CMS has released its Policy and Technical Changes for the 2025 Contract Year for the Medicare Advantage Program. The rule focuses largely on improving health equity, protecting Medicare beneficiaries, and increasing access to behavioral health services.  

CMS is proposing changes to the Utilization Management Committee, requiring that one member have experience with health equity. Additionally, CMS proposes that the committee conduct an annual health equity analysis on its use of prior authorization to include the impact of prior authorization on enrollees with social risk factors such as being eligible for Medicare and Medicaid or having a disability. 

CMS is proposing a new facility specialty type, Outpatient Behavioral Health, that would include mental health counselors, marriage and family therapists, and opioid treatment programs, among other behavioral health specialists and facilities. The proposal would expand network adequacy requirements to help improve beneficiary access to behavioral health services.  

CMS also proposes that Medicare Advantage (MA) plans notify beneficiaries mid-year of any unused supplemental benefits and prohibit contract terms between brokers and MA plans that could affect the broker’s ability to objectively assist beneficiaries in choosing the most appropriate MA plan for their needs.  

Comments on this proposed rule are due on January 5, 2024.