(Dec. 6, 2024) – The Centers for Medicare & Medicaid Services released a proposed rule to "hold Medicare Advantage and Part D plans more accountable for delivering high-quality coverage so that people with Medicare are connected to the care they need when they need it."
CMS proposes to permit coverage of anti-obesity medications and enhance Medicare Advantage prior authorization and utilization management guardrails. The proposed guardrails include the following:
- Refining the definition of internal coverage criteria
- Changing the reopening rules to eliminate the discretion of a Medicare Advantage organization to reopen an approved authorization for an inpatient hospital admission
- Using artificial intelligence
- Requiring Medicare Advantage organizations to make a provider directory available to CMS for inclusion in the Medicare Plan Finder online tool
- Ensuring equitable access to behavioral health benefits
CMS will accept comments about the proposed rule until 4 p.m., Monday, Jan. 27, 2025.
CMS Finalizes New Model to Improve Access to Kidney Transplants
The Centers for Medicare & Medicaid Services released a final rule establishing a new, six-year mandatory model to increase access to kidney transplants while improving the quality of care for people seeking kidney transplants.
The Increasing Organ Transplant Access Model participants will now have a financial incentive to perform more transplants. Participating transplant hospitals will be encouraged to identify their underserved populations and address gaps in care for donors and transplant recipients.
MLN Connects Provider eNews Available
The Centers for Medicare & Medicaid Services issued the following updates to MLN Connects Provider eNews: