CMS releases proposed Medicare Advantage rule: 5 things to know

CMS published a proposed rule Feb. 5 that seeks to lower drug costs for Medicare Advantage beneficiaries, boost payments for the plans and rework Star Ratings, among other proposals.

Five things to know.

1. The Contract Year 2021 and 2022 Medicare Advantage and Part D Proposed Rule seeks to raise payments to Medicare Advantage plans by less than 1 percent for 2021, compared to 2.53 percent this year.

2. For Star Ratings, CMS plans to increase the measure weights for patient experience and complaints, as well as access measures, from two to four for Medicare Advantage plans.

3. The rule would implement an amendment under the Social Security Act to allow Medicare-eligible individuals with end-stage renal disease to enroll in Medicare Advantage plans. That change would take effect Jan. 1, 2021.

4. CMS proposed to allow Part D plans to lower out-of-pocket spending for prescription drugs through several changes, including allowing Part D plans to create a second "preferred" specialty tier featuring lower cost-sharing than the current specialty tier for prescription drugs.

5. CMS said the proposed changes would save the federal government roughly $4.4 billion over 10 years, with most of the savings coming from proposals affecting quality Star Ratings. CMS is accepting comments on the proposal through March 6.

Access the fact sheet here.

More articles on payers:
10 largest health insurers
CMS to allow Medicaid funding caps: 5 things to know
22 payer exec moves in January

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Top 40 articles from the past 6 months