CMS Enhances Medicare Advantage Beneficiary Protections

• By: Maureen Carland
• On: 04/10/2024 15:55:56
• In: Quality/Regulatory

The  Centers for Medicare & Medicaid Services (CMS) unveiled the Contract Year (CY) 2025 Medicare Advantage and Part D Final Rule, solidifying revisions to policies governing Medicare Advantage (MA), Part D, Medicare Cost Plans, and the Program for All-Inclusive Care for the Elderly (PACE).

AHCA/NCAL effectively advocated for specific policies within the rule aimed at ensuring individuals enrolled in a MA plan have access to high-quality care and timely, medically necessary services. One of the highlights include:
Right to Fast Track Appeals of Non-Hospital MA Plan Decisions: Beneficiaries are granted the right to expedite appeals through Quality Improvement Organizations rather than the MA plan for terminated non-hospital services, regardless of timeliness or beneficiary status.
 
Additionally, CMS finalized several other proposals, including:
1. Advancement of Medicare-Medicaid integration policies
2. Expansion of access to behavioral health services
3. Transparency regarding supplemental benefits
4. Mid-year notification for unused supplemental benefits
5. Parameters on agent/broker compensation
6. Expansion of health equity requirements on MA utilization management committees
 
For further details, refer to the CMS fact sheet and the full final rule in the Federal Register. These regulations take effect on June 3, 2024, and are applicable to coverage beginning January 1, 2025.

Stakeholders are reminded of CMS's previously issued request for information on Medicare Advantage data, with the comment period closing on May 29, 2024. AHCA/NCAL intends to submit comments.

This final rule follows the release of the CY 2025 Medicare Advantage Rate Announcement earlier. CMS estimates a 3.7% increase ($16 billion) in MA plan revenues on average, despite reduced MA benchmark rates.  
 
Staff contact: mcarland@mehca.org