The Medicare Rights Center recently submitted comments in response to proposed rule changes from the Centers for Medicare & Medicaid Services (CMS) pertaining to Medicare Parts C and D for 2020 and 2021. Many of the proposed rules implement changes that Congress made to the law that establishes Duals Special Needs Plans (D-SNPs). D-SNPs are special plans designed to serve the needs of people who are eligible for both Medicare and Medicaid, also known as “dual eligibles.”

In the course of reauthorizing the existence of this type of specialized plan as part of the Bipartisan Budget Act of 2018, Congress made some changes to the plan requirements—mandating that they better combine Medicare and Medicaid benefits, improve fiscal responsibility, and streamline appeals processes. CMS’ proposed rule goes into more detail about how plans will meet those requirements.

Drawing on our experience working with helpline callers who are enrolled in D-SNPs across the country—as well as our work with the special plans for dually eligible individuals created under New York State’s demonstration program, Fully Integrated Dual Advantage (FIDA) plans—Medicare Rights submitted comments urging CMS to require a high level of functional integration.

In our experience, D-SNPs that do not have a robust understanding of their enrollees’ Medicaid rights, benefits, and the systems they need to navigate and access those benefits do not adequately serve their dual-eligible enrollees. We encourage CMS to establish uniform integrated appeals processes in collaboration with State Medicaid authorities and to ensure that, from the beneficiary perspective, there is seamless coordination of benefits provided under each program.

The proposed rule would also expand the telehealth benefits that Medicare Advantage (MA) plans may offer as supplemental benefits. While Medicare Rights generally supports the broadening of the telehealth options for supplemental benefits, such as for oral health care, we encourage CMS to work to ensure parity for Original Medicare so that all people with Medicare have the opportunity to access these services. In implementing this expanded coverage, CMS should also ensure robust consumer protections are in place, and require plans to demonstrate how they intend to address inequalities in access to the internet and devices so that telehealth benefits are available to all their members.

CMS is also proposing to streamline electronic communication between MA and Part D Plans and prescribers about formulary restrictions before the point-of-sale. Important improvements to the way that CMS determines the risk adjustment that is made to MA plan payments are also included. We support these changes, which are needed to ensure plans and providers are paid appropriately, and to protect program integrity.

Read more about the rule here.

Read our comments.