The Centers for Medicare & Medicaid Services (CMS) has finalized requirements to increase access to telehealth for seniors in Medicare Advantage (MA) plans, expand the types of supplemental benefits for MA members with chronic diseases, increase access to MA for patients with End Stage Renal Disease (ESRD), and modify calculations for Star ratings.
The agency announced Friday it had finalized a subset of proposed policies before the June 1 deadline for MA and Part D plans to submit bids. CMS said it would address the remaining proposals initially announced February 18 for plans later in 2020 for the 2022 plan year. Subsequent provisions will be effective on or before Jan. 1, 2021 but applicable no earlier than Jan. 1, 2022. This approach will give plans time and information to design the best coverage for Medicare beneficiaries, according to the announcement.
The rule encourages MA plans to increase their telehealth benefits and increase plan options for beneficiaries living in rural areas. CMS said it is giving MA plans more flexibility to count telehealth providers in certain specialty areas (such as dermatology, psychiatry, cardiology, ophthalmology, nephrology, primary care, gynecology, endocrinology, and infectious diseases) toward meeting CMS network adequacy standards. This flexibility will encourage plans to enhance their benefits to give beneficiaries access to the latest telehealth technologies and increase plan choices for beneficiaries residing in rural areas.
Beneficiaries with ESRD will now have more coverage choices in the Medicare program. Previously, beneficiaries with ESRD were only allowed to enroll in MA plans in limited circumstances. The rule implements the changes made by the 21st Century Cures Act to give all beneficiaries with ESRD the option to enroll in an MA plan starting in 2021. This will give beneficiaries with ESRD access to more affordable Medicare coverage options that may include extra benefits, such as health and wellness programs, transportation, or home-delivered meals that are not available in Medicare Fee-For-Service.
Star ratings changes
CMS also made changes to enhance the MA and Part D Star Ratings system to further increase the impact that patient experience and access measures have on a plan’s overall Star rating. It also adopted a series of changes in the March 31, 2020, Interim Final Rule with Comment Period (CMS-1744-IFC) for the 2021 and 2022 Star Ratings to accommodate challenges arising from the COVID-19 public health emergency.
In a fact sheet, CMS projects an estimated $3.65 billion net reduction in spending by the federal government over 10 years due to the finalized change to the Part C and Part D Star rating methodology to remove outliers before calculating Star Ratings cut points, which offsets costs arising from the Medical Loss Ratio (MLR) provisions and other refinements to the MA and Part D Quality Star ratings system.
Click here to download the final rule from the Federal Register.