Earlier this month, the Centers for Medicare and Medicaid Services (CMS) released their annual Medicare Advantage (MA) and Part D Proposed Rule for 2025 (fact sheet) which governs requirements for MA and Part D plans. Among its provisions, the proposed rule promotes enrollment in aligned Dual Eligible Special Needs Plans (D-SNPs), includes additional flexibility in development of Part D formularies, requires additional outreach on supplemental benefits, institutes new network adequacy requirements for behavioral health providers, institutes new guardrails for agents and brokers, requires an annual health equity analysis of Utilization Management policies, and revises certain appeals processes. Comments on the rule are due January 5, 2024.
For a detailed summary of the proposed rule, read Healthsperien’s comprehensive section-by-section analysis here.