America's Benefit Specialist March 2023

CMS RELEASES 2024 ADVANCE NOTICE WITH PROPOSED PAYMENT UPDATES FOR THE MEDICARE ADVANTAGE AND PART D PRESCRIPTION DRUG PROGRAMS MEDICARE MATTERS

On February 1, CMS released the calendar year 2024 Advance Notice for the Medicare Advantage (MA) and Part D Prescrip tion Drug Programs that would update payment policies for these programs. The Advance Notice builds on a proposed rule that CMS released in December 2022 that would, if final ized, strengthen beneficiary protections for the millions of people who rely on Medicare Advantage and Medicare Part D prescription drug coverage. In addition to the payment updates, the Advance Notice outlines several updates and improvements made by the Inflation Reduction Act (IRA) to the Part D program that will go into effect or be in effect on January 1, 2024. These include the continuation of reduced cost-sharing for insulin and eliminated cost-sharing for recommended, preventive vaccines, as well as the elimination of cost-sharing for Part D prescription drugs in the catastrophic phase and expan sion of eligibility for full cost-sharing and premium subsidies

under the Low-Income Subsidy program. Through these changes to the Part D program for 2024, the new drug law provides financial relief for people with Medicare by improv ing access to affordable treatments and strengthening the Medicare program both now and in the long run. The Advance Notice proposes updates to MA payment growth rates and changes to the MA and Part D payment methodologies. These proposals include technical updates to the MA risk-adjustment model to keep the model up to date and improve payment accuracy, such as by fully tran sitioning to the Internal Classification of Diseases (ICD)-10 system, which has been in use since 2015. In addition, CMS is seeking comment on MA quality measurement under Part C Star Ratings as part of CMS’s overarching efforts to align quality measures across federal programs and with private payers, reduce burden, and improve the effectiveness of quality programs.

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