MA, Part D Rule Contains Many Highlights for Health Plans

In lieu of a draft Call Letter attached to its annual rate notice for the coming year (see story, above), CMS on Feb. 5 issued a 900-page proposed rule containing a slew of non-rate-related changes to the Medicare Advantage and Part D programs for contract years 2021 and 2022. While that rule (85 Fed. Reg. 9002, Feb. 18, 2020) seeks to codify numerous policy changes that were already made via statute and subregulatory guidance — including CMS’s expanded definition of “primarily health related” supplemental benefits and the entry of patients with end-stage renal disease (ESRD) into the MA program starting on Jan. 1, 2021 — it also features new and noteworthy proposals such as flexibility around network adequacy and medical loss ratio calculations, industry experts tell AIS Health.

“There are not game-changers in this regulation, but there are another series of program tweaks that are, in total, pretty helpful to MAOs,” observes Michael Adelberg, a principal with Faegre Drinker Consulting and a former top CMS MA official.

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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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