(Dec. 20, 2024) – On Nov. 27, the Centers for Medicare & Medicaid Services released the contract year 2026 Medicare Advantage and Part D Policy and technical changes proposed rule. The proposed rule increases oversight and improves accountability of Medicare Advantage plans while also improving protections of Medicare beneficiaries.
KHA has prepared a summary of the significant provisions that can be viewed here. Key highlights of the proposed rule include:
- Permit coverage of anti-obesity medications in the Medicare and Medicaid programs.
- Fortify existing limitations on insurer use of internal coverage criteria and requirements for MA plans to provide coverage for all reasonable and necessary Medicare Part A and B benefits.
- Update MA and Part D plan medical loss ratio reporting requirements to improve oversight.
- Require MA plans to make provider directory information more widely available through the Medicare Plan Finder tool.
- Improve transparency through increased oversight of agent and broker materials and marketing from MA plans.
- Limit enrollee cost sharing for behavioral health services to an amount that is no greater than Traditional Medicare.
- Apply additional guardrails of insurer use of artificial intelligence to ensure it does not result in inequitable treatment or access to care.
--Jaron Caffrey