News: CMS issues proposed rule to revise policy for Medicare Advantage Program and others

On November 6, 2023, CMS issued a proposed rule that would revise the Medicare Advantage Program (MA), Medicare Prescription Drug Benefit Program (Part D), Medicare Cost Plan Program, Programs of All-Inclusive Care for the Elderly, and Health Information Technology Standards and Implementation Specifications. In the fact sheet released with the proposed rule, CMS stated that the proposed policies and changes will promote access to behavioral healthcare providers, promote equity in coverage, and improve supplemental benefits.

Among other changes, CMS is proposing to improve access to behavioral health care services for MA plan enrollees by proposing updates to network adequacy standards, including adding a range of behavioral health providers under a category called “Outpatient Behavioral Health” as a facility-specialty, which CMS would set MA plan network adequacy standards for.

CMS also proposes new requirements for MA plans, including that they should demonstrate that special supplemental benefits for the chronically ill meet the legal threshold of having a reasonable expectation of improving the health or overall function of chronically ill enrollees and are supported by research.

CMS is also proposing to redefine Medicare Advantage plan “compensation” in order to address loopholes and set a fixed amount that agents and brokers can be paid, in an effort to stop anti-competitive steering incentives for Medicare beneficiaries who rely on them to navigate complex Medicare choices.

“The proposed policies build on existing Biden-Harris policies to strengthen beneficiary protections and guardrails to promote healthy competition and ensure Medicare Advantage plans best meet the needs of beneficiaries,” CMS stated in the proposed rule fact sheet.

Editor’s note: To read CMS’s proposed rule, click here. To read the fact sheet, click here.