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Top 7 takeaways from CMS proposed regulations

July 5, 2023

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Top 7 takeaways from CMS proposed regulations

The Centers for Medicare and Medicaid Services (CMS) works to ensure that Medicare beneficiaries receive the best possible care. To do so, CMS regularly proposes new regulations for Medicare Advantage plans (MAPDs). As Medicare agents and beneficiaries, it's important to stay up-to-date with these proposed regulations and their implications. Here are the top 7 takeaways from CMS' proposed regulations that you should know about – and if you do business in Florida, we have one additional takeaway at the end. 

1 – Free Vaccines

One of the proposed regulations from CMS would make vaccines recommended by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) available to Medicare recipients free of charge.

2 – Capped insulin copays

Another proposed regulation from CMS would cap copays for a 30-day supply of any insulin that a Medicare drug plan covers at $35. This proposed rule change would make accessing potential life-saving medications more affordable and accessible to those affected by diabetes.

3 – More coverage for behavioral health

CMS is proposing to pay for licensed clinical social workers, psychologists and other behavioral health specialists to be part of a beneficiary’s primary care office visit. This proposed rule change would emphasize the importance of mental health to the beneficiary’s overall health.

4 – More coverage for dental care

The regulation would expand the type of “medically necessary” dental services CMS would cover, such as a cleaning or other dental work that will improve the outcome of an organ transplant or cancer treatment. 

5 – A is going up... and B is going down

Part A's deductible would increase to $1,600 per stay, up $44 from 2022. But the Part B deductible for 2023 would decrease to $226, a $7 decline from 2022 and the first drop in a decade. 

6 – Immediate coverage

Typically Medicare recipients have to wait a month or two before the effective date of their plan. Under a new proposed rule, the beneficiary would receive coverage immediately, with no waiting period for it to take effect, as long as they are eligible to enroll. 

7 – Not all calls need to be recorded

CMS is proposing to limit the requirement to record calls between third-party marketing organizations (TPMOs) and beneficiaries to marketing sales and enrollment calls; this would mean that client service calls might not need to be recorded.

New Florida statue

Lastly, for agencies that do business in Florida, you should be aware that a new Florida statute will prevent you from holding a license if your agency contains the words “Medicare” or “Medicaid” in it. Please reach out if you need assistance navigating the new requirement. 

These are a subset of the proposed regulations from CMS that could have important implications for you and your clients. You can read the full memo here. And remember, these are not final, but they do give you a sense for what changes you might expect in the next year.

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Byron Edwards

Byron Edwards

COO @ Spark

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