CMS Proposes Medicare Advantage and Part D Changes to Maximize Competition and Coverage

The Centers for Medicare & Medicaid Services (CMS) published its “2020 Medicare Advantage and Part D Advance Notice Part II and Draft Call Letter” outlining proposed changes to “modernize and maximize competition,” and  address the nation’s opioid crisis. The proposed changes will allow older adults and chronically ill individuals to choose plans that more closely align with their specific needs.

Among these changes, is the policy that builds on a rule that went into effect in January including coverage for transportation to medical appointments and home meal delivery. Part II of the notice includes that transportation for nonmedical needs could also be covered.

“CMS is committed to modernizing Medicare and our top priority is to ensure that seniors have more choices and affordable options in receiving their Medicare benefits,” said CMS Administrator, Seema Verma, in a statement. “Medicare Advantage enrollment is at an all-time high
as more and more seniors are choosing to enroll in private Medicare health and drug plans, and we need to maximize competition by providing plans the flexibility to meet patients’ needs.”

CMS stated in the release that it is “deeply concerned about the magnitude of the opioid epidemic and its impact on our communities, and is committed to a comprehensive and multipronged strategy to combat this public health emergency.” 

CMS will continue to monitor use of opioid pain medications through the overutilization monitoring system in 2019 that has already reduced high-risk overutilization of prescribed opioids in the Part D program. It also proposes additional policies for 2020 including: pain management and complementary and
integrative treatments in Medicare Advantage, access to opioid reversal agents, and measuring usage using the Star Ratings development process.

The notice builds upon Part I of the Advanced Notice that CMS released in December 2018. CMS is accepting comments on both proposals through March 1 before releasing the final Rate Announcement and Call Letter on April 1, 2019.  —Edan Stanley