New CMS Regulation Proposes Another Set of Plan-Friendly Tweaks to Medicare Advantage

On February 5, the Centers for Medicare and Medicaid Services (CMS) proposed several interesting tweaks to the Medicare Advantage (MA) and Medicare Part D programs through an 895-page proposed regulation, Contract Year 2021 and 2022 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicaid Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly.

some of the most important new policies and program changes proposed in the new regulation, focusing particularly on benefits (social determinants of health, medical loss ratio and prescription drug benefits) and the use of telehealth to meet network adequacy.

Additional Proposed Changes and Analysis of the Rule

The proposed regulation, which arrives three months later than originally forecasted, also codifies numerous policies that have existed only via guidance memos and CMS’s annual Call Letter to MA and Part D plans. The regulation includes other important provisions that we do not cover above, including provisions related to:

• Giving MA and Part D plans additional tools and requirements for combatting the opioid crisis.
• Adding transparency to pharmacy network performance requirements.
• Bringing Medicare beneficiaries with end-stage renal disease (ESRD) into the MA program.
• Amending the Quality Rating System (star measures).
• Sunsetting so-called “D-SNP Look-alike” plans in order to facilitate greater care integration for Medicare-Medicaid dual eligibles.

Source: https://www.jdsupra.com/legalnews/new-cms-regulation-proposes-another-set-41876/