{"id":21739,"date":"2022-07-27T15:15:11","date_gmt":"2022-07-27T19:15:11","guid":{"rendered":"https:\/\/medicareadvocacy.org\/?p=21739"},"modified":"2022-07-27T15:15:14","modified_gmt":"2022-07-27T19:15:14","slug":"issue-brief-75-june-2022-medicare-telehealth-report-and-other-issues","status":"publish","type":"post","link":"https:\/\/medicareadvocacy.org\/issue-brief-75-june-2022-medicare-telehealth-report-and-other-issues\/","title":{"rendered":"Issue Brief #75- June 2022 – Medicare & Telehealth Report and Other Issues"},"content":{"rendered":"\n
  1. TELEHEALTH UPDATE   <\/strong><\/li><\/ol>\n\n\n\n

    Special Report:<\/strong> Telehealth and the Medicare Population: Building a Foundation for the Virtual Health Care Revolution<\/strong><\/p>\n\n\n\n

    As the United States slowly emerges from the COVID-19 pandemic, this exponential expansion of telehealth and virtual care options are poised to change our nation\u2019s health care landscape, with the enticing potential of improving access to care. With significant change also comes significant challenges, however, and when considering how to grow telehealth in a way that benefits all equally, it will be essential to examine and address the racial, social, and economic disparities that are already beginning to drive a \u201cdigital divide\u201d in this country that could impact the quality of care that people receive.<\/p>\n\n\n\n

    The Center for Medicare Advocacy (the Center) has recently released an examination of these issues through a report entitled Telehealth and the Medicare Population: Building a Foundation for the Virtual Health Care Revolution<\/em><\/a>. Authored by Chiplin Medicare and Health Policy Fellow Cinnamon St. John, the Center\u2019s report explores current gaps in accessibility and infrastructure, discusses how these gaps could stand in the way of ensuring that all Medicare beneficiaries have equal access to the advantages that telehealth can provide, and highlights key policy priorities that should inform the design of future regulation and legislation.<\/p>\n\n\n\n

    While grounded in research, the report\u2019s findings were additionally informed by interviews with experts from around the nation about the experiences (both challenges and conveniences) that older adults and people with disabilities have had when utilizing virtual care. We examined these issues through the lens of what we call \u201cT.A.P. Challenges: Technology, Accessibility, and Peopleware.\u201d Throughout the report, we describe driving factors and key considerations behind each of these three categories of T.A.P. challenges, illustrated by examples from the field.<\/p>\n\n\n\n

    While the Center recognizes the value of telehealth services and is heartened by the potential to increase access to the country\u2019s health care system, we are also committed to ensuring that no beneficiaries are caught in the chasm created by the digital divide \u2013 created through disparities between those who can afford access and are able to utilize technology, and those who cannot. Furthermore, telehealth must supplement, not replace, in-person care options.<\/p>\n\n\n\n

    In the early days of the pandemic as the critical role of virtual care solutions became clear, the Center published guiding principles to aid in making decisions about whether and how to expand Medicare coverage for telehealth. In addition to the findings and recommendations included in our most recent report, these guiding principles still hold true today.<\/p>\n\n\n\n

    Those guiding principles are:<\/p>\n\n\n\n

    1. Ensure any covered telehealth services are clinically appropriate;<\/li>
    2. Ensure that telehealth options supplement, rather than replace, in-person-care \u2013 and ensure that payment incentives align with this goal;<\/li>
    3. Promote behavioral health parity to help address the unmet needs of current and future beneficiaries in both urban and rural settings;<\/li>
    4. Ensure that any expansion of telehealth does not exacerbate health, racial, or income disparities, and that actions and expenditures are authorized to meaningfully address the digital divide that many Medicare beneficiaries face \u2013 including lack of limited access to digital literacy training, reliable broadband, and remote technologies;<\/li>
    5. Ensure equitable access to telehealth for underserved communities, including Black Americans and people of color, individuals with disabilities, and people with limited English proficiency; purposefully collect data on such access; and ensure compliance with all existing civil rights laws, including rules requiring the use of interpreters and the provision of materials in alternative formats and non-English languages;<\/li>
    6. Require providers to accurately disclose beneficiary cost-sharing obligations prior to service, and to fully document such disclosures; connect beneficiaries and providers with resources they need to understand their financial responsibilities; and carefully monitor to ensure that any waivers of cost-sharing are not happening in a discriminatory or otherwise problematic way;<\/li>
    7. Ensure that any expansion of telehealth protects patient privacy and data security for personal health information. HIPAA privacy protections must apply to telehealth interactions between the patient and provider and personal health data must also be kept secure;<\/li>
    8. Ensure any expansion of telehealth is identical in traditional Medicare and private Medicare Advantage, and that the services and necessary equipment to access telehealth are equally available to all beneficiaries, regardless of the coverage pathway they choose;<\/li>
    9. Ensure that telehealth does not weaken Medicare Advantage network adequacy standards, including by prohibiting telehealth providers from satisfying network adequacy requirements;<\/li>
    10. Require public release of data concerning Medicare-covered telehealth, including the types of services provided, beneficiary experience and preferences, programmatic and beneficiary spending, health outcomes, and quality measurements; ensuring monitoring, oversight, data collection, and evaluation continues ongoingly so as to best inform future telehealth policymaking; and<\/li>
    11. Provide an extended phase-out period for the temporary COVID telehealth waivers and rules in order to minimize interruptions in care and prevent rushed policy development.<\/li><\/ol>\n\n\n\n

