Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

Special Report: Recent Changes in Law, Regulations and Guidance Relating to Medicare Advantage and the Prescription Drug Benefit Program

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September 2018

Numerous changes were made to Medicare law, regulations and guidance during the first half of 2018.The changes are particularly noteworthy regarding Part C, governing private Medicare plans, known as Medicare Advantage (MA), and Part D, the prescription drug benefit.This report focuses on the impact to Medicare beneficiaries from changes to Parts C and D pursuant to the Bipartisan Budget Act of 2018 (BBA), a final rule issued on Parts C and D (CMS-4182-F), and the Final Call Letter for 2019.[1]

While the BBA made a number of significant changes to Medicare beyond Parts C and D, those changes are not generally discussed here.[2]  Instead, this report highlights many of the changes to MA and Part D most relevant to Medicare beneficiaries and those supporting or assisting them.  Part I of the report provides a summary of these changes, along with relevant citations, and is organized by changes to MA, Part D and changes that impact both programs.  Part II of the report considers the potential impact of some of these changes, particularly with respect to MA benefits, consumer decision-making and informed choice, and the impact of the changes on the traditional Medicare program.

Outline

  1. Summary of Changes
    1. Part C
      BBA of 2018
      C & D Rule and Call letter
    2. Part D
      BBA of 2018
      C & D Rule
    3. Part C & D
  2. Discussion
    1. Introduction
    2. MA v. Traditional Medicare
      1. Tipping the scales
      2. Steering in CMS materials
    3. MA Changes – Laissez Faire Oversight and Education
    4. Consumer Decision-Making
  3. Conclusion

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[1] The Bipartisan Budget Act of 2018 (BBA) was signed into law on February 9, 2018 (Public Law No. 115-123) see Division E – Health & Human Services Extenders; the bill is available here.  The final rule for Parts C & D (CMS-4182-F) was published on April 16, 2018 – entitled “Medicare Program; Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program”, 82 Fed Reg 16440 (April 16, 2018), is available here (also see this Centers for Medicare & Medicaid Services (CMS) press release summarizing the rule here).  The Final Call Letter, which is sub-regulatory guidance, was released on April 2, 2018, formally known as the Announcement of Calendar Year (CY) 2019 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter, is available here; also see CMS press releases discussing the Call Letter here and here.  Note that some of the descriptions of changes in law and rules are taken directly from summaries provided by CMS.
[2] For an overview of the Center’s analysis of the BBA of 2018, see “Center for Medicare Advocacy Statement on the Health Extenders in the Budget Agreement”, February 9, 2018, at: https://www.medicareadvocacy.org/statement-on-the-health-extenders-in-the-budget-agreement/.