CMS Finalizes a Subset of Policies in MA and Part D Final Rule, Including ESRD MA Enrollment and MA and Part D Star Rating Changes; Subsequent Final Rule to Address Remaining Policies

On May 22, 2020, the Centers for Medicare & Medicaid Services (CMS) released the Contract Year (CY) 2021 Medicare Advantage (MA) and Part D Final Rule (press release; fact sheet).  Of note, CMS is finalizing only a subset of the proposed policies, and will address the remaining proposed policies in subsequent rulemaking in 2020.

  • What is it. Due to the upcoming June 1, 2020, MA and Part D bid deadline for the 2021 plan year, CMS is finalizing a subset of the policies proposed in February. CMS intends on issuing a second final rule to address the remaining proposed policies. The agency notes that the entire healthcare sector is focused on the COVID-19 pandemic, and believes this approach provides plans with adequate time and information to design the best coverage plans. The first final rule is focused on more immediate regulatory actions, including the implementation of certain provisions of the Bipartisan Budget Act (BBA) of 2018 and the 21st Century Cures Act.
  • Why is it important for you. CMS finalizes policies to expand access to telehealth services in MA plans by ensuring beneficiaries can receive care at home and providing flexibility to count telehealth providers in certain specialty areas towards meeting CMS network adequacy standards. Additionally, CMS finalizes proposals to enhance the MA and Part D Star Ratings system, including increasing the predictability of the ratings by reducing the influence of outliers and increasing the measure weights for patient experience and access measures. Finally, the final rule implements allowing beneficiaries with end-stage renal disease (ESRD) to enroll in MA plans
  • Potential next steps.  CMS intends to address the remaining proposed policies in subsequent rulemaking in 2020. CMS plans on making any provision finalized in the second final rule, although effective on or before January 1, 2021, applicable no earlier than January 1, 2022. The remaining proposed policies include permitting a second specialty tier in Part D plans and the requirement for real-time benefit tools. Our summary of the proposed rule can be found here.

Our full client summary is available here.

Erin Slifer joined Wynne Health Group in May 2019, following a year-long internship with the firm’s policy team while pursuing