News Briefs

✦ CMS will bar several Medicare Advantage Prescription Drug (MA-PD) plans from enrolling new beneficiaries for 2022 because they did not meet minimum medical loss ratio (MLR) requirements. According to a series of notices posted to the CMS Enforcement Actions page, CMS issued enrollment suspensions to the following organizations: MMM Healthcare, LLC, Triple-S Advantage, Inc., UnitedHealthcare of Arkansas, Inc., UnitedHealthcare of the Midwest, Inc., and UnitedHealthcare of New Mexico, Inc. Because the plans failed to meet the 85% MLR threshold for their Part D contracts for three consecutive years, they will be removed from the list of MA-PD plans during the upcoming Annual Election Period, CMS said.

✦ CMS is seeking to repeal a Trump-era rule that would have given national Medicare coverage for four years to a “breakthrough” device as soon as it receives FDA approval. The agency on Sept. 13 issued a Notice of Proposed Rulemaking (NPRM) that proposes to fully repeal the Medicare Coverage of Innovative Technology (MCIT) and Definition of “Reasonable and Necessary” final rule (86 Fed. Reg. 2987, Jan. 14, 2021). CMS said it is seeking comment on the proposed repeal and its plan to “conduct future rulemaking to explore an expedited coverage pathway for innovative technologies (balanced with evidence development to ensure beneficial health outcomes for beneficiaries) and a regulatory definition of the Reasonable and Necessary standard for Medicare coverage.” AdvaMed, the global trade association representing medical technology manufacturers, issued a statement calling the move the “wrong decision for countless Medicare patients” and “the wrong decision for American medical innovation.”

© 2021 MMIT

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues, including drug benefits and specialty pharmacy, for more than a decade. She served as editor of Drug Benefit News (the predecessor to Radar on Drug Benefits) from 2004 to 2005 and again from 2011 to 2016, and now manages Radar on Medicare Advantage. Lauren graduated from Vassar College with a B.A. in English.

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