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CMS Continuing Telehealth Push in Announcing Changes for Part D and Medicare Advantage Beneficiaries

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Original story posted on: May 22, 2020

The changes will be applicable to some 67 million enrollees.  

The approximately 67 million Americans with either Medicare Advantage (MA) or Medicare Part D health plans will enjoy more benefits and options following the implementation of changes federal officials announced just prior to the start of Memorial Day weekend.  

The Centers for Medicare & Medicaid Services (CMS) announced Friday that for MA beneficiaries in particular, it has finalized requirements that will increase access to telehealth, expand the types of supplemental benefits available for patients with chronic diseases, provide support for more care options in rural communities, and expand access to patients battling end-stage renal disease (ESRD).

Due to the upcoming June 1 MA and Part D bid deadlines for the 2021 plan year, officials said they are finalizing a subset of the proposed policies before the MA and Part D plans’ bids are due. CMS plans to address the remaining proposals for plans later in 2020 for the 2022 plan year, with Friday’s announcement noting that the “entire healthcare sector is (currently) focused on caring for patients and providing coverage related to … COVID-19.”

“CMS’s rapid changes to telehealth are a godsend to patients and providers, and allows people to be treated in the safety of their home,” CMS Administrator Seema Verma said in a statement. “The changes we are making will help make telehealth more widely available in Medicare Advantage, and are part of larger efforts to advance telehealth.”

The use of telehealth has exploded amid the coronavirus pandemic, during which CMS has moved to relax regulations governing it, allowing for such visits to be reimbursed similarly to face-to-face office visits. A recent survey of more than 840 physicians by the firm Merritt Hawkins reportedly found that while fewer than one in five utilized telehealth as recently as 2018, nearly half have embraced the practice during the pandemic.

CMS said in its announcement that it is also 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, officials said, 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.”

CMS said in its announcement that it is also finalizing proposals 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.” The system helps Medicare beneficiaries, their families, and their caregivers compare the quality of health and drug plans being offered.

To view a fact sheet on the 2021 Medicare Advantage and Part D Final Rule (CMS-4190-F1), go online to https://www.cms.gov/newsroom/fact-sheets/contract-year-2021-medicare-advantage-and-part-d-final-rule-cms-4190-f1-fact-sheet.

The final rule can also be downloaded from the Federal Register and viewed in its entirety online at: https://www.federalregister.gov/public-inspection/current

Mark Spivey

Mark Spivey is a national correspondent for RACmonitor.com, ICD10monitor.com, and Auditor Monitor who has been writing and editing material about the federal oversight of American healthcare for more than a decade. He can be reached at mcspivey@hotmail.com.

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