      The Centers for Medicare & Medicaid Services (CMS) has professed a commitment to addressing health disparities<\/a> as a foundation of all its work \u201cin every program and across every community.\u201d In recognizing \u201csystemic racism, persistent poverty and other disparities,\u201d the Biden Administration, too, pledged a commitment to pursuing a comprehensive approach<\/a> to advancing equity for all. This special telehealth report is aimed at advocates, lawmakers, and policy makers to aid in the creation of holistic policies that, as much as possible, do not create an unintended consequence of widening the digital divide.<\/p>\n\n\n\n

      Let us build upon the lessons learned from pandemic experiences to help create a future where better health, quality care, and equality are realized.<\/p>\n\n\n\n

      Read or download the full report here: https:\/\/medicareadvocacy.org\/wp-content\/uploads\/2022\/05\/Telehealth-Report_CMA_final.pdf<\/a><\/p>\n\n\n\n

      1. <\/li><\/ol>\n\n\n\n

        President Biden\u2019s Nursing Home Reform Agenda<\/strong><\/p>\n\n\n\n

        Last month, we discussed \u201cProtecting Seniors and People with Disabilities by Improving Safety and Quality of Care in the Nation\u2019s Nursing Homes,\u201d a broad and comprehensive nursing home reform agenda set out in a White House Fact Sheet (Feb. 28, 2022), https:\/\/www.whitehouse.gov\/briefing-room\/statements-releases\/2022\/02\/28\/fact-sheet-protecting-seniors-and-people-with-disabilities-by-improving-safety-and-quality-of-care-in-the-nations-nursing-homes\/<\/a> (and mentioned by the President in the State of the Union Address on March 1, 2022).<\/p>\n\n\n\n

        Five key themes in the agenda:<\/p>\n\n\n\n

        1. Ensuring Taxpayer Dollars Support Nursing Homes that Provide Safe, Adequate, and Dignified Care (minimum nurse staffing requirements, antipsychotic drugs)<\/li>
        2. Enhancing Accountability and Oversight (funding for surveys, Special Focus Facility program, increase penalties and other enforcement sanctions, accountability for chain owners)<\/li>
        3. Increasing Transparency (facility ownership and finances)<\/li>
        4. Creating Pathways to Good-paying Jobs with the Free and Fair Choice to Join a Union (improving staffing and workforce sustainability)<\/li>
        5. Ensuring Pandemic and Emergency Preparedness in Nursing Homes (COVID-19 testing, vaccinations, on-site infection preventionists)<\/li><\/ol>\n\n\n\n

          Request for Information on Nurse Staffing<\/strong> (Critical now; Comments due to CMS by June 10)<\/p>\n\n\n\n

          As part of its annual update to Medicare Part A payments to skilled nursing facilities, 87 Fed. Reg. 22720 (Apr. 15, 2022), https:\/\/www.govinfo.gov\/content\/pkg\/FR-2022-04-15\/pdf\/2022-07906.pdf<\/a>, the Centers for Medicare & Medicaid Services (CMS) includes a Request for Information, \u201cRevising the Requirements for Long-Term Care (LTC) Facilities To Establish Mandatory Minimum Staffing Levels,\u201d at pp. 22789-22795.  CMS poses 17 questions, many, with multiple questions.<\/p>\n\n\n\n

