Medicare Compliance & Reimbursement

Cost-savings is at the heart of the final rule.

CMS continues to reshape healthcare, ensuring quality and value are intertwined with all of its programs. In its latest offering, the agency solidifies Medicare Advantage and Part D payment changes for 2020 while reducing costs for beneficiaries.

Background: On April 5, CMS issued a two-part final rule addressing Medicare Advantage (MA) and Part D. On the MA side, the agency builds on recent policies by expanding telehealth, updating plan designs, and pushing value-based care forward. The Part D section of the ruling provides some cost-sharing incentives that aim to combat opioid overuse.

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

Register These Two Top MA Takeaways

Telehealth expansion: CMS, bolstered by provisions outlined in the Bipartisan Budget Act of 2018 (BBA 2018), updated telehealth services for MA plans starting in the contract year 2020. In the past, telehealth was only an option offered through beneficiaries’ supplemental benefits, but CMS wants to change that.

“Under this final rule, MA enrollees may have great opportunities to receive healthcare services from places like their homes, rather than being required to go to a healthcare facility,” CMS advises. “MA plans will now have broader flexibility than is currently available in how they pay for coverage of telehealth benefits to meet the needs of their enrollees.”

The final rule allows MA plans the option to offer telehealth benefits to MA patients’ beyond their supplemental benefits in both rural and urban environments, aligning with BBA 2018 legislation, indicate attorneys Matthew M. Shatzkes and Susan Ingargiola of the national law firm Sheppard, Mullin, Richter & Hampton LLP, in the Sheppard Mullin Healthcare Law Blog.

However, “MA Plans will continue to be able to offer MA supplemental benefits (that is, benefits not covered by fee-for-service Medicare) via remote access technologies and/or telemonitoring for those services that do not meet the requirements for coverage under fee-for-service Medicare or the requirements for MA additional telehealth benefits (such as the requirement of being covered by Medicare Part B when provided in-person),” Shatzkes and Ingargiola explain.

Chronically-ill patients: In 2020, MA plans can offer supplemental benefits to chronically-ill patients along the lines of things like meal delivery and transportation for non-medical needs.

“MA plans will have broad discretion to determine which supplemental benefits provide a reasonable expectation of improving or maintaining a chronically ill person’s health,” notes attorney Meredith Parnell of national law firm Crowell & Moring LLP, in the C & M Health Law Blog.

Final thoughts: By offering flexible, innovative policies, CMS hopes to promote cost savings and allow patients, particularly seniors, more diverse care options. This translates to substantial savings for the Medicare Trust Fund, too, and possibly a pay increase for MA providers.

“It is clear that CMS intends for these changes to incentivize more MA plans to offer more telehealth services and to increase access to patient-centered care by giving enrollees more control to determine when, where, and how they access benefits,” Shatzkes and Ingargiola note. “According to CMS, the MA additional telehealth benefits are expected to produce $557 million in savings for enrollees over 10 years from reduced travel time to and from providers.”

Note: See the final rule published in the Federal Register on April 16 at https://s3.amazonaws.com/public-inspection.federalregister.gov/2019-06822.pdf.