CMS Proposed Changes to Medicare Advantage and Part D

 Friday, February 7, 2020

CMS this week released a proposed rule to the Medicare Advantage (MA) and Part D programs that would implement various provisions of the SUPPORT Act and 21st Century Cures Act. Included in the proposal for MA plans:

  • Revisions to the MA medical loss ratio methodology;
  • An update to the MA network adequacy standards that would incentivize MA plans to contract with certain telehealth providers and expand access to MA plans in counties where network development can be challenging, such as rural areas;
  • A codification of the MA network adequacy methodology and standards.

Part D changes include:

    • A mandate to Drug Management Programs (DMPs);
    • Modification of the definition of opioid-at-risk Part D beneficiaries for inclusion in DMPs;
    • Requirement for plans to include a beneficiary real-time benefit tool.

Comments on the proposed rule will be accepted through Apr. 6.

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