Enhancements to Medicare Advantage for 2024
CMS is constantly looking at the regulations that govern the sale, provision, and use of Medicare and Medicaid. They examine the experiences of the insurers that are contracted by the government to provide the insurance plans. Additionally, they examine the experiences of the beneficiaries who purchase them. Any amendments they choose to make are intended to take effect the following year. In 2023, CMS looked at the rules surrounding Medicare Advantage in particular. What changes are planned for Medicare Advantage 2024?
CMS Final Rule
The CMS issued a final proposal on April 5th of 2023 for the enhancement of Medicare Advantage. They did not address the comments that the public had given on the proposed amendments. However, did say that they plan to address them at a later, more appropriate date. The amendments proposed have to do with prior authorization and how that affects beneficiaries’ access to healthcare. Previously, prior authorization meant that beneficiaries who had Medicare Advantage health insurance plans had to essentially request permission before receiving care. That indirectly means that beneficiaries could be denied care. (Traditional Medicare does not require prior authorization.) There were concerns that Medicare Advantage customers were not receiving the same quality of care as Original or Traditional Medicare beneficiaries because of these rules.
Changes to Medicare Advantage 2024
This is about to change, however, as the new rules proposed by CMS are designed to make sure that Medicare Advantage customers have the same access to necessary tests, scans, prescriptions, and procedures that their counterparts in Original Medicare to. The American Medical Association says that the new rules have, “taken important steps towards rightsizing the prior authorization process.” UnitedHealthcare, which is just one of the insurers with Medicare Advantage plans, says it plans to reduce their number of denials of care by nearly three million a year.
CMS’ new rule requires that prior authorization policies may only be used to confirm the presence of a diagnosis. This ensures that the treatment is medically necessary. CMS is also requiring that all Medicare Advantage plans develop committees to ensure that denials and approvals are working effectively to get beneficiaries the care they need within the new guidelines. Finally, the new rules require that a prior authorization approval is effective for the entire course of treatment as long as medically reasonable and necessary to avoid disruptions in care.
All together, beneficiaries and insurers alike hope that these new regulations will help ensure that Medicare Advantage plans provide equitable access to care moving forward.
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