          \u201cComments On Mandatory Staffing Ratios for Nursing Homes Due to CMS by June 10\u201d (CMA Alert, May 26, 2022), https:\/\/medicareadvocacy.org\/comments-on-mandatory-staffing-ratios-for-nursing-homes-due-to-cms-by-june-10\/<\/a>, includes a link to draft model comments for the 17 questions drafted by the Consumer Voice for Quality Long-Term Care, California Advocates for Nursing Home Reform, Justice in Aging, Long Term Care Community Coalition, and the Center for Medicare Advocacy, https:\/\/theconsumervoice.org\/uploads\/files\/actions-and-news-updates\/RFI_Comment_Outline.pdf<\/a><\/p>\n\n\n\n

          Feel free to use any, all, or none of the model comments.  Answer some, none, or all of the questions.  What\u2019s important is to let CMS know why nurse staffing is important and the poor outcomes for residents when there are not enough (well-trained, well-compensated, well-treated) staff.<\/p>\n\n\n\n

          Additional information from Consumer Voice about submitting comments, available at https:\/\/theconsumervoice.org\/issues\/issue_details\/staffing<\/a><\/p>\n\n\n\n

          Additional points<\/strong>:<\/p>\n\n\n\n

          First, the Nursing Home Reform Law (1987) gives the Secretary full authority to enact and enforce mandatory minimum staffing requirements, defining the \u201cduty and responsibility\u201d of the Secretary<\/p>\n\n\n\n

          to assure that requirements which govern the provision of care in skilled nursing facilities under this subchapter, and the enforcement of such requirements, are adequate to protect the health, safety, welfare, and rights of residents and to promote the effective and efficient use of public moneys.<\/p>\n\n\n\n

          42 U.S.C. \u00a71395i-3(f)(1).  The Medicaid provisions of the Reform Law are identical.  42 U.S.C. \u00a71396r(f)(1).  Decades of research document better care outcomes for residents when staffing levels are higher.  There is substantial diversion of public reimbursement to owners\u2019 related parties, management fees, and profits. <\/p>\n\n\n\n

          Lawsuit filed by New York state nursing facilities, challenging a state budget law requiring 70% of revenue to be spent on resident care (with 40% on resident-facing care) and limiting profits to 5%, illustrates how much money is diverted.  Plaintiffs claim they would have had to remit $824 million  to the state, using 2019 data. \u201cHow Do Nursing Homes Spend the Reimbursement They Receive for Care?\u201d (CMA Report, Jan. 26, 2022), https:\/\/medicareadvocacy.org\/how-nursing-homes-spend-public-money\/<\/a> (looked at eight Special Focus Facilities and candidates and five defendants sued by U.S. Attorney for overbilling Medicare, plaintiffs in the lawsuit, and how much they claim they would have had to remit to the state); \u201cNew York Nursing Homes Suing the State Received Federal Provider Relief Funds\u201d (CMA Alert, Feb. 3, 2022), https:\/\/medicareadvocacy.org\/new-york-nursing-homes-suing-the-state-received-federal-provider-relief-funds\/<\/a>  (finding that the same 13 facilities received $19,529,428 in Provider Relief Funds)<\/p>\n\n\n\n

          Second, the fact that additional actions are necessary to solve the decades-long problem of inadequate staffing does not mean that CMS should not act now to enact mandatory minimum staffing standards, which are key to getting sufficient staff.  Federal staffing standards have not been sufficient.<\/p>\n\n\n\n

          1. MEDICARE ADVANTAGE OVERSIGHT<\/strong><\/li><\/ol>\n\n\n\n

            Office of Inspector General (OIG) Report re: Medicare Advantage Denials of Prior Authorization<\/strong><\/p>\n\n\n\n

            Recently the OIG issued a report focusing on Medicare Advantage plan denials titled \u201cSome Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care<\/a>\u201d (April 2022, OEI-09-18-00260). OIG reviewed a sample of denials of prior authorization requests and payment denials issued by 15 of the largest MA plans during one week in June 2019.  From this review, which included the services of health care coding experts and physician reviewers, OIG estimated the rates at which MA plans denied prior authorization and payment requests that it determined met Medicare coverage and MA billing rules.  It also examined the reasons for these denials and the types of services associated with the denials.<\/p>\n\n\n\n

            Among the prior authorization requests denied<\/strong> by MA plans, OIG found that 13 percent met Medicare coverage rules<\/strong> \u2013 \u201cin other words, these services likely would have been approved for these beneficiaries under original Medicare.\u201d With respect to payment requests denied<\/strong>, OIG found that 18 percent met Medicare coverage rules<\/strong> and MA billing rules.<\/p>\n\n\n\n