New Rule Boosts Medicare Access & Protection: Biden-Harris Move
TL/DR –
The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is finalizing policies that enhance protections for enrollees of Medicare Advantage and Medicare Part D prescription drug plans. The policies aim to increase competition, improve access to care, and guard against harmful marketing and prior authorization. Key measures include setting a limit on compensation for agents or brokers to avoid anti-competitive steering, requiring an expert in health equity on management committees of Medicare Advantage plans, evaluating network adequacy for outpatient behavioral health specialty types, finalizing new rules for supplemental benefits, and allowing Part D plans to substitute lower-cost biosimilars more quickly.
Final Rule Enhances Competition, Boosts Care Access, and Implements Enrollee Safety Measures
US Department of Health and Human Services (HHS) officially confirms the adoption of policies to bolster protections for Medicare Advantage and Medicare Part D enrollees. The Contract Year (CY) 2025 Medicare Advantage and Part D rule advances existing CMS protocols to stimulate competition, enhance care access, including essential behavioral health services, and safeguard individuals from improper marketing and prior authorization.
“Healthy competition within Medicare Advantage and Medicare Part D is key in offering consumers a variety of plan choices to fit their needs. Further consumer protections will facilitate smart decisions and hassle-free coverage”, states HHS Secretary Xavier Becerra. He underscores the Biden-Harris Administration’s commitment to bolstering competition in healthcare and reducing costs.
CMS continues to ensure that Medicare Advantage and Part D prescription drug plans remain robust, stable, and affordable. This latest rule reinforces consumer protections, allowing Medicare beneficiaries to confidently choose suitable coverage options,” says CMS Administrator Chiquita Brooks-LaSure.
In an effort to curb predatory marketing, CMS is taking notable steps to expand protections for Medicare Advantage and Part D programs. These include setting a compensation limit for agents and brokers to prevent anti-competitive steering and ensuring beneficiary data is not shared without express consent. These measures align with President Biden’s Executive Order on Promoting Competition in the American Economy.
The rule also mandates inclusion of a health equity expert on Medicare Advantage plan utilization management committees. This helps identify any disproportionate delays or denials of access to required care for enrollees with disabilities or limited income. The regulation additionally promotes access to behavioral health providers and services, ensuring essential mental health and substance use disorder treatments are available.
Moreover, the rule introduces new guardrails for certain supplemental benefits for chronically ill enrollees, ensuring they are evidence-supported and meet health needs. It also necessitates mid-year, personalized communication about accessing unused benefits, ensuring taxpayer investments are utilized effectively.
Greater flexibility for Part D plans to substitute cost-effective biosimilars for their reference products is also finalized, promoting quicker access to affordable drug treatment options.
“This final rule reinforces our commitment to improving access to care and addressing predatory marketing, enhancing the Medicare program and the lives of those we serve.”, asserts Dr. Meena Seshamani, CMS Deputy Administrator.
The final rule fact sheet can be found at cms.gov/newsroom. CMS also invites the public to submit comments to the Medicare Advantage Data Request for Information (RFI) by May 29, 2024. View the RFI on the Federal Register’s webpage at federalregister.gov.
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