CMS Proposes New Rule for Medicare Advantage Programs

Andrew Bell

Senior Manager

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On Thursday, January 6, 2022, the Centers for Medicare and Medicaid Services (CMS) issued their annual proposed rule, aimed at informing health plans and stakeholders of potential changes to the Medicare Advantage and Part D programs. Many of the underlying proposed changes are aimed at improving health equity in the programs. These proposals, if adopted, will impact health plans, the DSNP product, marketing and communications to members, network adequacy, and many other key facets of health plan operations.

A few of the significant changes proposed by CMS are outlined below.

  1. Network Adequacy Requirements
    1. CMS is proposing that plan applicants must demonstrate they have a sufficient network of contracted providers prior to agency approval of an application for a new or expanded MA plan
  • Marketing Oversight and Communication Enhancements
    • CMS is seeking to increase oversight of third-party marketing organizations to identify and prevent potential deceptive marketing tactics, particularly around enrollment of members
    • CMS is also proposing the reinstatement of a multi-language insert in specified materials to inform beneficiaries of the availability of free language and translation services
  • D-SNP Plan Operational Enhancement
    • CMS is proposing that all D-SNP plans establish and maintain at least one enrollee advisory committee in order to hear from the members in order to improve health equity
    • Special Needs Plans, under the following proposed changes, would also be required to add to the current Health Risk Assessment (HRA) questions regarding a member's housing stability, food security, and access to transportation status
  • Enhanced Transparency in Medical Loss Ratio (MLR) Reporting
    • The proposal would reinstate MLR reporting requirements that were already in effect from 2014-2017
  • Star Rating Calculation Adjustment (HOS Measure Inclusion)
    • The adjustment would make the calculation for three HOS measures (Improving Bladder Control, Monitoring Physical Activity, and Reducing the Risk of Falling) possible until PHE guidance

In summary, CMS continues to highlight and emphasize the importance of Health Equity in its latest proposed ruling through tightening marketing and communication guidelines to alterations in DSNP plan operations. The potential regulatory changes would once again signal to health plans that a robust and thoughtful health equity strategy is no longer nice to have, but a must.