FMO Lawsuits Could Delay Agent and Broker Compensation Rules

With Medicare Advantage plan bids off to CMS for the 2025 plan year, MA organizations now turn their attention to arrangements with agents and brokers who will sell their plans this fall and the field marketing organizations (FMOs) that support them. But at least three complaints have been filed challenging CMS’s implementation of new provisions that will impact those relationships and take effect Oct. 1.

A central question raised in all three complaints is whether CMS exceeded its regulatory authority by abruptly setting a cap on administrative payments made to agents and brokers by MA organizations that have long been allowed in the MA program. Sources say a delay or additional clarifying guidance could result from at least two of the complaints, which were filed in a federal court with a history of striking down HHS regulations. CMS, meanwhile, is taking the stance that it is following Congress’ orders to ensure a level playing field among plans.

© 2024 MMIT
Lauren Flynn Kelly

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.

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