Medicare Advantage and Part D Plans: CMS Flexibilities to Fight COVID-19
Since the beginning of the COVID-19 Public Health Emergency, the Trump Administration has issued an unprecedented array of temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic. These temporary changes will apply immediately across the entire U.S. healthcare system for the duration of the emergency declaration. The goals of these actions are to 1) expand the healthcare system workforce by removing barriers for physicians, nurses, and other clinicians to be readily hired from the community or from other states; 2) ensure that local hospitals and health systems have the capacity to handle a potential surge of COVID-19 patients through temporary expansion sites (also known as CMS Hospital Without Walls); 3) increase access to telehealth in Medicare to ensure patients have access to physicians and other clinicians while keeping patients safe at home; 4) expand in-place testing to allow for more testing at home or in community based settings; and 5) put Patients Over Paperwork to give temporary relief from many paperwork, reporting and audit requirements so providers, health care facilities, Medicare Advantage and Part D plans, and States can focus on providing needed care to Medicare and Medicaid beneficiaries affected by COVID-19.
Patients Over Paperwork
COVID-19 Diagnostic Testing
Coverage of Testing and Testing-Related Services for COVID-19: As a result of the Families First Coronavirus Response Act and the CARES Act, Medicare Advantage Organizations are not permitted to charge cost sharing for clinical laboratory tests for the detection of SARS-CoV-2 or the diagnosis of the virus that causes COVID-19, the administration of such tests, and specified COVID-19 testing-related services during the period March 18, 2020 through the end of the public health emergency declared by the Secretary under section 319 of the Public Health Service Act. In addition, Medicare Advantage organizations may not impose any prior authorization or other utilization management requirements with respect to the coverage of COVID diagnostic tests, its administration and specified testing-related services furnished on or after March 18, 2020 and during the applicable emergency period.
Medicare Advantage (Part C) and Part D Star Ratings: 2021 Star Ratings Data Collection CMS is committed to allowing health plans, providers, and physician offices to focus on caring for Medicare beneficiaries during this public health emergency and not put individuals at risk by requiring travel or collection of data in offices that may be overwhelmed by patients needing care. In light of the public safety issues in continuing to require the collection, validation and submission of data for the 2019 measurement year, the first Interim Final rule removed the requirement for Medicare health plans to submit Healthcare Effectiveness Data and Information Set (HEDIS) 2020 data covering the 2019 measurement year for the Medicare program. Medicare health plans can use any HEDIS data that they have collected for their internal quality improvement efforts. CMS is removing the requirement for submission of 2020 Consumer Assessment of Healthcare Providers & Systems (CAHPS) survey data for Medicare health and drug plans for similar concerns about the potential associated with activities to collect and submit the survey data. Both Part C and D plans can use any CAHPS survey data collected for their internal quality improvement efforts. This year’s Health Outcomes Survey, administered by NCQA in partnership with CMS as a component of HEDIS data collection, was scheduled to be from April through July 2020. This survey administration has been postponed to late summer, and CMS will continue to monitor the situation to see if any further adjustments are needed. Medicare Advantage (Part C) and Part D Star Ratings: 2021 Star Ratings Calculations In addition to modifying the 2020 data submission requirements for HEDIS and CAHPS surveys, CMS is taking the following action with respect to 2021 Star Rating calculations:
Medicare Advantage (Part C) and Part D Star Ratings: 2022 Star Ratings Calculations For 2022 Star Ratings, CMS expects Medicare Advantage contracts to submit HEDIS data in June 2021, and Medicare Advantage and Prescription Drug Plan (Part D) contracts to administer the CAHPS survey in 2021 as usual so there is not a concern about data collection for the 2020 performance period. However, to address concerns about overall performance in 2020, we are changing the applicability date of the guardrails policy from January 1, 2020 to January 1, 2021, delaying implementation of the 5-percentage point cap so that cut points for the 2022 Star Ratings can change by more than 5 percentage points if national performance declines overall as a result of the outbreak. CMS will calculate the Part C and D improvement measure scores for the 2022 Star Ratings as codified but recognizes that the COVID-19 outbreak may result in a decline in industry performance, therefore expanding the “hold harmless rule” to include all contracts at the overall and summary rating levels. Medicare appeals in Fee for Service, Medicare Advantage (MA) and Part D