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Holy HSD Tables - Your Network Just Got Bigger

Updated: Jan 25, 2023

Today CMS announces further updates to 2021 plan year (and beyond) benefits. If you are intimately involved in your organization’s plan benefit package (PBP) and bid filing process, new plan implementation, or service area expansion, you may not have time to participate in that <virtual> Memorial Day barbeque!

Summary of changes and actions steps for consideration:

Enhanced Telehealth

Today’s rule encourages MA plans to increase their telehealth benefits and increase plan options for beneficiaries living in rural areas so beneficiaries can get care at home instead of traveling to a healthcare facility.

CMS is giving MA plans more flexibility to count telehealth providers in certain specialty areas (such as Dermatology, Psychiatry, Cardiology, Ophthalmology, Nephrology, Primary Care, Gynecology, Endocrinology, and Infectious Diseases) towards meeting CMS network adequacy standards.

This provides not only the opportunity to offer enhanced benefits but the availability to enhance your network (HSD tables) to supplement any known network gaps.

More Options for those with ESRD

Changes made by the 21st Century Cures Act gives all beneficiaries with ESRD the option to enroll in an MA plan starting in 2021. This should have been on the radar for many already. Ensuring appropriate benefit design and bid costs tied to this population will be key. In addition, revision of all applicable marketing material to account for these changes must occur beginning with the plan year 2021.

Stars – Changes are Coming

CMS is also finalizing proposals to enhance the MA and Part D Star Ratings system to further increase the impact that patient experience and access measures have on a plan’s overall Star Rating. to discuss this in detail.


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