Final rule notches win for BMA advocacy by leveraging telehealth to modernize network adequacy requirements and increase access to care, opening the door to new innovations
Washington, D.C. – Better Medicare Alliance (BMA), the leading research and advocacy organization supporting Medicare Advantage, responded today to the Centers for Medicare & Medicaid Services’ (CMS) final Medicare Advantage rule for contract year 2021, with additional rulemaking expected for 2022.
Better Medicare Alliance applauded the rule’s finalized language on telehealth, network adequacy, and expanded eligibility for supplemental benefits for the chronically ill. These provisions, which were strongly championed by Better Medicare Alliance, allow Medicare Advantage beneficiaries greater access to a wider set of health care providers through changes to telehealth and network adequacy requirements. CMS additionally expanded the list of specialists who are eligible to employ these changes, including the addition of primary care and nephrology – thereby giving newly-enrolled End-Stage Renal Disease (ESRD) beneficiaries additional support to manage their care and expanding access to Medicare Advantage for seniors in rural and underserved areas.
The rule further expands eligibility for Special Supplemental Benefits for the Chronically Ill (SSBCI), building on Better Medicare Alliance’s years-long advocacy for greater flexibilities in benefit design to address the needs of this vulnerable population. These changes will improve care for individuals living with complex chronic conditions who often experience complex medical and socioeconomic challenges too often left unmet.
“This final rule takes important strides to preserve and strengthen the Medicare Advantage coverage that 24.4 million beneficiaries rely on today,” said Allyson Y. Schwartz, President and CEO of the Better Medicare Alliance. “The added flexibility to address the needs of all beneficiaries, with particular attention to those with complex chronic conditions, provides the opportunity for Medicare Advantage to offer greater access to care, new innovations in care delivery, and lower costs for millions of Americans. We are especially grateful to CMS for the changes championed by Better Medicare Alliance that expand the power of telehealth, modernize network adequacy requirements, and further improve supplemental benefits for those with chronic conditions – all of which will enable Medicare Advantage to reach new populations with coordinated, quality care and services that allow beneficiaries to live healthier lives.”
“All told, this rule contains reforms that can unleash Medicare Advantage’s potential to offer innovative care for the chronically ill, including newly enrolled beneficiaries with end-stage renal disease,” said Schwartz. “Better Medicare Alliance looks forward to continuing to work with CMS to address issues related to the coronavirus, as well as parts of the rule that will be attended to later, with the goal of ensuring that Medicare Advantage continues to modernize Medicare to meet beneficiaries’ needs and offer high-quality care at a lower cost.”
Read CMS’s final rule in its entirety HERE.
Following the issuance of CMS’s proposed rule in February, Better Medicare Alliance led a multipronged advocacy campaign dedicated to securing finalization of proposals to modernize network adequacy requirements through the use of telehealth.
See Better Medicare Alliance’s earlier letter to CMS with statements of support for telehealth and network adequacy reforms from American Telemedicine Association (ATA), Consumer Action, Health Care Transformation Task Force, National Black Nurses Association, Population Health Alliance, and others HERE (Attachment D, pages 16-17).