Changes Medicare Beneficiaries May See Under the New Administration

​On January 19, 2021, the Centers for Medicaid and Medicaid Services (CMS) issued a final rule addressing Medicare Part C – Medicare Advantage Plans and Part D Prescription Programs. The rule is complex, but here are some of the provisions that are particularly relevant.

Medicare Advantage Plans and Prescription Programs
The rule codifies many of the agency’s marketing guidelines but has been criticized for blurring the line between educational events and marketing events held by insurers and managed care organizations. Under the new rule, plan sponsors can hold an event advertised as educational and immediately thereafter, solicit enrollees in their plans. The agency walked back prior guidelines that had required clear separation in time and venue between educational events and those that are meant to market specific plans.

The rule also codified a 2019 change eliminating the requirement that plan materials contain language informing non-English speakers of the availability of interpreters and translated plan documents.
The rule also allows Part D plans to offer a “preferred” tier for each of their plan offerings. The idea is to allow access to specialty drugs within the higher tier.

Changes We May See First Under the New Administration
It seems likely that the Biden administration will take aim at these new rules once new staff is in place and acclimated. The administration has already overturned one Trump-era policy change that sought to allow individuals to enroll in Social Security while opting out of Medicare Part A. Advocates have asked the Biden administration to quickly suspend or rescind the January 19 final rule such as:

• The “Geo” Demonstration Model and the Medicaid Managed Care Organization (MCO)-based Direct Contracting Entity Model
• Revisions to the Medicare Part D Model that weakens the protected drug classes guarantee
• Expansion of a program that limits access to home care for those with longer-term and chronic conditions

 
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This article is an abridged and edited version of one that originally appeared HERE.
Posted on February 22nd, 2021 | Authors : Shana Siegel