November 26, 2024 Washington, DC — Statement from Katie Smith Sloan, president and CEO, LeadingAge, the association of nonprofit providers of aging services on the Contract Year (CY) 2026 MA and Part D proposed rule (CMS-4208-P) released today: 

“LeadingAge is committed to ensuring Medicare Advantage (MA) enrollees’ access to timely, necessary care and services while also preserving the viability of our nonprofit and mission-driven provider members. With plans’ market share now at over 50 percent of all Medicare-eligible older adults and growing, our advocacy on a range of MA-related issues, including those impacting participants of Programs for All Inclusive Care for the Elderly (PACE), is increasingly urgent.

We’ve made progress. Throughout 2024, enforcement of the CY2024 MA policy rule (CMS-4201-F) has been a priority, with a particular emphasis on prior authorization (PA). The Centers for Medicare and Medicaid Services (CMS) responded to our urging with a commitment to audit plan compliance with the rule in year one, and has used information gathered from those audits to identify those aspects of the rule in need of refinement to achieve the desired intent.

Those audits also inform the rule released today, which addresses several important areas on which we’ve called for additional clarification and increased plan oversight: prior authorization (PA) and internal coverage criteria; PA and the use of artificial intelligence (AI) and Flex Cards marketing and access.

While we are continuing to review the details in this 700-plus page document, we can say with certainty that the further explanation and details provided on these areas bring us closer to the achievement of a shared goal: MA that works for all–enrollees, providers, taxpayers and plans.

Yet more work remains. More must be done on PAs and concurrent reviews for post-acute care providers. And no reference in today’s rule is made regarding how MA Flex Cards should be treated in eligibility determination for government benefits, including Medicaid or supplemental security income (SSI). We will continue our push for clarity to preclude the possibility that older adults who enroll in MA plans lured by Flex Cards lose their government assistance as a result.”