CMS has issued its annual update to the Medicare Advantage, Special Needs Plan and PACE programs as part of its CY2025 Medicare Advantage policy and technical proposed rule. The rule will be officially published in the Federal Register on Wednesday, November 15th. This is an earlier release than prior MA proposed rules. Comments will be due right after the new year on January 5th at 4:00 PM CT.
The proposed rule contains several beneficiary improvements, but a couple notable proposals include enhancing beneficiaries’ right to an independent, fast-track appeal when non-hospital services are terminated by their plan. These appeals would be conducted by an independent review entity such as a Quality Improvement Organization (QIO) even if the appeal request isn’t timely or the person has left the facility. This fast track, independent review is a benefit afforded to Medicare FFS beneficiaries but has been limited for those enrolled in an MA or SNP plan. The rule also seeks to create additional opportunities for dual eligibles to enroll in an integrated DSNP plans. Both appear to be positive. Watch for an article soon with a complete analysis.
