The Centers for Medicare & Medicaid Services (CMS) published a proposed rule on Feb. 5 that updates the Medicare Advantage (MA) and the Medicare prescription drug benefit program. Here’s what you need to know.
The proposed rule outlines changes to prescription drug pricing, Star ratings, and end-stage renal disease (ESRD).
If finalized, CMS says the changes would lead to an estimated $4.4 billion savings to the federal government over 10 years, mainly as a result of the tweaks to the Star rating system. The agency said it expects some of the savings will be passed on to MA beneficiaries in the form of increased benefit offerings and reduced premiums or cost sharing.
Here are 5 things you need to know about the proposal:
Star rating changes: CMS proposes to double the weight of patient experience/complaints and access measures to empower patients to work with their doctors to make health care decisions that are best for them. It also wants to tweak the Star ratings methodology by directly reducing the influence of outliers on cut points.
ESRD: Under the proposed rule, patients with ESRD would be able to enroll in MA plans beginning in 2021. Currently most patients with ESRD receive care through Medicare and are only able to enroll in a MA plans in limited circumstances. In a fact sheet, CMS said that expanding enrollment options will empower patients to choose the type of Medicare coverage that best meets their needs. “This will give patients with ESRD access to more affordable Medicare coverage choices and extra benefits such as transportation or home delivered meals,” CMS said in an accompanying press release.
Prescription drug costs: The proposal also calls for Part D plans to offer beneficiaries real-time drug price comparison tools beginning January 1, 2022 so consumers can shop for lower-cost medication under their prescription drug benefit plan. In the press release, CMS explained that the tools would allow patients to compare drug prices at the doctor’s office and easily look up their copay. “With this tool, patients would be better able to know what they’ll need to pay before they’re standing at the pharmacy cash register, and pharmaceutical companies and plans would have to compete on the basis of the costs that patients face for their prescription drugs.”
Telehealth: Beginning this year MA beneficiaries can access additional telehealth benefits not offered under Medicare fee-for-service, allowing patients the opportunity to receive health care services from their homes rather than at a health care facility. In the proposed rule, CMS said it wants to build on those benefits and give MA plans more flexibility to count telehealth providers in certain specialty areas like psychiatry, neurology, or cardiology toward network adequacy standards, which would encourage greater use of telehealth services and increase plan choices for beneficiaries. “These proposed changes aim to give seniors more plan choices in rural areas, increase competition between plans, and allow providers to take advantage of the latest health care technologies and innovations,” CMS said in the announcement about the proposed rule.
Comments on the proposal: CMS will accept comments through 5 p.m., Monday, April 6. Comments may be submitted electronically by visiting http://www.regulations.gov and following the “submit a comment” instructions.