New rules proposed by CMS take aim at improving the adequacy of provider networks and giving individuals dually eligible for Medicare and Medicaid more choices among Medicare Advantage plans.
Under the proposal, beginning Jan. 1, 2023, plan sponsors would have to prove that their network is adequate enough to provide care for beneficiaries before CMS signs off on expanded or new MA plans.1 CMS will provide MA sponsors with information about network adequacy before applying to help speed and streamline bid submissions.1,2 Plans would be allowed a 10-percentage-point credit “toward the percentage of beneficiaries residing within published time and distance standards for new or expanding service area applicants” to account for the challenge of building out networks almost a year in advance, according to a CMS fact sheet.1 Plans would need to be fully compliant once the coverage year begins.1
MA plans would also have to provide more information on medical-loss ratio calculations and report their spending on supplemental benefits such as vision and dental under the proposed rules.1 “Our proposal would require MA organizations and Part D sponsors to report the underlying cost and revenue information needed to calculate and verify the MLR percentage and remittance amount,” the CMS said in the fact sheet.1
Plans’ performance on dual-eligibles would also be better detailed in Star Ratings under the rules, in an effort to facilitate comparison shopping.1 The proposed rules “would help to easily identify disparities between [dual-eligible special needs plans] and other MA plans and help CMS and states better drive quality improvement for dually eligible beneficiaries.”1
The proposal comes at a time when more dual-eligibles are interested – and enrolling – in MA plans. An analysis commissioned by the Better Medicare Alliance found that dual-eligibles make up 23% of the entire MA population, and a greater number of them select MA plans, compared with Medicare beneficiaries who aren’t dually eligible.3
Plans can better serve dual-eligibles – and get ready for a continued influx of these enrollees – by preparing for the proposed rules and ensuring that their offerings are comprehensive enough to stand out to prospective members.
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References
- CY 2023 Medicare Advantage and Part D Proposed Rule (CMS-4192-P). CMS. Jan. 6, 2022. https://www.cms.gov/newsroom/fact-sheets/cy-2023-medicare-advantage-and-part-d-proposed-rule-cms-4192-p
- King, Robert. CMS proposes Part D price concessions be applied at point-of-sale, new requirements for MA plans. Fierce Healthcare. Jan 6, 2022. https://www.fiercehealthcare.com/payer/cms-proposes-part-d-price-concessions-be-applied-at-point-sale-new-requirements-for-ma-plans
- ATI Advisory for the Better Medicare Alliance. Dual Eligible Beneficiaries Receive Better Access to Care and Cost Protections When Enrolled in Medicare Advantage. Better Medicare Alliance. December 2021. https://bettermedicarealliance.org/wp-content/uploads/2021/12/BMA-Q4-Brief-2021.pdf
