CMS releases proposed rule for 2025 Medicare Advantage, prescription drug plans

The Centers for Medicare & Medicaid Services Nov. 6 proposed changes to the Medicare Advantage and prescription drug programs for contract year 2025 intended to improve access to behavioral health care; ensure that agents and brokers enroll individuals in the best plan for their needs and that MA plans offer appropriate supplemental benefits; streamline enrollment for individuals dually eligible for Medicare and Medicaid; and annually review MA utilization management policies for health equity considerations.

Among other changes, the proposed rule would streamline the appeals process for enrollees if their MA plan terminates coverage for certain post-acute care services; standardize the appeals process for MA Risk Adjustment Data Validation audit findings; limit out-of-network patient cost-sharing for certain plans serving dually eligible enrollees; and give Part D plans more flexibility to substitute biosimilars for reference drug products.

For more on the rule, see the CMS fact sheet. AHA members will receive a Special Bulletin with further details from the proposed rule.