CMS Issues New Policies To Provide Greater Transparency For Medicare Advantage And Part D Plans

CMS ISSUES NEW POLICIES TO PROVIDE GREATER TRANSPARENCY FOR MEDICARE ADVANTAGE AND PART D PLANS

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CMS ISSUES NEW POLICIES TO PROVIDE GREATER TRANSPARENCY FOR MEDICARE ADVANTAGE AND PART D PLANS

The Centres for Medicare and Medicaid Services (CMS) are coming up with new policies to bring reforms in the healthcare industry. It is heralded as the final rule which aims at providing improved and better transparency for Medicare Advantage and Part D plans.

The new policies of the 2023 Medicare Advantage and Part D plans Final Rule push for affordable healthcare by reducing out-of-pocket charges for prescription drugs. However, that advantage will be in effect from 2024.

What Does The New CMS Policy Do? The Biden – Harris administration has been committed to offering healthcare for all with quality and affordable care packages and this Final Rule is the extension of that. In fact, different areas have been worked on in the new CMS policy.

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CMS ISSUES NEW POLICIES TO PROVIDE GREATER TRANSPARENCY FOR MEDICARE ADVANTAGE AND PART D PLANS

Some of CMS Policies are:  Price Negotiation  Uninterrupted Service  Marketing Standards Revised  New Standards For Application  Medical Loss Ratio Reporting  HEDIS  Improved Coordination Between CMS & State  Annual MA Assessment

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CMS ISSUES NEW POLICIES TO PROVIDE GREATER TRANSPARENCY FOR MEDICARE ADVANTAGE AND PART D PLANS

Why Do The New Policy Changes Matter?

CMS released the new rule on the day the Office of Inspector General released an unflattering report on prior authorization denials by Medicare Advantage. The report stated that there had been a constant denial of payment for services that met the coverage rules of Medicare and the MAO billing.

As part of the process now, the government with the new rule wants to have a detailed understanding and report on where MA plans are using the government money.

Therefore, the rules are re-established for better transparency and improved support that can be given to the social determinants of health.

It is believed that many dually eligible individuals are at much higher risk of failing to have the security of housing, food, access to transportation, and health literacy. In addition, since the work of CMS is fiscal stewardship, it needs to know where the Medicare money is used and on which Medicare Advantage benefits.

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