12 ways Medicare Parts C and D are changing
CMS is issuing new regulations to MA and Part D plans that might impact your clients. Read more to prepare yourself to confidently tackle the changes.
To better regulate and improve coverage for Medicare Advantage and Part D recipients, CMS has adopted a final rule to implement changes to their policies. These changes will impact applicants, enrollees, providers, and plans through 12 major revisions:
1. Enrollee participation in plan governance. To offer protection to enrollees, and ensure plans are offering their best to the beneficiaries they serve, managed care plans are to hold advisory committee meetings to receive feedback that can improve access to and quality of care.1
2. Standardizing housing, food insecurity, and transportation questions on health risk assessments. To determine if special needs plans are adequately supporting individual recipients in attaining their best outcome, assessments of their social, physical, and functional health and risk factors will be conducted to improve plan coverage. 1
3. Redefining definitions for fully integrated and highly integrated D-SNPs. Establishing new definitions of differing D-SNPs will offer beneficiaries a simplified enrollment process. 1
4. Additional opportunities for integration through state Medicaid agency contracts. Defining new ways states use contracts will help beneficiaries better comprehend the coverage they’re eligible for and receiving.1
5. Attainment of the maximum out-of-pocket limit. Placing a limit on what Medicare Advantage plans demand enrollees contribute to their cost-sharing will promote treatment of enrollees who might be a higher cost to the plan, increasing payment for providers treating these beneficiaries.1
6. Special requirements during a disaster or emergency for Medicare Advantage plans. Beneficiaries experiencing disasters or emergencies will have ensured access to covered services in the duration of the period and not lose access to care.1
7. Amend MA network adequacy rules by requiring a compliant network at application. When enrollees in expanded service areas are required to meet standards for network adequacy at1. the time of application, it helps CMS evaluate the suitability of a network’s providers delivering care to beneficiaries.1
8. Part C and Part D quality rating system. With the exceptional circumstances of COVID-19, changes to 2022’s methodology for Star Ratings were initiated, allowing quality ratings for Medicare Advantage contracts to be calculated.1
9. Past performance methodology to better hold plans accountable for violating CMS rules. In addition to net worth and sanctions, new criteria such as bankruptcy, compliance actions, and Star Ratings are being used as part of the methodology that determines whether an organization can expand or establish new contracts.1
10. Marketing and communications requirements on MA and Part D plans to assist their enrollees. To counter recent complaints submitted by enrollees and stakeholders regarding third-party marketing organizations, this provision will require that these plans provide materials in multiple languages and offer translation services, ensuring better access to needed assistance and care.1
11. Greater transparency in medical loss ratio reporting. More transparency and regulation of the details and types of information included in these reports will allow for more reliable consideration of the quality of service, effects of rule changes, and the accuracy of medical loss ratio reports.1
12. Pharmacy price concessions to drug prices at the point of sale. Any discounts or subsidies from the Part D sponsor for the Part D plan must be taken into consideration when calculating the point-of-sale prices of prescription drugs.1
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