CMS Announces Medicare Advantage and Part D Proposed Rule for 2023
The proposed rule would revise the MA and Part D regulations
By: Catie Hillard
March 2, 2022 – The Centers for Medicare and Medicaid Services (CMS) released the Contract Year 2023 Medicare Advantage and Part D proposed rule. The proposed rule would lower out-of-pocket prescription drugs costs for Medicare Part D and improve consumer protections. It would also improve health equity in Medicare Advantage (MA).
This is significant as over 27 million beneficiaries are enrolled in Medicare Advantage plans, and an increasing number of enrollees utilize Part D prescription drug coverage. Some MA enrollees are also enrolled in Medicaid. Approximately 3.7 million dually eligible beneficiaries receive Medicare services through dual-eligible special needs plans (D-SNPs).
The proposed rule would touch on everything from marketing and communications to medical loss ratio reporting, and regulations for D-SNPs.
Proposed Medicare Advantage and Part D Changes
The proposed rule would have a big impact on Medicare Advantage and Part D. These changes include:
- Lowering Beneficiary Cost-Sharing at the Pharmacy Counter: Requiring Part D plans to apply all price concessions they receive at the point of sale.
- Marketing and Communications Oversight: Designed to protect Medicare beneficiaries by ensuring that they get accurate coverage information.
- Beneficiary Access to Care During Disasters and Emergencies: Ensure beneficiaries have uninterrupted access to needed services during disasters and emergencies.
- Greater Transparency in Medical Loss Ratio (MLR) Reporting: Reinstating MLR reporting requirements.
- 2023 Part C Star Ratings Calculations for Certain Measures Given Impacts of the COVID-19 Public Health Emergency (PHE): Technical change proposed that would allow CMS to calculate 2023 Star Ratings for various measures.
Proposed Changes for D-SNPs
CMS is also putting an increased emphasis on D-SNPs in the proposed rule. There are several proposed changes that address D-SNPs, including:
- Enrollee Input on D-SNP Operations: Proposing that all D-SNPs establish and maintain enrollee advisory committees and consult with them on health equity-related issues.
- Social Determinants of Health and Special Needs Plan Health Risk Assessments: Simplifies the appeals and grievance process for D-SNPs.
- New Pathways to Simplify D-SNP Enrollee Materials: A proposed mechanism that allows states to require specific D-SNPs to use integrated materials to make the full scope of Medicare and Medicaid benefits available through these plans.
- New Pathways to Have Star Ratings Specific to the Performance of the Local D-SNP: Creating a new pathway to allow states with integrated care programs to easily identify disparities between D-SNPs and other MA plans.
- Maximum Out-of-Pocket Policy for Dually Eligible Beneficiaries: Proposing a maximum out-of-pocket (MOOP) limit in an MA plan that is calculated based on the accrual of all Medicare cost-sharing in the plan benefit.
- Technical and Definitional Updates for FIDE SNPs and HIDE SNPs: Proposal to require in 2025 and beyond, that all fully integrated dual eligible special needs plans (FIDE SNPs) have exclusively aligned enrollment, and that all Medicaid home health and behavioral health services be covered.
For more information or to see the proposed rule, click here.
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