CMS issues final rule for Medicare Advantage, Part D plans

The Centers for Medicare & Medicaid Services today issued a rule finalizing certain telehealth and network adequacy proposals for Medicare Advantage and Part D prescription drug plans for contract years 2021 and 2022, as well as certain provisions of the Bipartisan Budget Act of 2018 and 21st Century Cures Act, among other changes. The agency plans to issue a separate final rule to address other remaining provisions of the proposed rule.

Under the telehealth and network adequacy changes, CMS will provide MA plans with a 10-percentage-point credit for certain provider specialty types when it contracts with telehealth providers in the dermatology, psychiatry, cardiology, neurology and otolaryngology specialties. In addition, CMS will award MA plans a 10-percentage-point credit toward the percentage of beneficiaries residing within required maximum time and distance standards in a state with Certificate of Need laws, or other “state imposed anti-competitive restrictions.”

In comments on the proposed rule, AHA raised concern that the proposals may unintentionally encourage plans to use telehealth services as substitutes for existing in-person services, and hinder enrollee access to and choice of providers based on faulty assumptions regarding the impact of CON policies on supply of providers.