by
John R. Fischer, Senior Reporter | April 12, 2019
Improvements to Medicare Advantage and Part D star ratings are also being finalized, with the final rule updating the methodology for calculating star ratings. This provides information to consumers on the quality of plans so that they can identify a high-value one, and improves the stability and predictability of plans. The methodology includes adjustments for how ratings are set in the event of extreme and uncontrollable events, such as hurricanes.
"MA plans may independently determine which Part B services are clinically appropriate to furnish as MA additional telehealth benefits," said the CMS spokesperson. "If an MA plan covers a Part B service as an MA additional telehealth benefit, then the MA plan must also provide access to such service through an in-person visit and not only through electronic information and telecommunications technology. The enrollee would have the option whether to receive such service through an in-person visit or through electronic information and telecommunications technology."
The final rule is expected to improve the quality of care for beneficiaries who are eligible for both Medicare and Medicaid as part of the Dual Eligible Special Needs Plans. Members of these plans often have complex health needs and must go through multiple organizations for both separately when complaining. The final rule will create one appeals process across Medicare and Medicaid, making it easier for enrollees in certain D-SNPs to receive high-quality services.
In addition, plans will be better able to seamlessly integrate Medicare and Medicaid benefits across both programs, such as when notifying the state Medicaid agency of hospital and skilled nursing facility admissions for certain high-risk patients, to encourage coordination of care for patients.
The finalizations are part of the agency’s modernization of Medicare Advantage and Part D programs to increase competition and improve quality among private Medicare health and drug plans.
CMS is currently updating the Medicare Plan Finder with the new choices, so that beneficiaries can evaluate and choose the plan that works best for them.
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