This evening, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program. Included within this rule are proposed changes to the Medicare Advantage program. Some of these changes are required by statute while others are new proposals from CMS. This marks the first regulation related to Medicare Advantage (MA) and Part D to be released since 2014.

Public comment on these and other proposals contained in the rule are due to CMS by 5 P.M. on January 16, 2018.

If you have questions about how this proposal could impact you or your company, reach out to Melissa Andel, Director of Health Policy, at melissa@appliedpolicy.com or 202-558-5272.

Meaningful Difference Requirements to be Eliminated While CMS Proposes Changes to Uniformity

CMS is proposing to eliminate the meaningful difference requirement beginning with MA bid submissions for contract year (CY) 2019. The meaningful difference requirement meant that CMS would only approve a bid submitted by MA organizations if the benefit package was substantially different from those of other plans that organization offered in the area. This included differences in premiums, cost sharing, or benefits offered. CMS noted that this proposal was not related to a statutory change and aims to improve competition, innovation, and available benefit offerings.

In this proposed rule, CMS also discussed changes to uniformity requirements. CMS would give MA organizations the ability to reduce cost sharing for certain covered benefits, offer specific tailored supplemental benefits, and offer different deductibles for beneficiaries that meet specific medical criteria. Beginning in CY 2019, MA plans would be able to exercise this flexibility within each segment of an MA plan. CMS plans to provide operational details of this policy in the upcoming call letter.

CMS Formalizes Statutorily Required Change to Enrollment Period

The 21^st Century Cures Act eliminates the Medicare Advantage Disenrollment Period and establishes a new Open Enrollment Period (OEP) starting in 2019 so CMS is proposing changes to existing regulations to comply with the statute. This new OEP will take place from January 1^st through March 31^st annually and will allow individuals in an MA plan to make a one-time election to switch to another MA plan or to original Medicare.

CMS Proposes Creation of Preclusion List

An additional proposal included in this rule is to eliminate the prescriber and provider enrollment requirement and replace it by creating a “preclusion list.” The list would include certain individuals and entities in the following categories:

• Are currently revoked from Medicare, are under a reenrollment bar, and CMS determines that the underlying conduct that led to the revocation is detrimental to the best interests of the Medicare program
• Have engaged in behavior for which CMS could have revoked the individual or entity to the extent applicable and CMS determines that the underlying conduct is detrimental

CMS is proposing that an MA organization shall not make a payment for items or services that are provided by anyone or any entity included on the preclusion list. The list would also be available to Part D prescription plans.