HRS Monitoring CMS Proposed Changes for Medicare Advantage & Part D Plans in 2026 as Presidential Transition Creates Questions About Their Finalization

December 19, 2024 – On November 26th, the Centers for Medicare and Medicaid Services (CMS) proposed a number of changes for Medicare Advantage (MA) and Part D Prescription Drug Plans in contract year 2026, many of which will be of interest to electrophysiologists and their practice staff.

Notably, CMS proposes new requirements associated with plans’ use of “internal coverage criteria” to ensure coverage of reasonable and necessary Medicare Part A and B benefits, additional guardrails about plans’ use of artificial intelligence (AI) tools to mitigate ongoing health equity challenges, and elimination of plans’ discretion to reopen approved authorizations for hospital admissions. Expanding on previously finalized policies, CMS also proposes to increase its oversight of MA agent and broker marketing to ensure prospective enrollees receive accurate and transparent information before they sign-up.

You can read about these and other proposals in a CMS fact sheet. However, it remains to be seen whether and in what form these proposals might be finalized under a new administration.