CMS will implement new risk adjustment payment rates, prior authorization requirements and network standards for Medicare Advantage plans in 2024.
Here are five changes coming to the program in 2024:
- CMS will begin phasing-in risk adjustment payment changes in 2024. The agency will phase in the rate changes, which payers have said amount to funding cuts, over three years. CMS Medicare Advantage plans will see an average payment increase of 3.32 percent between 2023 and 2024.
- MA plans will have new prior authorization requirements to comply with in 2024. In its 2024 final rule, CMS said coordinated care plan prior authorization policies may only be used to confirm the presence of diagnoses or other medical criteria and to ensure a service is fully necessary.
- Beginning in 2024, plans cannot impose any prior authorization requirements for any ongoing treatments during the first 90 days a member is enrolled in a plan.
- Medicare Advantage plans will be required to establish a utilization management committee to review policies annually and ensure policies are in line with traditional Medicare's requirements.
- CMS will impose more requirements on MA plans' behavioral health networks in 2024, including requiring plans to have clinical psychologists and licensed clinical social workers in-network and codifying wait time standards for behavioral health services.
CMS also implemented new standards for Medicare Advantage marketing in 2023, which applied to advertising for any plans offering coverage in 2024. The new standards prohibit advertising that does not mention a specific plan and using the Medicare logo or language in ways that are misleading or confusing.
The agency also implemented new auditing standards for Medicare Advantage plans this year, which took effect in April. The rules are currently being challenged in court.