What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for contract year 2026 that would increase oversight of Medicare Advantage (MA) plans.
What else to know: The rule includes additional proposed changes to the prior authorization process and guardrails for artificial intelligence use.
Under the proposed rule, CMS would:
- Fortify existing limitations on insurer use of internal coverage criteria
- Update MA plan reporting requirements regarding the medical loss ratio (MLR) to address concerns about the vertical integration of insurers
- Require MA plans to make provider directory information widely available through the Medicare Plan Finder tool
- Enable Part D and MA plan coverage of anti-obesity medications for individuals diagnosed with obesity
Additional details are available in a CMS fact sheet. Comments on the proposed rule are due to CMS by Jan. 27, 2025. CHA will provide a members-only summary in the coming weeks.
