’s seniors have been following guidance to rely on telehealth services during the coronavirus pandemic,” Cortez Masto said in the announcement. “They should not be penalized if, as in many cases, their access to video services is limited, either by the availability of broadband in their area or by their budgets. I’m glad to support this bipartisan bill that will modernize the payment rules and make sure Nevadans can get the care they need safely.”

Matt Eyles, president and CEO of America’s Health Insurance Plans, applauded the move to reintroduce the legislation. “While new flexibilities have encouraged the use of telehealth in Medicare Advantage, restrictions that require telehealth to include engagement through video mean that millions of Americans have been left behind,” he said in a statement, adding that many seniors in rural and urban communities struggle due to lack of access to broadband Internet services. For many of these seniors, a phone call is their only option for health care at home.

New poll finds MA satisfaction reaches all-time high

A recent Morning Consult poll of more than 1,200 seniors on Medicare commissioned by Better Medicare Alliance shows near-universal satisfaction with MA coverage, provider networks, and handling of the current COVID-19 health crisis.

The poll, conducted from December 11-17, 2020 also gauged MA beneficiaries’ views about the Medicare enrollment process, supplemental benefits, Star ratings, and telehealth usage and favorability. Findings showed that seniors enrolled in an MA plan are most likely to have personally used vision (64 percent), dental (48 percent), telehealth (43 percent), and wellness (40 percent) coverage.

“Overall, 98 percent of respondents are satisfied with their Medicare Advantage coverage–an increase from 94 percent in the fall of 2019. For nonwhite beneficiaries, that number rises to 99 percent," said Allyson Y. Schwartz, president and CEO of the Better Medicare Alliance, in an announcement. “What’s more, 97 percent of beneficiaries are satisfied with their network of doctors, hospitals, and specialists and 98 percent of respondents specifically indicated satisfaction with their health plan’s response to COVID-19.”

The poll also found:

·        Ninety-five percent of seniors on Medicare believe it is important to have a choice of plans other than traditional Medicare.

·        Seniors enrolled in MA plans were most likely to consider their network of doctors, hospitals, and specialists (96 percent), lower monthly premiums (94 percent), and lower co-pays for appointments and services (95 percent) when they selected a MA plan.

·        The percentage of seniors who have used telehealth services during the COVID-19 pandemic rose from 24 percent in May 2020 to 40 percent in December 2020. Among those who have used telehealth services during the COVID-19 pandemic, ninety-one percent said they had a favorable experience.

·        More than half of seniors enrolled in MA plans said they were not familiar with the ‘Star ratings’ system used by the government to grade MA plans on quality. Furthermore, two in three seniors who have MA plans and were familiar with the ‘Star ratings’ system did not refer to it when selecting their MA plans.

·        Two thirds of seniors on Medicare felt that they had enough information about MA when they first enrolled in Medicare, an 11 percent increase from 2019. Still, 30 percent of seniors would have liked more information about the option of MA.

Biden administrations to open ACA special enrollment period

The White House on Thursday announced plans to open a special enrollment period in the Affordable Care Act (ACA) marketplaces to help Americans who lost their employer-based health insurance during the COVID-19 pandemic. In a fact sheet about the executive order, the administration said it expects the Department of Health and Human Services will open HealthCare.gov for the special enrollment period from Feb. 15-May 15. In addition, the order calls for federal agencies to reconsider rules and other policies that limit Americans’ access to health care and consider actions that will protect and strengthen that access. Those actions include policies that undermine protections for people with pre-existing conditions, including complications related to COVID-19; demonstrations and waivers under Medicaid and the ACA that may reduce coverage or undermine the programs, including work requirements; policies that undermine the health insurance marketplace or other markets for health insurance; policies that make it more difficult to enroll in Medicaid and the ACA; and policies that reduce affordability of coverage or financial assistance, including for dependents. 

COVID-19 update: CDC warns virus deaths could reach 514K next month

Rochelle Walensky, the new director of the Centers for Disease Control and Prevention (CDC), said during a public health briefing on Wednesday that the United States is on track to have as many as 514,000 deaths from COVID-19 by Feb. 20.  Although the country had its highest reported numbers of deaths in a single day on Jan. 20 (4,383 deaths), Walensky said the seven-day average for deaths has decreased over the past week.

“Though I am encouraged by these trends, our case rates remain extraordinarily high, and now is the time to remain vigilant," she said. "If we continue in the current trajectory, the CDC's most recent national ensemble forecast predicts that 479,000 to 514,000 COVID 19 deaths will be reported by Feb. 20, 2021. I know this is not news we all want to hear, but this is something we must say so we are all aware. But if we are united in action, we can turn things around."

Safe, effective vaccination is key to ending the pandemic, Walensky said. However, it could take months to vaccinate everyone who wants the vaccine, according to Andy Slavitt, senior adviser to the White House COVID-10 response team. The administration is limited by vaccine supply and how fast it can administer the vaccines once they are produced and arrive at distribution sites. Any stockpile that may have existed previously, no longer exists, he said.

The administration said on Tuesday it intends to increase weekly vaccine supplies to states by 16 percent over the next three weeks and purchase enough doses to vaccinate most of the population by the end of the summer.

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