CMS released its proposed rule for Medicare Advantage and Part D plans for the 2019 benefit year.
Here are six things to know.
1. CMS estimated its proposed changes could save Medicare $195 million from 2019 to 2023.
2. The agency proposed changing the methodology for Medicare Advantage and Part D Star Ratings. The updates would change to how Star Ratings measures are calculated and weighted. CMS uses the ratings to determine quality bonus payments for plans.
3. Under current law, Medicare Advantage organizations and Part D sponsors must report their medical loss ratios. An MLR is the percentage of premium revenue a payer spends on medical care for its members, as opposed to overhead costs and other expenses. Plans can incur penalties for failing to maintain an MLR of at least 85 percent. In its proposed rule, CMS aims to "significantly" reduce the amount of MLR information plans submit to CMS annually. In addition, CMS is proposing MLR calculations include expenses related to fraud prevention, detection and recovery activities. In other words, more can be included in what plans spend on medical services, and possibly increase payers' profits.
4. The agency proposed allowing Part D sponsors to electronically provide certain beneficiary documents, such as evidence of coverage. Additionally, CMS is updating the electronic prescribing standard for the Part D e-Prescribing Program, replacing a prior version from 2013.
5. CMS' proposal would also implement the Comprehensive Addiction and Recovery Act of 2016. Under CARA, CMS said it must establish rules allowing Medicare Part D sponsors to voluntarily implement a drug management program limiting "at-risk" beneficiaries' access to substances deemed "frequently abused drugs." This would start with the 2019 plan year.
6. CMS is accepting comments on its proposed rule until Jan. 16, 2018. The proposals will be published in the Federal Register Nov. 28.
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