Provision of additional telehealth benefits
(1) MA plan option
(1)MA plan option#
For plan year 2020 and subsequent plan years, subject to the requirements of paragraph (3), an MA plan may provide additional telehealth benefits (as defined in paragraph (2)) to individuals enrolled under this part.
(2)Additional telehealth benefits defined#
(A) In general For purposes of this subsection and section 1395w–24 of this title : (i) Definition The term “additional telehealth benefits” means services— (I) for which benefits are available under part B, including services for which payment is not made under section 1395m(m) of this title due to the conditions for payment under such section; and (II) that are identified for such year as clinically appropriate to furnish using electronic information and telecommunications technology when a physician (as defined in section 1395x(r) of this title ) or practitioner (described in section 1395u(b)(18)(C) of this title ) providing the service is not at the same location as the plan enrollee. (ii) Exclusion of capital and infrastructure costs and investments The term “additional telehealth benefits” does not include capital and infrastructure costs and investments relating to such benefits.
(B) Public comment Not later than November 30, 2018 , the Secretary shall solicit comments on— (i) what types of items and services (including those provided through supplemental health care benefits, such as remote patient monitoring, secure messaging, store and forward technologies, and other non-face-to-face communication) should be considered to be additional telehealth benefits; and (ii) the requirements for the provision or furnishing of such benefits (such as training and coordination requirements).
(2)(A)In general#
For purposes of this subsection and section 1395w–24 of this title :
(i) Definition The term “additional telehealth benefits” means services— (I) for which benefits are available under part B, including services for which payment is not made under section 1395m(m) of this title due to the conditions for payment under such section; and (II) that are identified for such year as clinically appropriate to furnish using electronic information and telecommunications technology when a physician (as defined in section 1395x(r) of this title ) or practitioner (described in section 1395u(b)(18)(C) of this title ) providing the service is not at the same location as the plan enrollee.
(ii) Exclusion of capital and infrastructure costs and investments The term “additional telehealth benefits” does not include capital and infrastructure costs and investments relating to such benefits.
(3)Requirements for additional telehealth benefits#
The Secretary shall specify requirements for the provision or furnishing of additional telehealth benefits, including with respect to the following:
(A) Physician or practitioner qualifications (other than licensure) and other requirements such as specific training.
(B) Factors necessary for the coordination of such benefits with other items and services including those furnished in-person.
(C) Such other areas as determined by the Secretary.
(3)(A)#
Physician or practitioner qualifications (other than licensure) and other requirements such as specific training.
(3)(B)#
Factors necessary for the coordination of such benefits with other items and services including those furnished in-person.
(3)(C)#
Such other areas as determined by the Secretary.
(4)Enrollee choice#
If an MA plan provides a service as an additional telehealth benefit (as defined in paragraph (2))—
(A) the MA plan shall also provide access to such benefit through an in-person visit (and not only as an additional telehealth benefit); and
(B) an individual enrollee shall have discretion as to whether to receive such service through the in-person visit or as an additional telehealth benefit.
(4)(A)#
the MA plan shall also provide access to such benefit through an in-person visit (and not only as an additional telehealth benefit); and
(4)(B)#
an individual enrollee shall have discretion as to whether to receive such service through the in-person visit or as an additional telehealth benefit.
(5)Treatment under MA#
For purposes of this subsection and section 1395w–24 of this title , if a plan provides additional telehealth benefits, such additional telehealth benefits shall be treated as if they were benefits under the original Medicare fee-for-service program option.
(6)Construction#
Nothing in this subsection shall be construed as affecting the requirement under subsection (a)(1) that MA plans provide enrollees with items and services (other than hospice care) for which benefits are available under parts A and B, including benefits available under section 1395m(m) of this title .