CMS Completes New Rules Modifying Medicare Advantage Program

April 22, 2024 10:05:00

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) published a regulation implementing changes in policy to Medicare Part C and Part D. The changes expand on policies under the Biden-Harris administration to promote healthy competition, strengthen guardrails and protections, and ensure Medicare Part D plans meet the needs of all who enroll.

The changes in policy include restrictions on beneficiary data distribution, revisions on compensation rules for brokers and agents who hinder anticompetitive steering, and improvements to behavioral health access.

We look at them in detail below.

Limitations on beneficiary data distribution by third-party marketing organizations

The CMS determined that third-party organizations sometimes distribute and/or sell contact information for beneficiaries to other third-party organizations. This data is usually collected when a beneficiary starts the process of enrolling in a plan with these organizations.

In its final regulation, CMS allows these entities to sell contact information for beneficiaries only if the organizations obtain written consent from them.

Agent and broker compensation

The final regulation has updated rules that govern compensation that brokers and agents receive for enrolling beneficiaries of Medicare into Prescription drug plans (PDPs) and Medicare Advantage (MA).

Current rules limit the compensation agents and brokers can receive, but with these changes, administrative costs are now included in compensation limits. The new regulation also bars plans from entering into anticompetitive contracts with brokers and agents. Specifically, the new regulation forbids contract terms between plans and brokers or agents that may interfere with their ability to evaluate and recommend plans that best fit the healthcare needs of a beneficiary.

Improved access to providers of behavioral health care

The new rule allows evaluations to consider the number of outpatient facilities and providers of behavioral healthcare. This includes mental-health counsellors, family and marriage therapists, community mental-health centers, opioid treatment programs, addiction facilities and specialists, among others.

Notice issuance of available supplemental benefits

Most Medicare Advantage plans provide supplemental benefits that include dental, hearing, vision and fitness in addition to standard benefits under Medicare. The government subsidizes these benefits through rebates to help address unmet social determinants of health needs.

In the last couple of years, utilization of these benefits by enrollees has been low. In order to address this, the new regulation requires that plans provide notices to their members who have not used the benefits afforded to them.

Changes under the new rule are expected to take effect on June 3, 2024.

Entities such as Astiva Health now have to analyze these changes to the Medicare Advantage program and find ways to make any needed changes in their operations in order to be in compliance with the new requirements.

NOTE TO INVESTORS: The latest news and updates relating to Astiva Health are available in the company’s newsroom at

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