On April 4, the Centers for Medicare & Medicaid Services (CMS) released their Contract Year (CY) 2025 Medicare Advantage and Medicare Part D Policy and Technical Changes final rule. The AAMC had previously submitted comments in response to the proposed rule [refer to Washington Highlights, Jan. 12]. The rule finalizes an array of policies related to Medicare Advantage (MA) and Part D plans.
The CMS finalized their proposals to expand network adequacy standards in MA plans for mental and behavioral health by establishing new facility-specialty provider category, Outpatient Behavioral Health, that will include a range of behavioral health providers under one category for determining network adequacy. Additionally, the agency finalized several policies to reduce misleading marketing and advertising tactics from MA plans, including capping agent/broker compensation to a set amount and updating marketing requirements for special supplemental benefits for the chronically ill to prevent misleading practices that make it appear these the benefits are available to everyone.
Plans will also now be required to send beneficiaries a midyear notice regarding any supplemental benefits in their plan that they have not used. Utilization management committee requirements were also expanded to require at least one member of the committee have expertise in health equity and additionally will require an annual health equity analysis be conducted on the use of prior authorization and made publicly available. The CMS also finalized proposals to increase Dual Eligible Special Needs Plan (D-SNP) enrollment flexibilities and reduce lookalike plans that would limit the number of D-SNP plans offered by MA organizations. Lastly, the agency finalized their proposals related to biosimilar biological product maintenance changes and the timing of substitutions to allow more flexibility for Part D plan sponsors.
- Washington Highlights