Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

CMS finalizes 2016 payment and policy updates for Medicare health and drug plans
The Centers for Medicare and Medicaid Services (CMS) has released final Medicare Advantage (MA) and Part D Prescription Drug program changes for 2016 that provide fair and accurate payments to plans, and encourage the delivery of high-quality care for all populations.

The finalized policies fully consider the many comments received during the public comment period. Particular care is being taken to ensure that plan sponsors have the right incentives to care for dual-eligible populations over the long term. The rate announcement finalizes changes in payments that will affect plans differently depending on the characteristics of those plans.

In the final call letter, CMS continues to update the star ratings measures to drive improved quality for Medicare Advantage and Part D enrollees. To enhance program integrity and payment accuracy, Medicare Advantage plans will continue to be provided stringent oversight for improper payments, just like other providers in the Medicare program.

Lastly, the final policies will provide enrollees with greater information to make informed and timely decisions about their care and their coverage. The final call letter takes steps to require Medicare Advantage plans to maintain accurate provider directories in a timely manner and make those directories widely available. These steps will help enrollees better understand the providers and choices available to them. CMS will also ensure that Part D sponsors provide clear and accurate access to information on preferred cost-sharing pharmacies in their networks so that all beneficiaries have access to affordable coverage.

To view a fact sheet on the 2016 rate announcement and final call letter, click here.