New CMS Medicare Advantage Final Rule: Beneficiary Data, Agent Compensation, Behavioral Healthcare Access, and More
Course Details
- smart_display Format
On-Demand
- signal_cellular_alt Difficulty Level
Intermediate
- work Practice Area
Health
- event Date
Thursday, July 11, 2024
- schedule Time
1:00 p.m. ET./10:00 a.m. PT
- timer Program Length
90 minutes
-
This 90-minute webinar is eligible in most states for 1.5 CLE credits.
This CLE webinar will guide healthcare practitioners through the Centers for Medicare & Medicaid Services' (CMS) CY 2025 Medicare Advantage and Part D final rule, effective Oct. 1, 2024, that significantly updates CMS policies to promote competition and equity in coverage, increase access to behavioral health services, protect individuals from inappropriate marketing, and improve supplemental benefits. The panel will offer best practices for navigating the final rule's requirements.
Ms. Bergeron provides strategic business and regulatory counsel to prominent health care and private equity clients. She regularly advises on complex transactions across a wide range of health care industry sectors. Ms. Bergeron has been advising clients on a range of issues associated with the pandemic, including navigating financial relief provisions for health care providers under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act).
Ms. Fingold’s practice focuses largely on the regulation of Medicare managed care (including Medicare Advantage, Part D, dual eligibles, PACE, demonstrations), Medicaid managed care, commercial managed care products (including surprise billing), and behavioral health (including mental health parity). Her clients range from small start-ups to large corporate entities with multiple subsidiaries. They include Medicare Advantage, PACE, Medicaid, and other managed care plans; provider entities; vendors to providers and managed care companies (including administrative support entities, providers of software and online services, agents/brokers/field marketing organizations, and advertising/marketing entities). Before building her private practice, Ms. Fingold gained 20 years of experience in the federal government: 13 years at CMS, working on Medicaid, Medicare Advantage/Part D, and ACA implementation, and seven years at MedPAC.
CMS recently released the CY 2025 Medicare Advantage and Part D final rule, effective Oct. 1, 2024, that makes significant changes to certain CMS policies including to promote competition, protect beneficiaries' data from being used inappropriately for marketing, increase access to behavioral health services, promote equity in coverage, and improve supplemental benefits.
One of the most notable changes in the final rule is related to agent/broker compensation to stop what CMS says is anticompetitive steering of enrollees toward some Medicare Advantage (MA) and Part D plans over others based on the agent/broker's financial interests rather than the enrollee's healthcare needs. The final rule caps agent/broker non-salary compensation, eliminates separate payments for administrative services, and intends for compensation to encompass all administrative fees and commissions paid to independent agents/brokers. The final rule also prohibits contractual terms that create incentives to enroll beneficiaries in plans other than in the best interests of the beneficiary and that provide bonuses for hitting volume-based sales targets for plan sales.
Other significant updates include requiring express written consent from beneficiaries before third-party marketing organizations (TPMOs) may share personal beneficiary data with other TPMOs for marketing or enrollment purposes; improving access to behavioral healthcare services by finalizing important updates to network adequacy standards; and requiring MA plans to issue mid-year notices to enrollees that include a list of supplemental benefits to which they are entitled but have not yet accessed.
Listen as our expert panel guides practitioners through the notable changes in the CMS CY 2025 Medicare Advantage and Part D final rule and offers best practices for compliance.
- Introduction
- Medicare Advantage Part C and Part D prescription drug plan marketing
- Agent and broker compensation
- Distribution of personal beneficiary data by TPMOs
- Improving access to behavioral healthcare providers
- Supplemental benefits
- Mid-year enrollee notification of available supplemental benefits
- New standards for special supplemental benefits for the chronically ill
- Annual health equity analysis of utilization management policies and procedures
- Other changes
- Practitioner takeaways
The panel will review these and other important considerations:
- How does the final rule encourage competition?
- What impact will the final rule's requirements related to administrative fees and capped compensation have on agents/brokers?
- What is the status of the recent lawsuits filed to challenge these regulatory changes?
- In what ways does the final rule promote equity and access to healthcare?
- How will the final rule's requirements improve supplemental benefits available to enrollees?
- What are best practices for navigating the final rule's requirements and ensuring compliance?
Related Courses
HIPAA and Beyond: Health Information Privacy Updates
Tuesday, June 10, 2025
1:00 p.m. ET./10:00 a.m. PT
Structuring Physician Compensation Arrangements
Wednesday, June 11, 2025
1:00 p.m. ET./10:00 a.m. PT