This document provides a detailed summary of the final rule containing policy and technical changes to Medicare Advantage and other programs for 2020 and 2021.
Medicare Advantage for Years 2020 and 2021 Final Rule Summary
On April 5, 2019, the Centers for Medicare & Medicaid Services (CMS) of the Department of Health and Human Services (HHS) placed on public display a final rule providing for policy and technical changes to Medicare Advantage (MA), Part D prescription drug plans, PACE and Medicaid for 2020 and 2021. The rule, set to be published in the Federal Register on April 16, 2019, implements certain provisions of the Bipartisan Budget Act of 2018 (BBA 2018, P.L. 115- 119), including expanding the ability of MA plans to provide additional telehealth services as a basic benefit, and revising the appeals and grievances requirements and better integrating standards for enrollees in Dual Eligible Special Needs Plans (D-SNPs). In addition, it makes changes to methodologies and other updates to the Part C and D Star Ratings for 2022 and 2023 and makes several revisions and additions to the preclusion list provisions finalized in the April 2018 MA/PD final rule.
The final rule does not address provisions of the proposed rule involving the MA Risk Adjustment Data Validation (RADV) program. These include CMS’ intent to use extrapolation to estimate contract-level improper payments and several proposed methodological changes. Because CMS later extended the comment period for those RADV provisions until April 30, 2019 (83 FR 66661), CMS intends to address those changes in later rulemaking.