- CMS on Friday released a final rule that gives more weight to patient experience, complaint and access measures in Medicare Advantage and Part D star ratings and reduces the influence of outliers. It also finalizes a proposal to modify the calculation of 2021 and 2022 Part C and D star ratings to "address the expected disruption to data collection and impact on measure scores posed by the COVID-19 pandemic to avoid inadvertently creating incentives to place cost considerations above patient safety," according to a CMS fact sheet.
- The rule attempts to let more MA plans comply with network adequacy standards by reducing the percentage of rural beneficiaries that must reside within maximum time and distance areas and giving a credit toward that percentage for plans that contract with certain specialty providers.
- The rulemaking also implements a 21st Century Cures Act provision that allows all Medicare-eligible people with end-stage renal disease to enroll in an MA plan on Jan. 1 and also excludes kidney acquisition costs from MA benchmarks.
The final rule issued Friday doesn't address everything in the February proposed rule, and CMS said the remainder will be discussed in further rulemaking. "We understand that the entire healthcare sector is focused on caring for and providing coverage for coronavirus disease 2019 (COVID-19), and we believe this approach provides plans with adequate time and information to design the best coverage for Medicare beneficiaries," the agency wrote.
Bid submissions from plans are due June 1.
The change allowing ESRD patients to enroll in MA plans aligns with early action from the Trump Administration attempting to overhaul kidney care in the U.S. President Donald Trump in July issued an executive order aiming to increase preventive care for kidney patients, improve access to home dialysis and encourage development of artificial and wearable kidneys.
The telehealth changes come as doctors and patients have flocked to virtual care amid the pandemic. When most of the country was under stay-at-home orders, they turned to telehealth, and CMS responded by loosening reimbursement restrictions for virtual visits.
Mark Newsom, a former CMS staffer who has also held executive positions with CVS Health and Humana, wrote on Twitter the adjustments are "great news" for telehealth. "This and hopefully a permanent place for telehealth data in risk adjustment will go a long way toward modernizing the MA program with robust connected care," he said.
CMS estimated the star ratings adjustment for outliers will save $3.65 billion over the next 10 years.
The rule comes on the heels of a finalized rate increase for MA plans of 1.66% for 2021. That rule also finalized a plan to use more encounter data when calculating risk scores.