The Centers for Medicare & Medicaid Services this week proposed a rule that would protect seniors from misleading marketing related to Medicare Advantage (MA) coverage and bolster behavioral health under MA.
“People exploring Medicare coverage options deserve peace of mind that they are receiving honest, transparent and accurate information about health coverage options and have access to the care they need,” Meena Seshamani, MD, PhD, CMS deputy administrator and director of the Center for Medicare, said in a statement. “These proposed protections are commonsense and critical to the physical, mental and financial stability of millions of people who choose a Medicare coverage option each year.”
CMS proposes prohibiting ads that do not mention a specific plan name and ads that use words and imagery that may be confusing, or use language or logos in a way that may misrepresent a plan. CMS also proposes ensuring that those who are exploring Medicare coverage are not pressured into enrolling in plans that may not best meet their needs. Further, CMS proposes strengthening the role of plans in monitoring agent and broker activity.
MA has been under fire for misleading advertising. A Senate report released last month found that some MA plans masqueraded as government agencies in mailed advertisements, badgered seniors with phone solicitations, and even sent agents to grocery stores where they approached seniors about switching to different MA plans.
The CMS proposal released this week also offers expanding access to behavioral health. CMS proposes adding clinical psychologists, licensed clinical social workers and Prescribers of Medication for Opioid Use Disorder as specialty types for which it sets specific minimum standards and on which it evaluates MA networks.
Among its other provisions, the proposal aims to strengthen the Star Ratings program with a health equity index reward, beginning with the 2027 Star Ratings using measure data from the 2024 and 2025 measurement years. The idea is to further encourage MA plans to improve care for enrollees with certain social risk factors (dual eligibility, low-income subsidies and disability). And in a complement to a previous prior authorization proposal, CMS proposes policies to streamline prior authorization requirements and reduce disruption for enrollees.