CMS Releases Medicare Advantage (MA) and Part D 2019 Final Rule and Thanks Commenters, Including ASCRS and the Alliance of Specialty Medicine, for Recommendations for Regulatory Relief

This week, CMS released the 2019 MA and Part D final rule, which implements policies related to Medicare private plans and prescription drugs. In the proposed rule released late in 2017, CMS included a request for comment on recommendations for reducing physician burden related to private plans. In our comments, and comments submitted by the Alliance of Specialty Medicine, ASCRS recommended limiting plans’ ability to require physicians to participate in chart audits that are not specifically authorized by CMS, curbing the use of prior authorization, and ensuring MA plans have networks that are robust enough and include specialists and sub-specialists. CMS thanked commenters for their recommendations and noted it would keep them in mind for future rulemaking. In response to a specific recommendation made by ASCRS and the Alliance to incorporate network adequacy into the MA Star Ratings methodology, CMS indicated it would look into the feasibility of incorporating it as a measure in the future. We will keep you updated.