LeadingAge submitted comments Feb. 13 on CMS’s proposed rule governing how Medicare Advantage, Special Needs Plans, Part D and PACE programs will operate in CY2024 offering support for many of CMS’s proposed rules and suggestions for further refinement.
While the comments cover a wide swath of topics, as did the proposed rule, the majority of the LeadingAge comments honed in on members’ pain points – how MA plans make coverage determinations for traditional Medicare Part A & B services and prior authorizations.
CMS’s intent is to clarify that plans must cover traditional Medicare benefits under the same coverage criteria that is used in Medicare fee-for-service. It also seeks to limit how prior authorizations are used – – medical necessity and diagnoses confirmations — and limit the number of times these approvals must be sought. LeadingAge supports these two key objectives as well as many other provisions within the proposed rules including new guardrails on MA plan marketing behaviors.
LeadingAge also offered a number of recommendations on how CMS might further refine its proposals to ensure its goals around equitable access to care are met. Many of the recommendations directly address concerns raised by members, including suggestions that CMS:
Clarify that both the services and the duration of the service for Skilled Nursing Facility and Home Health services must be covered by MA plans, and plans cannot terminate services for “lack of progress/improvement”.
Standardize the prior authorization form for traditional Medicare A & B services since all plans must follow the same requirements.
Ensure that approved prior authorizations cover “course of treatment” and that definition clearly also applies to SNF and HH services.
Enhance enforcement of these provisions through the additional of a Confidential Provider Complaint Line on MA and by including MA plan complaint information on Medicare’s plan finder page for each plan listed.
Require MA plans provide a detailed explanation of non-coverage determinations.
Seek additional ways to reduce administrative burden on providers and to simplify the appeals process for beneficiaries.
While not directly addressed in the rule, we also highlighted the importance of safe discharges and noted MA plans should share some accountability. The proposed rule also contained a number of proposals related to the Program of All Inclusive Care for the Elderly (PACE) program. LeadingAge PACE comments urged CMS to balance the imposition of additional regulatory burden with ongoing flexibility for providers, while keeping participant wishes at the center of service provision.
To review all comments in the LeadingAge comment letter, click here.