Radar on Medicare Advantage

As states face intense budget pressures during the COVID-19 pandemic and beneficiary advocates urge the federal government to provide additional financial support to state Medicaid programs, extending postpartum care access would resolve a longstanding issue impacting children and families and close a significant gap in coverage during the pandemic and beyond, according to advocates and providers.

Roughly 700 women die each year due to pregnancy-related complications, and about 60% of cases are preventable, according to the Centers for Disease Control and Prevention (CDC). The CDC also estimates that more than 44,000 pregnant women have become infected with the coronavirus this year, resulting in an estimated 8,500 hospitalizations. Medicaid is the largest payer of maternity care in the U.S., yet current law does not require state Medicaid programs to cover women for more than 60 days after childbirth, and states must seek waiver approval to use federal matching funds to extend coverage.

Preliminary observations from several Medicare Advantage marketing experts indicate that during the 2021 Medicare Annual Election Period (AEP), consumers were slow to make enrollment decisions early on, and switching may not have been at the levels witnessed in recent years. At the same time, social distancing precautions during the COVID-19 pandemic led to significant traffic in the digital space, possibly signaling a permanent shift in how Medicare consumers shop for coverage.

Cavulus, a technology firm that serves the MA industry, in early November noticed a “slower start to AEP due to the ongoing pandemic and [MA] marketing efforts coinciding with substantial presidential campaign advertising,” says Patrick Phillips, the firm’s CEO. In a Nov. 5 press release, the company observed that while call centers were busy, most callers were asking clarification-type questions about potential changes to their existing insurer’s offerings, and said it expected comparative shopping among competing insurers to ramp up as the AEP neared its end.

With a recent emergency use authorization (EUA) granted to the first COVID-19 vaccine and another one expected at press time, states and the federal government this week began rolling out the vaccine to health care workers across the country. While health plans, particularly those that serve high-risk individuals such as dual-eligible Medicare-Medicaid beneficiaries, may be ideally situated to coordinate care and update members on vaccination opportunities, there are gaps in the current delivery system that could negatively impact the success of the rollout, one expert warns. And with many older adults not included in the first phase, it may fall to Medicare Advantage plans to ensure that seniors are informed about when and how to access the vaccine.

The FDA on Dec. 11 authorized emergency use of the COVID-19 vaccine made by Pfizer Inc. and BioNTech in individuals age 16 and older. And following an advisory panel’s Dec. 15 confirmation of the efficacy and safety of Moderna’s coronavirus vaccine, an EUA for that vaccine is imminent. HHS Secretary Alex Azar has said the federal government, which will cover the costs of the vaccine and its administration for Medicare enrollees, is aiming to have 100 million people vaccinated by the first quarter of 2021 with the two recommended doses. Meanwhile, news reports indicate two more vaccines could be authorized by the end of February, including one that would require only one dose.

✦ As part of the Trump administration’s recent flurry of health care rulemaking, CMS on Dec. 1 issued a final rule updating payment policies under the Physician Fee Schedule, including the permanent expansion of certain telehealth services in Medicare. During a call with reporters, CMS Administrator Seema Verma said nine out of 144 services that were temporarily added during the COVID-19 public health emergency will become a permanent part of the Medicare telehealth benefit, and another 59 services will be extended temporarily after the end of the PHE, allowing CMS to evaluate their impact on quality of care. Verma noted that without congressional action, these changes apply only to rural beneficiaries. Meanwhile, CMS said it is commissioning a study of the telehealth flexibilities it provided during COVID-19 to “explore new opportunities for services where telehealth and virtual care supervision, and remote monitoring can be used to more efficiently bring care to patients and to enhance program integrity, whether they are being treated in the hospital or at home.” View the rule at https://go.cms.gov/3obwdUo.

✦ The Trump administration on Nov. 20 issued two final rules aimed at advancing value-based care and improving care coordination in the private health care and Medicare markets. The CMS final rule, “Modernizing and Clarifying the Physician Self-Referral Regulations,” establishes new exceptions to the Stark Law regulations for value-based arrangements. Meanwhile, a final rule from the HHS Office of Inspector General (OIG) amends the safe harbors to the federal Anti-Kickback Statute by adding new safe harbors and modifying existing safe harbors that protect certain payment practices and business arrangements from AKS sanctions. The rule also codifies an exception to the civil monetary penalty rules to “remove potential barriers to more effective coordination and management of patient care and delivery of value-based care.” Each rule takes effect on Jan. 19, 2021. View the CMS rule at https://bit.ly/2KPqDc0 and the OIG rule at https://bit.ly/3oigSSh.