A proposed rule issued October 26, 2018, CMS https://www.cms.gov would increase efforts to modernize Medicare Advantage (MA) and Part D programs. Also, the proposed changes would provide flexibility to offer telehealth benefits and improve coordination for dual-eligible beneficiaries and provide much needed updates.
“The proposed changes would give MA plans more flexibility to innovate in response to patients and their needs,” said CMS Administrator Seema Verma. “I’m especially excited about the proposed changes to allow additional telehealth benefits which would promote access to care in a more convenient and cost-effective manner for patients.”
Specifically, the proposed plan would:
- Give MA plans more flexibility to offer government-funded telehealth benefits to all their enrollees, whether they live in rural or urban areas
- Allow greater ability for MA enrollees to receive telehealth services from home
- Plans would have greater flexibility to offer clinically appropriate telehealth benefits that are not otherwise available to Medicare beneficiaries
- Improve the quality of care for dually-enrolled beneficiaries in Medicare and Medicaid who participate in “Duel Eligible Special Needs Plans” (D-SNP)
- Unify the appeals process across Medicare and Medicaid and make it easier for enrollees in certain D-SNPs to navigate the system and plans would be required to seamlessly integrate benefits across the programs
The proposed changes would also help CMS recover improper payments made to MA organizations. CMS conducts Risk Adjustment Data Validation audits to confirm that diagnoses submitted by MA organizations for risk adjusted payments are supported by medical record documentation.
The proposed rule would strengthen CMS’s ability to return dollars to the Medicare Trust Funds as a result of these audits. If the changes are finalized, these changes would result in an estimate $4.5 billion in savings to the Medicare Trust Funds over a ten year period largely from the recovery of improper payments to MA plans through Risk Adjustment Data Validation audits.
Several reports have just been issued by Credit Suisse, a wealth management company https://www.credit.suisse.com/us/en.html with headquarters in Zurich Switzerland. One report just published on October 29 titled “Some Tricks and Some Treats in the CMS MA Telehealth Proposal” highlights key takeaways and thoughts on the CMS MA Proposal.
Researcher and contributing to the report are Jailendra Singh Research Analyst at Credit Suisse, covering healthcare providers and services along with other researchers A.J Rice, Eduardo Ron, and Craleb Harris.
Two other reports have just been released. “A High Growth and Cost-Saving Industry Shaping the Future of Health Care Delivery,” and a report researched by Jailendra Singh for Teledoc Health titled “A Leader in Growing Industry but Risk/Reward Balanced at Current Levels.”
For more information or to present some ideas and thoughts, email Jailendra Singh at jailendra.singh@credit-suisse.com