Special Bulletin: CMS Issues Proposed Rule for Medicare Advantage, Part D for 2021

The Centers for Medicare & Medicaid Services (CMS) Feb. 5 issued a proposed rule and the second part of the Advanced Notice, which would make policy and technical changes to the Medicare Part C and D programs, including the Medicare Advantage (MA) Program, the Medicare Prescription Drug Benefit Program, the Medicaid Program, the Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly. Unlike in prior years, the agency is not releasing a separate call letter; however, it will separately issue bidding instructions for plans.

In the rule, CMS proposes to increase the portion of a health plan’s risk score that is based on encounter data, enable plans to meet some network adequacy requirements through telehealth, and provide plans with greater flexibility to tailor benefit packages for the chronically ill, among other policy changes. CMS expects that these changes will result in an increase in MA plan revenue of 0.93%.

Key Takeaways

CMS proposes:

  • To allow health plans serving rural areas to use telehealth to meet some network adequacy standards.
  • To give plans greater flexibility to tailor benefit packages for the chronically ill.
  • A number of changes to the Part D program to drive greater utilization of generics and other measures to lower spending, including by requiring plans to offer consumer-facing cost comparison tools.
  • To implement several provisions of the SUPPORT Act to reduce opioid use.
  • To base 75% of a health plans’ risk score on encounter data.

CMS expects these changes will result in a 0.93% increase in revenue for MA.

View details under key resources. 

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