CMS Targets Medicare Advantage Beneficiaries In COVID-19 Efforts

CMS has released guidance regarding how Medicare Advantage and Part D Plans can properly respond to the COVID-19 outbreak.

For more coronavirus updates, visit our resource page, updated twice daily by Xtelligent Healthcare Media.

CMS is targeting Medicare beneficiaries with this latest slew of guidances due to the seemingly strong relationship between age and severity of the disease.

A February 2020 report from the Chinese Center for Disease Control and Prevention—the largest study of the disease to date—found that a significant 90 percent of cases occurred in individuals 30 years of age or older, with 87 percent between the ages of 30 and 79. It also found that around 22 percent of infected patients aged 70 or older resulted in a fatality.

“Medicare beneficiaries are at the greatest risk of serious illness due to COVID-19 and CMS will continue doing everything in our power to protect them,” said CMS Administrator Seema Verma. “Today we announced guidance to Medicare Advantage and Part D plans to remove barriers that could prevent or delay beneficiaries from receiving care.”

The announcement followed a meeting between President Trump, Vice President Pence, and payers and their associations.

“The President directed CMS to make sure Medicare Advantage beneficiaries have access to the healthcare services they need during this time,” Administrator Verma summarized.

“No one should hesitate to see their doctor to get tested and treated for COVID-19 because of costs,” said Matt Eyles, president and chief executive officer of America’s Health Insurance Plans (AHIP), in a written statement after the meeting. 

“Health insurance providers across the country have taken action to remove cost barriers to care.  America’s health insurance providers are committed to swift and significant action to help confront this challenge. Working together with government leaders and industry partners, we can overcome this challenge and keep the American people safe and healthy.”

The CMS guidance advises payers on several flexibilities related to COVID-19 prevention, focusing on decreased barriers to access to care and increased efficiency. The guidance includes recommendations to

• Waive test cost-sharing
• Waive treatment cost-sharing, including primary care, emergency department, and telehealth services
• Eliminate prior authorizations
• Eliminate prescription refill restrictions
• Decrease limitations around home or mail prescription delivery
• Increase patient access to care through telehealth

CMS paired this release with instructions for healthcare professionals and providers on proper protocol for wearing masks when treating COVID-19 and the screening, treatment, and transfer of infected patients.

A few days prior to the meeting between the president and payers, the board of directors for AHIP released a statement communicating their commitment to ensuring positive health outcomes for their members during the COVID-19 outbreak.

The statement outlined three key actions for which the payers took responsibility: prevention, testing, and treatment.

Specifically, they promised to collaborate with partners in the public and private sectors to diminish out-of-pocket costs related to COVID-19. The organization committed to cover testing and simplify the system to make testing more efficient by waiving requirements for networks, referrals, and prior authorizations. 

The payers also said that they would tackle drug shortages and work with federal and state officials to meet other immediate needs like changing benefits designs and expanding treatment options.

Second, AHIP agreed to work with providers to make treatments available to infected patients. This includes knowledge sharing and using care management programs. 

The payers particularly emphasized innovative use of telehealth and remote monitoring options as pivotal to the containment effort. They called on state and federal officials to take regulatory action to increase access to such tools.

Lastly, AHIP committed to spreading relevant information about how to prevent the spread of the COVID-19. The payers particularly specified seniors and patients dealing with chronic disease management. They promised to coordinate their efforts with the CDC, federal entities, and state and local governments.

“Health insurance providers will devote our resources, insights, and abilities to collaborate with key partners to confront and resolve this challenge. Working together with federal, state and community leaders; clinicians; pharmacies; drug makers; medical equipment providers; and other essential partners, we are confident that we can collectively overcome this challenge and keep the American people safe and healthy,” the statement concluded.

In tandem with its Medicare Advantage and Part D guidance, CMS released the Part D Senior Savings Model, which allows Medicare beneficiaries a selection of insulins—including rapid-acting, short-acting, intermediate-acting, and long-acting insulins—with a steady $35 copay. The goal is to increase medication adherence and access to medication which, as coronavirus spreads, is becoming more and more difficult to ensure.

As CMS and federal agencies work to stem the tide of this novel strain of coronavirus, many Americans are also relying on healthcare payers to follow through with their commitment.