What Do CMS’s Final Rule Updates Mean for Medicare Advantage Programs?

Every year, the Centers for Medicare and Medicaid Services (CMS) updates its Final Rule document that codifies the regulations for Medicare and Medicaid programs. After analyzing the complete 272-page Final Rule document—here are important regulatory CY22 changes worth noting:

Medicare Advantage ProgramsMedicare Communications and Marketing Guidelines (MCMG) document:

  • While CMS believes it would be duplicative to produce the MCMG in its current form, they do intend to continue producing subregulatory guidance to provide operational instruction to plans. Many MCMG instructions are now finalized in law.

Hours of operation:

  • CMS is restoring this requirement it [inadvertently] deleted to include the hours of operations from the MCMG (section 30.4 of the 2019 MCMG) when listing the customer service telephone number from materials.

Special Supplemental Benefits for the Chronically Ill (SSBCI):

  • A new requirement for a disclaimer to be used when SSBCIs are mentioned is in section 422.2267(e)(32).

Summary of Benefits (SB):

  • The term standardized materials, which are specified in §§ 422.2267(b) and 423.2267(b) must be used in the form and manner provided by CMS. Model materials, which are specified in §§ 422.2267(c) and 423.2267(c), are created by CMS. Plans may customize the SB so long as all required content is included and are not required to use the CMS model SB without customization.

Pre-enrollment Checklist (PECL):

  • It is unnecessary to require the PECL be included with the SB and the enrollment form. However, it is required to include the PECL with the enrollment form. Plans may include the PECL with other materials like the SB, if they choose.

For additional guidance, here’s a link to a fact sheet on the Contract Year 2022 Medicare Advantage and Part D Final Rule (CMS-4190-F2) and the 272-page Final Rule in the Federal Register.

Medicare Part D Benefit Parameters:
Annual Adjustments for Defined Standard Benefit in 2022.

  • Separately from the Final Rule, CMS has provided the Part D benefit parameters for 2022 earlier than in previous years. In January, CMS announced the Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies. The capitation rate tables and supporting data for CY2022 and the statutory component of the regional benchmarks, qualifying counties, and each county’s applicable percentage are posted in this section of the CMS website.

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About CODY: CODY® works with more than 60 government-funded, commercial, and ACA health plans across 45 states and Puerto Rico. We help health plans improve regulatory compliance, manage plan benefit data, and streamline member/provider communications to maximize performance across the enterprise. CodySoft®, our proprietary suite of software, is designed specifically for health plans. www.codyconsulting.com.