CMS finalizes telehealth and ESRD changes for Medicare Advantage
CMS today (Friday) finalized (earlier news release) several changes to Medicare Advantage and Part D but said more updates are coming.
The final rule will make it easier for Medicare Advantage plans to meet network adequacy standards. Advantage plans can now contract with telehealth providers for specialties like cardiology and receive a 10% boost to their percentage of beneficiaries that live within the time and distance requirements, according to a CMS fact sheet.
"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," CMS said in a statement.
The agency is also reducing the percentage of beneficiaries required to meet those standards from 90% to 85%, and easing network adequacy standards for outpatient dialysis. Advantage plans can also get a credit to offset the "adverse effects" of state Certificate of Need Laws, according to CMS.
Beginning in 2021, Medicare beneficiaries with end-stage renal disease will be able to enroll in Medicare Advantage plans, as mandated by the Cures Act. Until now, they couldn't get dialysis treatment under Medicare Advantage unless they were diagnosed with the disease after enrollment.
"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," according to CMS.
The final rule also boosts the impact of patient experience and access under the Medicare Advantage and Part D star ratings system. It also increases the predictability and stability of the ratings by lowering the impact of outliers, the agency said. By removing outliers from the ratings calculations, CMS estimates the federal government will save $3.65 billion over 10 years.
The agency said that the final rule "focuses on more immediate regulatory actions," which includes implementing changes required by the Bipartisan Budget Act of 2018 and the 21st Century Cures Act. Both laws required the changes to be made by June 1, 2020.
"CMS plans to address the remaining proposals for plans later in 2020 for the 2022 plan year," the agency said in a statement.