What’s happening: A summary of the finalized changes to Medicare Advantage (MA) and Part D programs for contract year 2025 is now available.
What else to know: The regulation is effective June 3.
The members-only summary, from Health Policy Alternatives, Inc., details the finalized changes, including:
- Streamlining the appeals process for enrollees if their MA plan terminates coverage for certain post-acute care services
- Standardizing the appeals process for MA risk adjustment data validation audit findings
- Limiting out-of-network patient cost-sharing for certain plans serving dually eligible enrollees
- Giving Part D plans more flexibility to substitute biosimilars for reference drug products
Additional details are available in a Centers for Medicare & Medicaid Services fact sheet.
