CMS Proposes Increased Consumer Protections, Access to Behavioral Health in New MA Rule

On Monday, the Centers for Medicare and Medicaid Services (CMS) proposed a new rule that would impose tighter regulations on Medicare Advantage insurers. The rule covers some hotly debated issues including prior authorization, supplemental benefits and marketing.

President Joe Biden announced last year that his administration would focus on consumer protections in healthcare, especially related to the high volume of MA-related advertising experienced by seniors. The Biden administration has also put significant pressure on MA insurers for overuse of risk adjustments and upcoding to increase reimbursements from the Medicare program.

The proposed rule takes these efforts a step further, by restricting health insurance company payments to brokers to a $632 cap per enrollment beginning in 2025. According to STAT News, CMS also proposed banning volume-based bonuses, where the real leverage for aggressive brokerage lies. Larger plans can offer brokers extra referral payments and additional incentives, which then steers larger volumes of beneficiaries away from more local, smaller options.

CMS also proposed changes that would take steps to close gaps in behavioral healthcare accessibility and bolster transparency for marginalized beneficiaries. Modern Healthcare notes that the agency included proposals for mandating public reporting of prior authorization’s harm for disabled beneficiaries and requiring that networks include behavioral healthcare including mental health counselors and addiction medicine clinicians.

Inside Health Policy also reports that the proposed rule would require plans to prove that their special supplemental benefits for the chronically ill would improve beneficiaries’ wellbeing and would update marketing requirements to cut down on misleading marketing. It would also add the new Outpatient Behavioral Health facility-specialty type to the list of specialties.

In response to the slew of proposals, the Better Medicare Alliance, which represents MA insurance plans, released a statement from CEO and President Mary Beth Donahue:

Better Medicare Alliance appreciates CMS’ continued efforts to help beneficiaries make the best choice for their health care needs and the agency’s continued focus on advancing health equity and improving access to care. BMA supports efforts to increase transparency and access for Medicare Advantage beneficiaries. As we review the proposed rule, we value CMS’ efforts to address these vital issues while preserving seniors’ choice and access to high quality, affordable care.

In a CMS press release, CMS Administrator Chiquita Brooks-LaSure continued to support efforts to protect beneficiaries:

People with Medicare deserve to have accurate and unbiased information when they make important decisions about their health coverage. Today’s proposals further our efforts to curb predatory marketing and inappropriate steering that distorts healthy competition among plans.