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The Centers for Medicare & Medicaid Services yesterday released a that would increase oversight of Medicare Advantage plans and better align them with traditional Medicare, address access gaps in behavioral health services and further streamline prior authorization processes, supplementing a  last week. The rule also would provide specific protections to ensure post-acute care services that would be covered by traditional Medicare cannot be denied by an MA plan or inappropriately redirected to a lower level of care. In addition, the rule would tighten MA marketing rules to protect beneficiaries from misleading advertisements and pressure tactics; expand requirements for MA plans to provide culturally and linguistically appropriate services; make changes to MA star ratings to address social determinants of health; and implement Inflation Reduction Act provisions to make prescription drugs more affordable for eligible low-income individuals. 

In a statement shared with the media today, Ashley Thompson, AHA senior vice president of public policy analysis and development, said, “The AHA commends CMS for taking important steps to increase oversight of Medicare Advantage plans to help ensure enrollees have equal access to medically necessary health care services that are supposed to be covered. The AHA has previously raised concerns about the negative effects of certain Medicare Advantage practices and policies that have the potential to directly harm patients through unnecessary care delays or outright denial of covered services. CMS’ proposed rule includes helpful provisions to ensure more consistency between Medicare Advantage and traditional Medicare by curtailing overly restrictive policies that can impede access to care and add cost and burden to the health care system. We also applaud CMS’ attention to access gaps in behavioral health services. The AHA will continue to carefully review the proposed rule and support efforts to improve the Medicare Advantage program for patients and their providers.”

AHA members will receive a Special Bulletin soon with more on the rule’s provisions.