CMS Final Rule Impacting Medicare Part C, Part D and Health Information Technology Requirements
Recorded Webinar | Rachel V. Rose | All Days
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On April 4, 2024, CMS issued a Final Rule, which among other items, revises the Medicare Advantage Program, Medicare Prescription Drug Benefit Program (Medicare Part D), Medicare Cost Plan Program, Programs of All-Inclusive Care for the Elderly (PACE), and Health Information Technology Standards and Implementation Specifications, as well as focusing on access to types of care, anticompetitive conduct, and third-party marketing of patient data. The focus on Part C also aligns with DOJ’s priority areas of enforcement, as well as the FTC’s focus on anticompetitive violations of antitrust laws. The purpose of this webinar is to provide an overview of the key areas and tips for mitigating the risk of non-compliance.
These changes empower consumers with more choices and affordable care, while improving the quality of care for enrollees and promoting fair competition among Medicare Advantage plans. New protections against unfair marketing practices ensure enrollees are recommended plans that best suit their needs, not plans agents are financially incentivized for. Increased transparency of supplemental benefits allows enrollees to maximize their plans offerings through mid-year notifications detailing available benefits and access methods. Improved access to behavioral health care comes with new network adequacy standards, guaranteeing a wider range of providers for Medicare Advantage enrollees. More affordable prescription drugs are on the horizon thanks to the Inflation Reduction Act, capping annual out-of-pocket costs for Part D enrollees at $2,000 starting in 2025. Additionally, Part D sponsors will have more flexibility to substitute lower-cost biosimilar medications for expensive brand names. Dually eligible individuals, those receiving both Medicare and Medicaid, will benefit from a number of provisions designed to enhance their experience. These include increased access to integrated care plans and protections against out-of-network cost-sharing for specific services. Overall, these changes significantly improve the Medicare Advantage and Part D programs for beneficiaries. By increasing consumer choice, improving access to care, and promoting fair competition, CMS empowers Medicare enrollees to make informed decisions about their healthcare.
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