Final Rule will strengthen popular Medicare private health insurance plans, expand telehealth access for patients, and improve coordination for dual-eligible individuals

Today, the Centers for Medicare & Medicaid Services (CMS) finalized policies that will increase plan choices and benefits, including allowing Medicare Advantage plans to include additional telehealth benefits. These policies continue the agency’s efforts to modernize the Medicare Advantage and Part D programs, unleash innovation and drive competition to improve quality among private Medicare health and drug plans.

“Today’s policies represent a historic step in bringing innovative technology to Medicare beneficiaries,” said CMS Administrator Seema Verma. “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 Medicare Advantage plans, beneficiaries can receive more benefits, at lower costs and better quality.”

The final policies announced today leverage new authorities provided to CMS in the Bipartisan Budget Act of 2018, which President Trump signed into law last year. CMS is finalizing changes that would allow Medicare Advantage beneficiaries to access additional telehealth benefits, starting in plan year 2020. These additional telehealth benefits offer patients the option to receive health care services from places like their homes, rather than requiring them to go to a healthcare facility.

Before this year, seniors in Original Medicare could only receive certain telehealth services if they live in rural areas. Starting this year, Original Medicare began paying for virtual check-ins across the country, meaning patients can connect with their doctors by phone or video chat. Historically, Medicare Advantage plans have been able to offer more telehealth services, compared to Original Medicare, as part of their supplemental benefits. But with the final rule, it will be more likely that plans will offer the additional telehealth benefits outside of supplemental benefits, expanding patients’ access to telehealth services from more providers and in more parts of the country than before, whether they live in rural or urban areas.

CMS is also finalizing changes that will make improvements to Medicare Advantage and Part D Star Ratings so that consumers can identify high-value plans. The final rule updates the methodology for calculating Star Ratings, which provide information to consumers on plan quality. The new Star Ratings methodology will improve the stability and predictability for plans and will adjust how the ratings are set in the event of extreme and uncontrollable events such as hurricanes.

The final rule will improve the quality of care for beneficiaries dually eligible for Medicare and Medicaid who participate in Dual Eligible Special Needs Plans (D-SNPs). These beneficiaries usually have complex health needs; if they have a complaint about their healthcare or about access to items and services, they have to work with multiple organizations, one responsible for Medicare benefits and another responsible for Medicaid benefits, in order to file an appeal. The final rule will create one appeals process across Medicare and Medicaid, which will make it easier for enrollees in certain D-SNPs to navigate the healthcare system and have access to high quality services. 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.

Today’s announcement builds on the 2020 Rate Announcement and Final Call Letter released earlier this week that gives Medicare Advantage plans flexibility to offer chronically ill patients a broader range of supplemental benefits that are not necessarily health related and can address social determinants of health. With these new telehealth and supplemental benefits, Medicare Advantage plans will have the flexibility to provide a historic set of offerings to beneficiaries. Medicare Advantage plans will be able to compete for patients based on their new offerings and overall cost. CMS is working to update the Medicare Plan Finder with these new choices, so that beneficiaries will be able to see their new choices and benefits and can pick the plans that work best for them.

The fact sheet on the CY 2020 Medicare Advantage and Part D Flexibility Final Rule (CMS-4185-F) can be found here. The final rule can be downloaded from the Federal Register.