On February 18, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule entitled Medicare and Medicaid Programs; Contract Year 2021 and 2022 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicaid Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (CMS-4190-P).
The proposed rule touches on a range of issues relating to the Medicare Advantage (MA) and Part D prescription drug programs, including an effort to put into regulation, or codify, sub-regulatory rules and guidance previously issued by CMS. On April 6, 2020, the Center for Medicare Advocacy submitted comments to the proposed rule. The Center’s comments included:
- General support for a proposal that would limit Dual-Eligible Special Needs Plans (D-SNP) “look-alikes,” but called for more strict enforcement measures;
- General support for proposals to update MA and Part D quality rating measures;
- Opposition to creating a new Part D specialty tier for high cost drugs;
- Opposition to proposals to allow MA plans to alter and increase cost-sharing for certain services based upon variable out-of-pocket limits;
- Opposition to proposals to weaken MA plan network adequacy requirements;
- Opposition to codifying MA and Part D marketing guidelines without adding back in consumer protections that were removed in 2019;
- General support for codifying special enrollment periods (SEPs), but called for specifically referencing Medicare Plan Finder errors and a call for new SEPs.
The Center for Medicare Advocacy’s full comments are available here.