|The Centers for Medicare and Medicaid Services’ Final Rule for Medicare Contract Year 2019 is now in effect as of June 15, 2018. The ruling makes annual program refinements to Medicare Advantage and Part D benefit programs and incorporates specific requirements from the Comprehensive Addiction and Recovery Act of 2016.
This year’s changes, announced in April, put a significant emphasis on customer experience and reflect some attention-grabbing updates to the stop-loss requirements initially specified in the Provider Incentive Plan (PIP) Regulations and discussed in our first paper for the Research and Insights section of our website.
Patient experience rules are changing to allow beneficiaries additional plan-switching periods if the plan they chose in the Fall doesn’t meet their expectations in the Spring. In addition, Access and Experience ratings will see a boost in their importance to Star ratings. Clearly, value means getting what you signed up for! Read more in the Gorman Health Group article.
The stop-loss tables, which are integrated into the PIP regulations, specify the attachment points and deductible structure available to provider groups participating in reinsurance programs based on aggregate panel size. The Final Rule updates to these requirements are based on the assertion by