CMS Proposes New Rules to Enhance Fairness for Medicare Advantage Beneficiaries
Proposed rule will help people with Medicare select and enroll in coverage options that best meet their health care needs by preventing plans from engaging in anti-competitive activity
By: Catie Hillard
November 15, 2023 – In a significant move to safeguard the interests of Medicare Advantage beneficiaries, CMS has announced proposed changes for 2025. The Contract Year 2025 Policy and Technical Changes to the Medicare Advantage Program proposed rule aims to curb anti-competitive practices and enhance behavioral healthcare access.
Central to these proposals is a new framework for compensating agents and brokers who guide beneficiaries in selecting appropriate Medicare Advantage plans. Historically, these professionals received variable payments depending on the plan chosen, which sometimes led to beneficiaries being steered towards plans that benefit agents more than the beneficiaries themselves.
CMS has put forth a proposal to standardize agent and broker compensation. A nationwide fixed compensation rate of $632 is set, regardless of the plan selected by the beneficiary. This initiative is designed to level the playing field, ensuring that agent guidance is driven by the health needs of beneficiaries rather than potential financial gains.
CMS’s proposed rule also targets marketing strategies that may influence beneficiary choices. The rule seeks to eliminate contractual arrangements that incentivize enrollment in certain plans through volume-based bonuses, a move aimed at fostering healthy competition among plans.
Chiquita Brooks-LaSure, CMS Administrator, stressed the importance of these changes, stating in a press release that, “CMS continues to improve the Medicare Advantage and Part D prescription drug programs and maintain high-quality health care coverage choices for all Medicare enrollees. People with Medicare deserve to have accurate and unbiased information when they make important decisions about their health coverage. Today’s proposals further our efforts to curb predatory marketing and inappropriate steering that distorts healthy competition among plans.”
Additionally, the CMS proposed rule focuses on improving access to behavioral healthcare services for Medicare Advantage beneficiaries. Under the new rule, a category named Outpatient Behavioral Health would be introduced, encompassing various mental health service providers, including addiction medicine physicians and opioid treatment programs. This move is in line with previous regulations that have recognized marriage and family therapists and mental health counselors as Medicare benefit categories.
The proposal also mandates that Medicare Advantage plans must actively inform beneficiaries about the supplemental benefits available to them, particularly those that cater to the needs of the chronically ill.
These proposed changes by CMS represent a significant stride towards ensuring that Medicare Advantage beneficiaries receive unbiased advice, fair compensation structures for agents and brokers, and enhanced access to vital behavioral health services. These reforms promise to create a more equitable and efficient healthcare system for all Medicare enrollees.
The full text of the proposed rule is available by clicking here.
The VBP Blog is a comprehensive resource for all things related to value-based payments. Up-to-date news, informative webinars, and relevant blogs in the VBP sphere to help your organization find success.