On November 6, 2023, a proposed rule was issued by the Centers for Medicare & Medicaid Services (CMS), marking significant developments in the policies and technical changes projected to come into effect for Contract Year (CY) 2025. This rule is primarily aimed at the Medicare Advantage (MA) and Medicare Prescription Drug Benefit Programs.
The proposed changes, as discussed in this article, focus mainly on the permissible payment structures for agents and brokers. While the proposed changes promise to challenge longstanding rules, the timeline for their effect varies. Some of these changes are anticipated to be enacted as soon as 2024, coming into force once the final rule is approved, but others may take longer.
But what does this mean for legal professionals working in large corporations and law firms? And, more specifically, how will these changes affect those working within the healthcare space, where these changes are most likely to have a significant impact?
Firstly, the rule’s most striking feature is CMS’s proposal to prohibit overrides in Medicare Advantage. While the term ‘overrides’ often applies to different activities, within the context of this rule, it refers to certain payment enhancements offered to brokers for selling Medicare Advantage plans. This represents a significant shift in the policy and could likely see new and different compliance issues arising.
Firmly understanding how these changes will unfold is critical, particularly for those working in healthcare law. As the proposals continue to develop, and specifics of how these changes are expected to materialize taking shape, a detailed examination will necessary.
To stay ahead of these proposed changes, legal professionals are advised to keep an eye on updates and closely monitor the developments of the rule. The review process of this rule could potentially lead to a variety of interpretations, applications, and invariably, legal challenges.