The Centers for Medicare & Medicaid Services (CMS) announced it will be publishing a final rule in the Federal Register on April 16, 2018 with policy and technical changes to various Medicare programs for contract year 2019.

This final rule will revise the Medicare Advantage (MA) program (Part C) regulations and Prescription Drug Benefit program (Part D) regulations to implement certain provisions of the Comprehensive Addiction and Recovery Act (CARA) to further reduce the number of beneficiaries who may potentially misuse or overdose on opioids while still having access to important treatment options; implement certain provisions of the 21st Century Cures Act; support innovative approaches to improve program quality, accessibility, and affordability; offer beneficiaries more choices and better care; improve the CMS customer experience and maintain high beneficiary satisfaction; address program integrity policies related to payments based on prescriber, provider and supplier status in MA, Medicare cost plan, Medicare Part D and the PACE programs; provide an update to the official Medicare Part D electronic prescribing standards; and clarify program requirements and certain technical changes regarding treatment of Medicare Part A and Part B appeal rights related to premiums adjustments.

CMS indicate the changes are necessary to support innovative approaches to improving quality, accessibility, and affordability, alone with improving the CMS customer experience. Four major provisions are described including:

  1. Implementation of the Comprehensive Addiction and Recovery Act of 2016, note there are specific provisions that address long-term care facilities and PACE
  2. Revisions to timing and method of disclosure requirements to be more inclusive of electronic distribution methods
  3. Preclusion list requirements for prescribers in Part D and individuals and entities in MA, cost plans, and PACE that rescinds current regulations that prescribers and providers must enroll in Medicare
  4. Physician Incentive Plans - Update Stop-Loss Protection Requirements

The rule will be finalized 60 days after publication in the Federal Register and most applicability dates are January 1, 2019. LeadingAge will review the rule and alert our members of relevant provisions.