Your round up of RDS program changes, CMS announcements and other significant industry news.

Medicare Part D Premiums in 2021

On July 29th 2020, the Centers for Medicare & Medicaid Services (CMS) announced the average basic premium for Medicare Part D prescription drug plans, which cover prescription drugs that beneficiaries pick up at a pharmacy.

The average basic Part D premium will be approximately $30.50 in 2021.The 2021 and 2020 average basic premiums are the second lowest and lowest, respectively, average basic premiums in Part D since 2013. This trend of lower Part D premiums, which have decreased by 12 percent since 2017, means that beneficiaries have saved nearly $1.9 billion in premium costs over that time. Further, Part D continues to be an extremely popular program, with enrollment increasing by 16.7 percent since 2017.

CMS has taken steps to modernize the Part D program by providing beneficiaries the opportunity to choose among plans with greater negotiating tools that have been developed in the private market and by providing patients with more transparency on drug prices. Improvements to the Medicare Part D program that CMS has made to date include:

Benefit Tools. As of 2021 Part D plans will be required to provide more information on out-of-pocket costs for prescription drugs to beneficiaries. This will be in the form of a real-time benefit tool provided to clinicians with information they can discuss with patients regarding out-of pocket costs at the time the prescription is written.

Clause Prevention. Implementation of Part D Legislation to prohibit "gag clauses" which prevent pharmacist from telling patients about lower-cost alternatives for obtaining their prescriptions.

Documentation. Beginning 2021, the Explanation of Benefits document that Part D beneficiaries receive monthly will be required to include information on drug price increases and lower-cost theraputic alternatives.

Innovative Medicines. A reduction in the maximum amount that low-income beneficiaries pay for specific innovative medicines, also known as "biosimilars". This will lower the out-of-pocket cost of these medications for the beneficiaries.

For a complete list of improvements being made to the Medicare Part D program

CLICK HERE.

CMS Updates Medicare Payment Policies for Several Types of Healthcare Providers

The Centers for Medicare & Medicaid Services (CMS) is finalizing three Medicare payment rules that further advance efforts to strengthen the Medicare program. Their goal is to better align payments for inpatient psychiatric facilities, skilled nursing facilities, and hospices.

Inpatient Psychiatric Facilities

CMS is finalizing a 2.2 percent payment rate update and finalizing its proposal to adopt revised Office of Management and Budget statistical area delineations resulting in wage index values being more representative of the actual costs of labor in a given area. This will allow advanced practice providers to operate within the scope of practice allowed by state law by documenting progress notes in the medical record of patients.

Skilled Nursing Facilities

Updates include routine technical rate-setting updates to payment rates, as well as finalizes adoption of the most recent statistical area delineations and applies a 5 percent cap on wage index decreases from FY 2020 to FY 2021. CMS projects aggregate payments to Skileld Nursing Facilities will increase by $750 million, or 2.2 percent, for FY 2021 compared to FY 2020.

Hospices

Hospice payment rates are updated by the market basket percentage increase of 2.4 percent ($540 million). Hospices that fail to meet quality reporting requirements receive a 2 percentage point reduction to the annual market basket percentage increase for the year. The hospice payment system includes a statutory aggregate cap. The aggregate cap limits the overall payments made to a hospice annually.

Additional Ways PDA Can Help Reduce Healthcare Costs

For most of you, this is going to be a very different-looking open enrollment and renewal period. Once you have all your members enrolled for benefits for the upcoming year, the prudent thing to do is to verify that everyone truly belongs on the plan.

We have services that can help you keep track of health plan eligibility, while saving healthcare dollars in smart and renewable ways. We’re experts in finding ways to get rid of unnecessary healthcare expenditures so you can preserve benefits for your members.

To discuss our savings-guaranteed process for verifying your dependents, Contact Us via email using this link or call us at 734-548-8287.

Upcoming RDS Deadlines

Reconciliations

(plan year end | recon. due date)

05/2019 | 08/31/2020

06/2019 | 09/31/2020

07/2019 | 10/02/2020

Applications

(plan year start | app. due date)

12/01/2020 | 09/01/2020

01/01/2020 | 10/02/2020

02/01/2020 | 11/02/2020