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2021 Medicare Advantage Rule Another Booster on Rocketing Telehealth

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The meteoric rise of telehealth amid the COVID-19 outbreak was recognized and possibly given an added boost by the rule for the 2021 Medicare Advantage contract year issued by CMS today.

The new rule allows MA plans to count telehealth providers in a wide range of specialties toward their network adequacy standards, CMS said in press statement summarizing the new rule. Dermatology, psychiatry, cardiology, ophthalmology, nephrology, primary care, gynecology, endocrinology, and infectious diseases were listed in the release.

As indicated before today, the new rule also opens up MA enrollment to more people end-stage renal diseases. Another change is added weight to patient experience and access metrics in the Star rating system that is a factor in how much the federal government pays MA plans.

Roughly, 34 million Medicare beneficiaries, or about a third of the total, are now enrolled in MA plans, a proportion that has grown steadily since the early 2000s. 

Better Medicare Alliance (BMA), a group that lobbies for the program, was enthusiastic about the 2021 rule in a press release, saying that it applauded provisions dealing with telehealth, network adequacy and supplemental benefits for the chronically ill.

“This final rule takes important strides to preserve and strengthen the Medicare Advantage coverage that 24.4 million beneficiaries rely on today,” Allyson Y. Schwartz, the group’s president and CEO, said in the press release.

You can read a CMS factsheet about the new rule here and download the rule from the Federal Register here.

CMS said in the prepared statement that because of the impending June 1, 2020, MA and Part D bid deadlines for the 2021 plan year, it was  finalizing a subset of proposed policies before the due date and that it will address the remaining proposals for plans later in 2020 for the 2022 plan year.

“We understand that the entire healthcare sector is focused on caring for patients and providing coverage related to 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,” said the CMS statement.

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