CMS finalizes expansion of telehealth benefits in MA plans, Part D policies

CMS has finalized a rule to implement a series of proposals issued earlier this year impacting Medicare Advantage plans and Medicare Part D plan sponsors. The rules were rushed into effect to get them out before the contract year 2021 bid deadline in June.

The final rule will cut $3.65 billion in federal spending over the next 10 years due to a change that removes outliers before cutting Star Ratings points in the Medicare Part C and D Star Rating methodology. The final rule also codified some Star Rating and MA enrollment changes for end-stage renal disease patients issued in the Cures Act.

CMS also finalized new policies that support telehealth options for MA plan options in rural areas, reducing the maximum time and distance standards from 90% to 85%. The agency is also offering a 10% credit toward the percentage of beneficiaries that must reside within the standards with plan contracts for a number of healthcare specialties.

The changes come at a time when healthcare providers are focused on the COVID-19 response and fewer Americans are visiting their physicians and other providers for routine, preventive care and other elective procedures.

“The COVID-19 response has also restricted access to healthcare,” HHS Secretary Alex Azar wrote in an op-ed for The Washington Post May 21. “Data suggests the numbers of Americans receiving important preventive services are down significantly, with mammograms down 87[%] and colonoscopies down 90[%].”

“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,” CMS Administrator Seema Verma said in a statement. “The changes we are making will help make telehealth more widely available in Medicare Advantage and are part of larger efforts to advance telehealth.”

See the final rule here.