As noted in this December 2022 CMA Alert, CMS released a proposed rule for Medicare Advantage and Part D for 2024 available here (87 Fed Register 79452, December 27, 2022). CMS also published a press release and accompanying fact sheet addressing the proposed rule. Comments were due on February 13, 2023. The Center for Medicare Advocacy submitted comments, which are available here.
As the Center noted in the introduction to our comments, “[w]e commend CMS for demonstrating, through this rule, a renewed interest in strengthening consumer protections and providing increased oversight of Medicare Advantage (MA) and Part D plans. After many years of regulatory neglect of the MA program, we applaud the proposals in this rule, particularly concerning MA prior authorization and marketing issues.”
If finalized, the provisions in the proposed rule will significantly improve consumer protections in a number of areas, including:
- Medicare Advantage Prior Authorization – among other changes, the rule would prohibit MA plans from denying coverage of a Medicare-covered item or service based on internal, proprietary, or external criteria not found in traditional Medicare coverage policies;
- Marketing of Medicare Advantage and Part D Plans – among other changes, the rule aims to crack down on misleading advertising, enhance requirements that agents and brokers explain coverage options, and better protect consumers from unwanted contact; and
- Enhance Access to Behavioral Health Services in MA Plans.
February 16, 2023 – D. Lipschutz