A final rule issued by CMS on April 5 cemented policies to increase plan choices and benefits for enrollees in the Medicare Advantage (MA) and Medicare Prescription Drug Benefit (Part D) programs, opening those beneficiaries to supplemental services like telehealth and streamlining the appeals process for those unsatisfied with their healthcare.
The final rule, which will take effect in the 2020 insurance cycle, leverages several authorities provided to CMS by the Bipartisan Budget Act of 2018, including the ability to offer additional telehealth benefits to MA beneficiaries, increase integration of Medicare and Medicaid benefits and establish a process to allow Part D plan sponsors to request standard extracts of Medicare Parts A and B claims data for their enrollees.
Original Medicare—comprised of hospital insurance and medical insurance, or Medicare Parts A and B—extended some telehealth services to patients if they lived in rural areas, but this year the program began paying for virtual check-ins across the country. The check-ins, which can be conducted via video chat or over the phone, replace office visits when a patient can’t make it to a physical location, even if they live in an urban area.
“Today’s policies represent a historic step in bringing innovative technology to Medicare beneficiaries,” CMS Administrator Seema Verma said in a statement. “With these new telehealth benefits, Medicare Advantage enrollees will be able to access the latest technology and have greater access to telehealth. By providing greater flexibility to MA plans, beneficiaries can receive more benefits, at lower costs and better quality.”
In addition to extended telehealth benefits, the 2020 final rule promises to make improvements to MA and Part D star ratings—CMS’ method for rating hospitals from one to five stars. Researchers have questioned the star system, finding in a March 27 study CMS’ approach underestimated certain factors like safety and was inferior to a more comprehensive rating system.
The final rule will also improve the quality of care for enrollees participating in Dual Eligible Special Needs Plans, or D-SNPs, CMS said. Right now, those beneficiaries are required to work with multiple organizations to file a complaint about their health or access to medical services, but the new policy creates one appeals process that remains uniform across Medicare and Medicaid programs.
“The final rule will also require plans to more seamlessly integrate Medicare and Medicaid benefits across the two programs, such as notifying the state Medicaid agency (or its designee) of hospital and skilled nursing facility admissions for certain high-risk beneficiaries, to promote coordination of care for these patients,” CMS added in its statement.
The agency said it’s currently working to update the Medicare Plan Finder with new choices established under the final rule.