In November 2023, the Centers for Medicare and Medicaid Services (CMS) released the 2025 Proposed Rule, which contains many provisions that would affect Medicare Advantage (MA) and Prescription Drug Benefit (Part D) contracts, including guardrails against anticompetitive steering, improved access to behavioral health providers, new standards for supplemental benefits for the chronically ill, and annual health equity analysis requirements. This white paper offers a detailed look, including:
- Unfinalized 2024 proposed rules with 2025 implications
- Estimated impact of "hold harmless" provision and finalized methodology changes
- Universal quality measures
- Proposed rule measure and process adjustments