CMS Releases Medicare Advantage and Medicare Prescription Drug Benefit Program Proposed Rule | Heart Rhythm Society

CMS Releases Medicare Advantage and Medicare Prescription Drug Benefit Program Proposed Rule

On November 6th, the Centers for Medicare & Medicaid Services (CMS) released its Contract Year 2025 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs proposed rule, which would revise the Medicare Advantage (Part C), Medicare Prescription Drug Benefit (Part D), Medicare cost plan, and Programs of All-Inclusive Care for the Elderly (PACE) regulations to implement changes related to Star Ratings, marketing and communications, agent/broker compensation, health equity, dual eligible special needs plans (DSNPs), utilization management, network adequacy, and other programmatic areas.

Regulatory Updates

This proposed rule also includes proposals to codify existing sub-regulatory guidance in the Part C and Part D programs.

Of particular interest is CMS’ proposal to require that beginning January 1, 2025, Medicare Advantage plan Utilization Management (UM) committees must include at least one member with expertise in health equity, that the committee must conduct an annual health equity analysis of the use of prior authorization using specific metrics, and that the report is approved by the member of the UM committee that is an expert on health equity and posted publicly on the plan’s website. CMS will accept comments on multiple aspects of these proposals until January 5, 2024.