CMS Expands Telehealth, Rural Plan Options for Medicare Advantage

CMS has finalized changes to Medicare Advantage and Medicare Part D telehealth policies and supplemental chronic disease management benefits. The agency has also expanded Medicare Advantage for rural and end stage renal disease (ESRD) care.

“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,” said CMS Administrator Seema Verma in the press release. “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 new telehealth policies cover a wider range of specialty providers for telehealth benefits, according to the fact sheet. The list includes dermatologists, psychiatrists, cardiologists, ophthalmologists, primary care physicians, gynecologists, infectious disease specialists, and others.

CMS sought to ease policies regarding rural healthcare in order to make more Medicare Advantage options available to rural residents. Now 85 percent of beneficiaries must live within the maximum time and distance standards to participate in a Medicare Advantage plan. Previously, CMS required 90 percent.

Medicare Advantage plans have had difficulty gaining traction in rural areas. In these areas, enrollment and primary care provider density can force premiums higher than in urban areas.

Medicare Advantage plans will also receive 10 percent credit for the percentage of beneficiaries that fall within that 85 percent.

CMS will also ease network adequacy standards regarding outpatient dialysis and residents of states with Certificate of Need laws and other laws which restrict competition.

The rule enacts the Cures Act mandate regarding ESRD Medicare-eligible beneficiaries. Starting the first day of 2021, all Medicare beneficiaries with ESRD will be eligible for Medicare Advantage.

The Medicare Advantage and Medicare fee-for-service payment adjustments will also go into effect, including the exclusion of kidney acquisition costs from Medicare Advantage benchmarks. These payment rates were disputed by some as insufficient.

CMS looked to refine the Medicare Advantage Star Ratings system and the Medicare Part D Star Ratings by implementing the Tukey outlier deletion to erase outliers that exert too much influence over the star ratings. Member experience will have more weight in the reformed star ratings systems.

The final rule adjusts the 2021 and 2022 Medicare Advantage and Medicare Part D Star Ratings to address the impacts of coronavirus on the process. Specifically, CMS said, the adjustments account for the fact that data collection and measure scores will be affected.

The final rule expands medical loss ratio (MLR) regulations to include “incurred claims” and adopts a deductible-based adjustment to make increase Medicare Advantage plans’ incentives to offer medical savings account contracts.

CMS extended the definition for special election periods as well to include a number of exceptional circumstances, including:

• Federal Emergency Management Agency emergencies and federal, state, or locally declared emergencies (“Government Entity-Declared Disaster or Other Emergency”)
• Individuals involuntarily disenrolled from an MA-PD plan Due to Loss of Part B
• Individuals Enrolled in a Plan that has been identified by CMS as a Consistent Poor Performer
• Individuals Enrolled in a Plan Placed in Receivership

Finally, the new rule also covers supplemental benefits for the chronically ill and crack down on “look-alike” dual eligible special needs plans.

The finalized rule will be published on June 2, 2020. An unpublished version is available on the Federal Register.