Preserving Medicare Telehealth to Protect Dual Eligibles

A broad consensus has emerged that Congress should make permanent the new telehealth flexibilities that the Centers for Medicare and Medicaid Services (CMS) authorized for the Medicare program in response to the coronavirus public health emergency.  This is particularly true to address the unique needs of individuals who are dually eligible for Medicare and Medicaid (“dual eligibles”). 

The specific telehealth flexibilities that should be retained:  (1) remove obsolete restrictions on the location of the patient, to permit home-based synchronous visits from all locations in the state, including the use of virtual visits, and (2)  give CMS the permanent authority to determine appropriate providers and services for telehealth.  

Making these permanent changes to Medicare would better protect dual eligibles because: 

·      Serving dual eligibles with long-term service and support (LTSS) needs in home and community-based service (HCBS) settings rather than nursing facility hot spots depends on the availability of access to medical services in disparate neighborhoods and communities to support rebalancing;

·      Far more than Medicare-only beneficiaries, dual eligibles face systematic access barriers due to high rates of disability, chronic illness, and poverty-related limitations such as inadequate transportation; and

·      Medicare-Medicaid integrated care models require solutions within the Medicare program to meet network adequacy and access standards in communities that lack local provider capacity, and telehealth is becoming an essential part of the solution. 

In short, to meet the needs of the 12 million dual eligibles in the United States, Congress should make permanent the new telehealth flexibilities first authorized for the Medicare program because of the coronavirus public health emergency. (The full policy brief is found on the download button.)