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CMS Finalizing 2021 Medicare Advantage and Part D Final Rule in Two Stages

The Centers for Medicare and Medicaid Services (CMS) has issued a final rule, Medicare Program; Contract Year 2021 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program, that includes some, but not all, of the provisions from the February proposed rule. CMS intends to include the remaining provisions in a second final rule to be issued at a later date. The intention was to implement certain provisions related to Medicare Part C and D programs in time for the contract year (CY) 2021 Medicare Advantage (MA) plan bid due date. The agency plans to make any provisions adopted in the second final rule applicable no earlier than Jan. 1, 2022.

The first final rule increases flexibility for provider network time and distance requirements and creates credits toward network requirements for plans that establish telehealth arrangements with certain providers, as well as for those operating in states with provider Certificate of Need laws. It also permits Medicare beneficiaries with End Stage Renal Disease (ESRD) to join MA plans and makes associated payment adjustments.

While the rule does restrict look-alike Dual Eligible Special Needs Plans (D-SNPs), it allows for an additional year for phase-out relative to the provision in the proposed rule. CMS adopted changes to the calculations of Part C and D star ratings, increasing the weights of patient experience/complaints and access measures. The rule also includes proposals to alter the Medical Loss Ratio calculation to reflect the addition of supplemental benefits and adjust for certain Medical Savings Accounts. Finally, the adopted rule codifies two new special election periods during which members may enroll or disenroll: when a plan is placed into receivership, and when a plan is deemed a consistent poor performer.

Other provisions from the proposed rule are expected to be addressed in the second final rule. The text of the first final rule is available here; the CMS fact sheet is here.

LeadingAge NY Contact: Darius Kirstein, dkirstein@leadingageny.org