California Health Advocates worked together with Center for Medicare Advocacy to submit comments on the 2025 proposed rule for Medicare Part C and Part D plans. The Centers for Medicare and Medicaid Services’ (CMS) proposed 2025 rule demonstrates CMS’ commitment to protect people with Medicare, and CHA and the Center supports most of the proposals in the rule. There is, however, more to do, and we will continue to point out where CMS can make further headway in properly overseeing private Medicare Advantage (MA) and Part D plans and those who sell them.
The submitted comments detail our support in certain areas and outline where more is needed. Some areas the proposed rule address and can be expanded upon include:
- Increasing language accessibility by requiring Medicare Advantage plans (MA or Part C) and Part D drug plans to offer a Notice of Availability in the top 15 languages of the state.
- Amending the appeals process to (1) require the Quality Improvement Organization (QIO – in California, the QIO is Livanta), instead of the MA plan, to review untimely fast-track appeals of an MA plan’s decision to terminate services in an home health agency (HHA), comprehensive outpatient rehabilitation facility (CORF), or skilled nursing facility (SNF); and (2) fully eliminate a provision requiring the forfeiture of an enrollee’s right to appeal a termination of services decision when they leave the facility. This proposal would align MA regulations regarding fast-track appeals with traditional Medicare rules.
- Amending the reporting requirements for Part C and D plans to gather more information about how people access their MA benefits, including denials and delays in care. Some additional questions/information we’d like gathered and made publicly available include:
- What share of Medicare Advantage enrollees use supplemental benefits offered by their plan and how does use vary by race/ethnicity, income, or health condition?
- What services and subgroups of enrollees, such as those with specific health conditions, have the highest prior authorization denial rates?
- Reason for prior authorization denials – Do certain insurers attribute denials of prior authorization requests to medical necessity more often than others?
- Do certain insurers respond to prior authorization requests more quickly?
- How often do Medicare Advantage insurers deny payments for Medicare-covered services?
- Addressing agent compensation and increased regulations to ensure that agent and broker commissions for MA and Part D plans be equalized across the board – one uniform commission for Part D and MA products alike.
- Implementing additional marketing and communications changes to protect beneficiaries.
Read all the details in the full 21-pages of comments submitted to CMS.
