CMS releases proposed rule on MA and Medicare Part D 

The Centers for Medicare & Medicaid Services today proposed changes to the Medicare Advantage and Medicare Part D programs, including implementing various provisions of the SUPPORT Act and 21st Century Cures Act. With regard to MA plans, CMS proposes changes to the medical loss ratio methodology by broadening the definition of incurred claims. In addition, CMS proposes to update the MA network adequacy standards to 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. Specifically, CMS proposes to allow MA plans to receive a 10% credit toward the percentage of beneficiaries residing within published time and distance standards when they contract with certain telehealth providers and reduce the required percentage of beneficiaries residing within maximum time and distance standards in certain county types (Micro, Rural, and Counties with Extreme Access Considerations). CMS also proposes to codify the MA network adequacy methodology and standards. For Part D plans, CMS proposes to mandate Drug Management Programs, modify the definition of opioid-at-risk Part D beneficiaries for inclusion in DMPs, and require Part D plans to implement a beneficiary real-time benefit tool. Comments on the rule are due to the agency by April 6.