For those unfamiliar with the US Medicare programme, which provides healthcare benefits for over-65s, it is a tale of two halves. The first, or original, half provides funding for hospitals directly through Centers for Medicare and Medicaid Services (“CMS”). The second half of the tale is funding provided to insurance companies (known as Medicare Advantage Organisations or MAOs) to provide healthcare insurance cover. The details are complex and available on the official government site here.
Each year CMS sets the rates which the government will pay the MAOs and the proposed rates were published for consultation last month with the final decision being published next month. One of the respondents to the consultation was the Telecommunications Industry Association which strongly advised the CMS to support the use of telehealth within any MA plans as a means to reducing the cost of healthcare. While the TIA support is good news, and claims to be in the spirit of “long-time supporters of enhanced telehealth and remote monitoring services” I suspect the reasons are not entirely altruistic.
CMS says in its consultation document that some MAOs have asked CMS to include “remote access technology-furnished” services as part of MA plan basic benefits. However, as basic benefits can’t include anything not in the “original half” (Parts A &B) CMS proposes to continue to include these as “mandatory supplemental services” in the coming year.
In this context remote access technologies are defined as Telemonitoring, Web- and Phone-based Technologies, Nurse Hotlines and other similar services. For 2015, CMS is also to allow MAOs to furnish medical services to beneficiaries via real-time interactive audio and video technologies as a mandatory supplemental benefit.