(April 19, 2024) – On April 4, the Centers for Medicare & Medicaid Services released its final Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, Programs of All-Inclusive Care for the Elderly and Health Information Technology Standards for contract year calendar year 2025 (CMS-4205-F). The final rule includes a series of changes intended to strengthen beneficiary protections, promote access to behavioral health care providers, advance equity in coverage and improve supplemental benefits in the MA program.
Specifically, the rule finalizes requirements that:
- Strengthen network adequacy standards for certain behavioral health provider types.
- Streamline the appeals process for enrollees if the MA plan terminates coverage for certain post-acute care services.
- Lay the groundwork for increasing data collection and reporting from Part C and D plans.
- Annually review MA utilization management policies for health equity considerations.
- Provide new guardrails for plan compensation to agents and brokers to prevent undue influence on beneficiary enrollment decisions.
- Ensure that MA plans offer appropriate supplemental benefits.
- Simplify enrollment for individuals dually eligible for Medicare and Medicaid.
- Standardize the appeals process for MA Risk Adjustment Data Validation audit findings.
- Limit out-of-network patient cost sharing for certain plans serving dually eligible enrollees.
- Give Part D plans more flexibility to substitute biosimilars for reference drug products.
For any questions, please contact Shannan Flach at (785) 233-7436.
--Shannan Flach