With the emergence of the COVID-19 public health emergency, the centers for Medicare and Medicaid Services (CMS) have released a final rule to help deliver more transparency regarding Medicare Advantage (MA) and Part D prescription drug programs. In doing so, CMS can further their commitment to increasing accessibility to affordable, high quality healthcare for individuals with Medicare and Medicaid. This rule establishes updated policies for MA and Part D programs that will go into effect on January 1, 2023.
Since the Medicare and Medicaid programs function separately, millions of Americans that are enrolled in both programs receive care with many gaps in it. For this reason, these dual eligible beneficiaries often experience multiple social and health difficulties including having trouble securing housing, transportation, food, among many other challenges. With the final rule in place, the Biden-Harris Administration aims to eliminate the gaps between Medicare and Medicaid by ensuring that enrollees receive a more seamless, coordinated, and holistic care that puts them first. This means considering the individual needs and preferences of each enrollee. To help achieve this, the rule requires all MA special needs plans to carry out assessments of social risk factors for plan members. By pinpointing the needs of each enrollee, the plans can determine what kind of person-centered care needs to be provided.
Furthermore, the rule enhances coordination between states and CMS as they cater to dual eligible beneficiaries. CMS wants to establish a system in which states can make it mandatory that dual eligible special needs plans use cohesive materials. That way dual eligible individuals can know their benefits in their entirety and with ease.
To further back the Biden-Harris Administration’s objective of increasing affordable access to healthcare for all, CMS’ final rule promotes the advancement of consumer protections and decreased costs for Medicare Part D beneficiaries. More specifically, Part D plan enrollees should see lower out of pocket costs for prescription drugs beginning in 2024. As for MA plan enrollees, the final rule lays down new measures to guarantee them continuous access to essential services throughout times of emergency, such as the coronavirus outbreak.
An additional key point highlighted in the final rule is the expansion of marketing and communication oversight. First, CMS is restoring the previous requirement that MA and Part D policies notify enrollees of their available option to use interpreter services at no cost. Second, all required plan documents that are given to enrollees must be offered in multiple languages. Third, special needs plans will be more clearly defined so that beneficiaries can better differentiate what their available options are. When deciding on which Medicare coverage they’d like to receive, these beneficiaries have various options that can be confusing. Thus, making it easier to distinguish the plans can allow beneficiaries to make a more confident decision when selecting their coverage. Lastly, CMS will be urging plans to play a larger role in the detection and prevention of using outside organizations to develop deceptive marketing tactics.
This rule is also restoring and expanding certain reporting requirements that allow further insight and transparency into MA and Part D plans. This involves costs, profits, and additional benefits that will help beneficiaries and taxpayers. The Director of the Center for Medicare, Dr. Meena Seshamani, stated, “As responsible stewards of the program, this rule enables us to learn more about how the Medicare dollar is being spent on certain Medicare Advantage benefits, such as housing, food, and transportation assistance, in order to better understand how we can most effectively support the health and social needs of people with Medicare.”
As a final point, the rule will strengthen CMS’ responsibility over managing oversight of the Medicare program by capping MA and Part D plans’ ability to enter new contracts if they are demonstrating weak performance. Additionally, CMS is revising application standards and management of MA applicants’ network of providers. That way CMS can make certain that enrollees will obtain access to a quality provider network prior to approving an MA contract.
With these new and updated policies, CMS hopes to provide Medicare coverage information that is clear and easily attainable by its beneficiaries. Moreover, it is anticipated that millions of Americans will find that a quality health care experience is well within reach.
To access the final rule fact sheet, click here. You can also download the final rule from the Federal Register by clicking here.
Need help with Medicare? Lets Talk! 770-452-9335 or schedule a phone or video appointment HERE!