DPC News

Press Release | Keeping Up With The New Medicare Rules

The Trump Administration has issued a number of new regulations affecting Medicare, private insurers, and beneficiaries. Deputy Director of Health Care Policy Tara O’Neill Hayes summarizes some of the key provisions in the various proposed and enacted regulations, which include:

  • Loosening the uniformity rules in Medicare Advantage;
  • Reducing Part D beneficiaries’ out-of-pocket costs;
  • Allowing step-therapy in Part B; and
  • Increasing risk-sharing in Medicare Accountable Care Organizations.

The administration is seeking to change Medicare through the regulatory process, writes Hayes, but because of the size and reach of Medicare, “the changes being implemented by [the Centers for Medicare and Medicaid Services] are likely to have a broader impact beyond just the Medicare program and its beneficiaries.”

Final Rules and Guidance Documents

Loosening the Uniformity Rules in Medicare Advantage

In April of this year, CMS finalized a rule that will provide Medicare Advantage plans greater authority to tailor their supplemental benefits to the unique needs of their patients.[1] Current law requires that MA plans provide uniform benefits at a uniform premium to all enrollees in a specific plan, which had previously been interpreted to include uniform cost-sharing. CMS is now interpreting the law in a way that allows MA plans, for enrollees that meet specific medical criteria, to reduce cost-sharing for certain benefits, to offer certain supplemental benefits, and to provide lower deductibles—as long as all similarly situated enrollees are treated the same and that such tailored benefits are for services medically related to the shared medical condition. For example, loosening the program’s uniformity requirements will allow plans to offer diabetic patients reduced cost-sharing for endocrinologist visits or more frequent foot exams. CMS reiterates that this rule change does not in any way change the program’s non-discrimination rules, and MA plans may not restrict access to or condition the coverage of a good or service based on health-status related factors.

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