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Medicare Advantage Proposal Aims for Flexibility

The Centers for Medicare and Medicaid Services (CMS) has filed a rule proposing Medicare Advantage policy changes for 2020. One of the most notable provisions would allow plans to cover additional telehealth services that are currently available to fee-for-service Medicare beneficiaries. Current benefits are limited to rural areas and certain health care facility locations. The rule proposes to reimburse Advantage plans for additional telehealth services.

The proposal would unify the Medicare and Medicaid appeals process for individuals enrolled in D-SNPs and require D-SNP sponsors to integrate benefits across the two programs. The rule would also make some changes to how plans are required to handle precluded providers, add additional quality measures to Medicare Advantage plan star ratings for 2022, and alter the Risk Adjustment Data Validation audit process to increase recoveries from Advantage plans by $4.5 billion over 10 years.

CMS expects that the proposed rule will increase the appeal of Medicare Advantage plans and projects an enrollment increase of 11.5 percent. Advance text of the filed rule is available here, and a CSM fact sheet is here.  Publication is expected in the Nov. 1st Federal Register with comments accepted until Dec. 31.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841