2025 Medicare Advantage Proposed rule
2025 Medicare Advantage Proposed rule
Medicare Advantage: Unveiling the 2025 Proposed Rule by CMS!
The Centers for Medicare & Medicaid Services (CMS) recently released the 2025 Medicare Advantage (MA) Proposed Rule.
In the proposed Rule places a spotlight on critical aspects, demonstrating CMS's commitment to improving health equity, restricting broker marketing practices, and expanding access to behavioral health services. We also saw some important announcements related to Star ratings!
Diving into the proposed Stars changes: What You Need to Know
- Focus on Universal Foundation measures : CMS is putting its weight behind this Universal Foundation (UF) measure as it moves towards a building-block approach to streamline quality measures across CMS quality and value-based care programs.
- CMS proposed to submit the Initiation and Engagement of Substance Use Disorder Treatment (IET) measure (Part C) to the 2023 Measures under Consideration process
- CMS has also proposed to add other UF measures via future rulemaking including UF measures such as Adult Immunization Status, Depression Screening and Follow-Up for Adolescents and Adults, and Social Need Screening and Intervention (Currently already being reported as they are display measures).
- Retiring the MTM Program Completion Rate Measure: CMS proposed to move/retire the MTM Program Completion Rate for CMR Star Rating measure to a display measure for at least 2 years. This move will happen if the substantive measure updates proposed in December 2022 are codified.
- Methodological Enhancements and Operational Updates:
- Revise the process for identifying data completeness issues and calculating scaled reductions for the Part C appeals measures.
- Update how the CAI and HEI reward are calculated in the case of contract consolidations.
- Revise an aspect of the QBP appeals process where it will allow the Administrator to the opportunity to review and modify the Quality Bonus Payment (QBP) outcomes after an appeals decision has been made.
- Add that a sponsor may request CMS review of its contract’s administrative claims data used for the Part D Patient Safety measures no later than the annual deadline set by CMS for the applicable Star Ratings year.
Stay tuned!
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