2013 Will be a Very Busy Regulatory Year
CMS is planning to issue a lot of regulations in 2013 that will impact Medicare Advantage (MA) and Prescription Drug Plans (PDPs) as well as plans that will be offered in the individual and small group market Exchanges.
The Medicare Advantage and Part D Advance Notice of Payment Rates and Call Letter will be issued in mid-February and the Final Rate Notice and Call Letter will be released the first week in April 2013. These documents provide critical rate and policy information for MA and PDP plan designs, benefits and cost structures as well as for overall compliance for plan year 2014.
CMS will issue a proposed rule on how they will implement the Medicare Advantage Medical Loss Ratio (MLR) Requirements which takes effect in 2014. The ACA requires MA plans to meet a minimum loss ratio of 85 percent or remit the difference to CMS.
CMS is also planning to issue a proposed rule in September 2013 on “Policy and Technical Changes to the MA and PDP Programs for Contract Year 2015”.
CMS also plans to finalize a number of regulations that implement provisions in the Affordable Care Act (ACA). These include:
• Insurance Market Rate Review
• Essential Health Benefits, Actuarial Value, and Accreditation
• Eligibility, Appeals and Other Provisions under the ACA
• Certain Preventive Services under the ACA
• Wellness Programs
• Notice of Benefit and Payment Parameters
• Minimum Essential Coverage Exemptions
• Nondiscrimination
Resources:
To learn more about how Gorman Health Group can help with Medicare Advantage Regulations visit our website.
To learn more about how Gorman Health Group can help with Part D Regulations visit our website.
To learn more about how Gorman Health Group can help with Compliance, visit out website.
Download Jean LeMasurier’s summary on three new proposed regulations implementing provisions in the Affordable Care Act.