The Centers for Medicare and Medicaid Services (CMS) released proposed changes to the Medicare Advantage (MA) program, including adjustments to the Star Ratings measures and new special enrollment rules, and other items of note for long-term care providers.

Within the Contract Year (CY) 2027 Medicare Advantage and Part D Proposed Rule are also three Requests for Information (RFIs) including one focused on dual eligibles intended to assess how Chronic Special Needs Plan (C-SNP) and Institutional Special Needs Plan (I-SNP) enrollment trends may affect state integration efforts.

According to an assessment by the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), one of the major proposals in the rule is the agency plans to shift from process-focused measures to outcome measures.

“It also proposes removing 12 administrative performance measures, noting that these measures have shown consistently high performance. Additionally, CMS proposes adding a new measure for Depression Screening and Follow-Up starting in CY 2027,” AHCA/NCAL said. 

On SNPs, CMS is seeking feedback on modernizing MA risk adjustment and quality bonus payments, as well as improving integration of Medicare-Medicaid benefits for dually eligible SNP enrollees, which is “spurred by the growth in the number of duals in C-SNPs in particular but also in I-SNPs.”

Marketing Gets a New Look

CMS said it is proposing two steps aimed at streamlining the enrollment experience, a new special enrollment period (SEP) for provider terminations, and codifying long-standing policy regarding utilization of SEPs.  More specifically, CMS said it wants to:

•  Modify an SEP for enrollees to change plans when one or more of their providers are leaving their plan’s network. MA enrollees who experience provider network changes mid-year may want to stay with their current provider who is leaving the network. To allow these enrollees to change their coverage more easily, this proposal removes the limitation on the existing SEP that required the MA organization and then CMS to deem the network change “significant.”

  
  

• Codify the existing policy that certain SEPs require prior CMS approval. This will provide transparency and stability for stakeholders about the MA and Part D programs and about the nature and scope of these SEPs by ensuring that the SEPs are changed only through rulemaking, CMS said.

The complete rule can be accessed at https://tinyurl.com/44688hkv.

Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.