The Centers for Medicare & Medicaid Services (CMS) has finalized changes to Medicare Advantage (MA) and Part D programs for contract year 2024. The final rule is effective June 5.
In the final rule, CMS:
- Streamlines prior authorization processes
- Ensures that MA beneficiaries have access to the same benefits and services as patients with traditional Medicare
- Improves access to behavioral health, including codifying appointment wait time standards for both primary care and behavioral health services as well as making clinical psychologists and licensed clinical social workers eligible for a 10-percentage point telehealth credit
- Increases oversight of MA plans, tightens MA marketing rules, and establishes health plan utilization management oversight
- Makes changes to the MA star ratings to advance health equity
Of note, CMS did not finalize its proposal to amend existing regulations regarding the standard for identifying overpayments for Medicare Parts A, B, C, and D.
Additional details are available in a CMS fact sheet. CHA will provide a summary of the final rule in the coming weeks.