CMS Final Rule Impacting Medicare Part C, Part D and Health Information Technology Requirements

Description

On April 4, 2024, CMS issued a Final Rule, which among other items, revises the Medicare Advantage Program, Medicare Prescription Drug Benefit Program (Medicare Part D), Medicare Cost Plan Program, Programs of All-Inclusive Care for the Elderly (PACE), and Health Information Technology Standards and Implementation Specifications, as well as focusing on access to types of care, anticompetitive conduct, and third-party marketing of patient data. The focus on Part C also aligns with DOJ’s priority areas of enforcement, as well as the FTC’s focus on anticompetitive violations of antitrust laws. The purpose of this webinar is to provide an overview of the key areas and tips for mitigating the risk of non-compliance.

These changes empower consumers with more choices and affordable care, while improving the quality of care for enrollees and promoting fair competition among Medicare Advantage plans. New protections against unfair marketing practices ensure enrollees are recommended plans that best suit their needs, not plans agents are financially incentivized for. Increased transparency of supplemental benefits allows enrollees to maximize their plans offerings through mid-year notifications detailing available benefits and access methods. Improved access to behavioral health care comes with new network adequacy standards, guaranteeing a wider range of providers for Medicare Advantage enrollees. More affordable prescription drugs are on the horizon thanks to the Inflation Reduction Act, capping annual out-of-pocket costs for Part D enrollees at $2,000 starting in 2025. Additionally, Part D sponsors will have more flexibility to substitute lower-cost biosimilar medications for expensive brand names. Dually eligible individuals, those receiving both Medicare and Medicaid, will benefit from a number of provisions designed to enhance their experience. These include increased access to integrated care plans and protections against out-of-network cost-sharing for specific services. Overall, these changes significantly improve the Medicare Advantage and Part D programs for beneficiaries. By increasing consumer choice, improving access to care, and promoting fair competition, CMS empowers Medicare enrollees to make informed decisions about their healthcare.

Learning Objectives:

• Understand the new guardrails for brokers and agents compensation models when assisting Medicare beneficiaries in enrolling in Medicare Advantage and Part D plans
• Appreciate are impermissible contract terms between Medicare Advantage organizations/ Part D sponsors and middleman Third Party Marketing Organizations (TPMOs) that may or may not create impermissible incentives
• Learn how the distribution, including selling and reselling of personal beneficiary data by third-party marketing organizations, implicate already existing rules and how will additional safeguards in the final rule assist with transparency
• Understand the impact of anti-competitive practices and legal implications
• Learn how additional behavioral health services intertwine with other laws and regulations
• Consider how violations of the facets of this Final Rule could lead to False Claims Act liability

Areas Covered in the Session:

• Healthcare Fraud
• Medicare
• Medicare Advantage
• Medicare Part D
• Medicare Advantage Risk Adjustment Data Validation
• Brokers and agents compensation models when assisting Medicare beneficiaries in enrolling in Medicare Advantage and Part D
• Medicare Advantage organizations/Part D sponsors and middleman Third Party Marketing Organizations (TPMOs) that may or may not create impermissible incentives
• Behavioral health services updates
• Live Q&A Session

Suggested Attendees:

• Healthcare CEOs, CFOs & COOs
• Healthcare Sector Participants
• Compliance and Legal Team
• Providers
• Consultants
• Insurance Industry Professionals
• Physician and Physician Assistants
• Billers and Coders
• Revenue Cycle Specialists
• Government Organization
• Defense Counsel
• Relator’s Counsel
• Compliance Officers
• Healthcare Attorneys
• Cybersecurity Professionals & Consultants
• Anyone in Healthcare