On January 6th, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule including policy and technical changes for Medicare Advantage (MA) and Part D plans, and Programs of All-Inclusive Care for the Elderly (PACE) for calendar year (CY) 2023. This is Part I of the 2023 Advance Notice and Draft Call Letter. Some important provisions of the rule include:
- A proposal to redefine “negotiated prices” of Part D drugs reported to CMS to require the incorporation of post-point of sale performance-based discounts;
- A series of changes to Dual Eligible Special Needs Plans (D-SNPs) to incorporate practices from pilot Medicare-Medicaid Plan demonstrations; and
- Expansion of oversight requirements around medical loss ratio requirements and new or expansion applications.
CMS expects that the costs associated with its proposals are relatively modest and are not expected to significantly change MA plans’ bids, supplemental benefits, or beneficiary premiums. However, a more complete understanding of the effect of regulatory changes on the MA and Part D markets in 2023 will not be possible until Part II of the Advance Notice is released. This typically occurs in late January.
SPG’s summary of key provisions of the rule is attached. CMS will accept comments through March 7th, and policies will be finalized in the 2023 Rate Announcement and final Call Letter by April 1st. The full text of the proposed rule is available here. A fact sheet is available here.