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CMS Proposes Changes to Medicare Advantage and Part D for 2021 and 2022

For CEOs, CFOs, government relations staff

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The Centers for Medicare & Medicaid Services (CMS) has issued Part II of the calendar year (CY) 2021 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies. This includes proposals related to MA payment methodologies for 2021 — including changes to payment and possible star ratings for end-stage renal disease patients — as well as requests for feedback on changes to prior authorization and initial opioid prescribing.

CMS estimates that MA plans will see a payment increase of 0.93% compared to CY 2020.

Part I of the Advance Notice — which includes proposals related to risk adjustment and encounter data — was issued in January. Comments on both Parts I and II are due March 6. A CMS fact sheet provides additional information.

CMS has also issued a proposed rule and is seeking comment on proposals to change and codify many longstanding policies on the MA and Part D programs that have been previously adopted through sub-regulatory guidance, such as the annual Call Letter and other guidance documents. Policies included in the proposed changes for MA plans are:

  • Network adequacy standards that incentivize MA plans to expand access to telehealth services
  • The medical loss ratio methodology
  • The MA star ratings, to increase the weight of beneficiary experience, complaints and access
  • Codification of previously adopted supplemental benefit requirements

For Part D plans, CMS proposes to expand drug management programs and medication therapy management programs, and require Part D plans to educate beneficiaries on opioid risks, alternate pain treatments, and safe disposal of opioids.

Comments on the proposed rule are due April 6. A CMS fact sheet provides additional information.