Lexology January 16, 2024
Medicare Advantage Proposed Rule for 2025
The United States Centers for Medicare & Medicaid Services (“CMS”) has proposed new rulemaking (88 FR 78476) to revise the Medicare Advantage (Part C) (“MA”) regulations for 2025. CMS is proposing new health equity requirements for prior authorization policies and procedures to aid in the disproportionate access to care for underserved populations. The key proposals include:
- requiring MA plans to include a health equity expert on their utilization management committees;
- the utilization management committees would be required to conduct an annual analysis of the plans’ prior authorization policies and procedures to survey the insureds’ social risk factors, such as eligibility for Part D low-income subsidies, dual eligibility for Medicare and Medicaid, or having...
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