| We are writing to call state attention to the release of the Contract Year 2025 Medicare Advantage and Prescription Drug Final Rule (CMS-4205-F). We encourage states to review the entire final rule, but some provisions of particular interest to states are under the following headers: Increasing the Percentage of Dually Eligible Managed Care Enrollees Who Receive Medicare and Medicaid Services from the Same Organization. These provisions will Replace Medicares current quarterly special enrollment period (SEP) with a one-time-per month SEP for dually eligible individuals and others enrolled in the Part D low-income subsidy program to elect a standalone PDP; Create a new monthly Medicare integrated care SEP to facilitate aligned enrollment across Medicare and Medicaid for full-benefit dually eligible individuals; Limit enrollment in certain D-SNPs to those individuals who are also enrolled in an affiliated Medicaid MCO; and Limit the number of D-SNPs that organizations can offer in certain circumstances Contracting Standards for Dual Eligible Special Needs Plan Look-Alikes, which will lower the current threshold for identifying D-SNP look-alikes Expanding Permissible Data Use and Data Disclosure for MA Encounter Data, which will broaden allowable state use of and expedite state access to MA encounter data for care coordination for dually eligible individuals For D-SNP PPOs, Limiting Out-of-Network Cost Sharing, which will reduce state liability for Medicare cost sharing in certain instances Update to the Multi-Language Insert Regulation Please review the press release and fact sheets, as well as the full final rule for more information. |
