Flurry of Medicare Advantage and Part D Changes Includes Significant Policy Shifts

These articles are why I’m a firm believer everyone should have a personal health insurance agent, as opposed to just signing up online or over the phone. There seems to be  changes every year, that it’s even difficult for an agent to keep up let alone the general public. Are you turning 65 in the near future and want to prepare before you make a decision on your Medicare options. Contact me for a no obligation consultation.– Dave Obregon

Summary

Last week, CMS released new regulations and guidance for Medicare Advantage Organizations (MAOs) and Part D Sponsors.  These documents—along with the Bipartisan Budget Act of 2018 that was passed in January—reflect significant policy and operational changes for the MA and Part D programs. The policy shifts affect supplemental benefit offerings, targeted benefits for certain populations, the Quality Star Ratings program, the MA risk adjustment model, physician incentive plan rules, medical loss ratio requirements, any willing pharmacy standards, and efforts to address opioid overutilization.

In Depth

Last week, the Centers for Medicare & Medicaid Services (CMS) released not one but two documents with significant policy and operational implications for Medicare Advantage Organizations (MAOs) and Part D Sponsors: a final regulation (Final Rule) stemming from a proposed rule issued in November 2017 and the Calendar Year (CY) 2019 Announcement and Final Call Letter (Final Call Letter). These documents—along with the Bipartisan Budget Act of 2018 (BBA) that was passed in January—implement significant changes to the Medicare Advantage (MA) and Part D programs.

In particular, MAOs are gaining greater flexibility to design targeted benefits and offer new types of benefits to members. MAOs and Part D Sponsors will also enjoy somewhat diminished administrative burdens under the new rules. Other significant policy shifts affect the Quality Star Ratings program, the MA risk adjustment model, physician incentive plan (PIP) rules, and medical loss ratio (MLR) requirements.

With respect to the Part D program specifically, CMS has issued new clarifications of the federal any willing pharmacy (AWP) standard and finalized new requirements for Part D Sponsors to address opioid . (Click here)

Leave a Reply

Your email address will not be published. Required fields are marked *