Follows changes made to 2024 Medicare advantage (MA) program, see rule #168925.
Proposal Overview
The rule would revise Medicare Advantage (Part C), Medicare Prescription Drug Benefit (Part D), Medicare cost plan, and Programs of All-Inclusive Care for the Elderly (PACE).
Would implement changes related to Star Ratings, marketing and communications, agent/broker compensation, health equity, dual eligible special needs plans (D–SNPs).
Includes number of policies that would improve these programs beginning with 2025.
Also proposals to codify existing sub-regulatory guidance in Part C, Part D program.
Proposes changes to utilization management, network adequacy, other program areas.
Additionally, would implement certain sections of laws related to the Parts C and D, including Bipartisan budget act (BBA) and Consolidated appropriations act (CAA).
Network Adequacy
Proposes regulatory changes that would improve access to behavioral health care by adding certain behavioral health specialties to MA network adequacy standards.
Specifically, propose to add a new facility-specialty type, outpatient behavioral health, to existing list of facility-specialty types evaluated as part of network adequacy reviews
Supplemental Benefits Notification
Proposes requiring MA plans to notify enrollees mid-year of supplemental benefits.
Would list supplemental benefits not utilized during the first 6 months of the year.
Currently not required to send any communication specific to supplemental benefits usage which could be an important part of a plan's overall care coordination efforts.
Aims to educate enrollees on access to supplemental benefits to encourage greater utilization of benefits and ensure MA plans are better stewards of the rebate dollars.
Agent Compensation
Proposing to generally prohibit contract terms between MA organizations and agents, brokers that may interfere with agent's/broker's ability to objectively recommend plans
Also to set a single compensation rate for all plans, eliminate regulatory framework which currently allows for separate payment to agents and brokers for admin services.
Consultation
Comments must be received no later than Jan. 5, 2024.
Planned Effectiveness
Revisions to risk adjustment data would also take effect 60 days after a final rule.
New marketing and communications policies in this rule are proposed to be applicable for all contract year 2025 marketing and communications, beginning Sep. 30, 2024.
Limited number of provisions are proposed to be applicable from Jan. 1, 2026.
Apr. 4, 2024 CMS Final Rule
On Apr. 4, 2024, CMS issued final rule and fact sheet on Medicare Advantage, Part D.
Key provisions include new guardrails for plan compensation to agents and brokers.
Limits distribution of personal beneficiary data by third-party marketing organizations.
Improves access to behavioral health care providers; annual health equity analysis of utilization management; rights to appeal coverage termination; among other changes.
Apr. 23, 2024 CMS Fed Reg Final Rule
On Apr. 23, 2024, CMS published final rule in federal register, effective Jun. 3, 2024.
