Press ReleasesBLOG POST: CMS final rule aims at boosting transparency, outcomes in MA plans

As part of an effort to improve transparency and optimize patient care, CMS recently finalized a proposed rule creating a number of new requirements that Medicare Advantage plans must meet.

The final rule, which will take effect in the 2023 coverage year, ensures that MA plan enrollees have continuous access to essential services during public health emergencies, like the COVID-19 pandemic, and disasters.¹ CMS will also move to limit MA plans’ ability to sign new contracts or expand existing ones until they show their network of contracted health care providers is capable of meeting enrollees’ needs.^1,2 Under the rule, contract applications or expansions will be also denied if plans have Star Ratings lower than 2.5, have entered bankruptcy, or are filing for bankruptcy.²

CMS will also reinstate and expand requirements for medical loss ratio reporting on supplemental benefits, such as food, housing and transportation, under MA plans to improve transparency.¹ “As responsible stewards of the program, this rule enables us to learn more about how the Medicare dollar is being spent on certain Medicare Advantage benefits,” said Dr. Meena Seshamani, CMS deputy administrator and director of the Center for Medicare.¹

Other highlights of the final rule include:

• Eliminating a loophole for MA enrollees who are dually eligible for Medicaid and whose medical costs are greater than the maximum out-of-pocket limit set forth by the MA plan in order to increase payments to providers that serve dual-eligibles¹
• Requiring MA special needs plans to assess social risk factors for enrollees to help deliver more tailored care to them, combat social determinants of health and potentially improve outcomes.^1,2

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^References

1. News release. CMS Issues New Policies to Provide Greater Transparency for Medicare Advantage and Part D Plans. April 29, 2022. Centers for Medicare & Medicaid Services. https://www.cms.gov/newsroom/press-releases/cms-issues-new-policies-provide-greater-transparency-medicare-advantage-and-part-d-plans
2. Morse, Susan. CMS final rule tightens Medicare Advantage and Part D transparency. Healthcare Finance. April 29, 2022. https://www.healthcarefinancenews.com/news/cms-final-rule-tightens-medicare-advantage-and-part-d-transparency