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.

Related News Articles

Headline
The AHA Oct. 3 responded to the Medicare Payment Advisory Commission’s recent analysis on the financial impacts of Medicare Advantage enrollment growth on…
Perspective
Public
“Trust but verify” is a phrase often associated with President Reagan and the need to ensure that treaties enacted with the Soviet Union were being upheld.…
Headline
The Centers for Medicare & Medicaid Services Sept. 30 issued a memo, through the Health Plan Management system, finalizing the Medicare Advantage…
Headline
The AHA Sept. 29 sent recommendations to the Department of Health and Human Services and the Centers for Medicare & Medicaid Services to help ensure…
Headline
The Centers for Medicare & Medicaid Services announced Sept. 26 that average premiums for Medicare Advantage and Part D would decline slightly in 2026.…
Headline
The AHA expressed support Sept. 22 to House and Senate sponsors of the Medicare Advantage Prompt Pay Act (H.R. 5454/S. 2879), legislation that would apply a…