{"id":10399,"date":"2023-12-18T09:19:18","date_gmt":"2023-12-18T09:19:18","guid":{"rendered":"https:\/\/distilinfo.com\/healthplan\/?p=10399"},"modified":"2023-12-18T09:21:00","modified_gmt":"2023-12-18T09:21:00","slug":"5-medicare-advantage-transformations-unveiled-2024-outlook","status":"publish","type":"post","link":"https:\/\/distilinfo.com\/healthplan\/5-medicare-advantage-transformations-unveiled-2024-outlook\/","title":{"rendered":"5 Medicare Advantage Transformations Unveiled | 2024 Outlook"},"content":{"rendered":"

In 2024, Medicare Advantage undergoes pivotal changes set by CMS. Revamping risk payments, prior authorizations, and network protocols aims to bolster care quality and transparency. These alterations span phased payment adjustments, stringent prior authorization guidelines, network oversight committees, reinforced behavioral health provisions, and refined marketing standards.<\/p><\/blockquote>\n

Medicare Advantage witnesses transformative changes in 2024 under CMS directives. These changes, encompassing payment restructuring, authorization reforms, and network enhancements, signify a strategic shift. The evolving landscape strives to augment care quality, fortify network protocols, and ensure transparent marketing practices.<\/p>\n

\u00a0Here’s an in-depth look at the five impending alterations:<\/em><\/h5>\n
\u00a01. Phased-in Risk Adjustment Payment Changes<\/em><\/h5>\n

CMS will initiate a phased approach to implement risk adjustment payment changes, spanning three years starting in 2024. This move, while interpreted as funding cuts by payers, intends to gradually introduce rate adjustments. As part of this adjustment, CMS projects an average payment increase of 3.32 percent for Medicare Advantage plans between 2023 and 2024.<\/p>\n

\u00a02. Revised Prior Authorization Requirements<\/em><\/h5>\n

In the 2024 final rule, CMS outlines updated prior authorization guidelines for MA plans. The new regulations stipulate that coordinated care plan prior authorization policies should solely verify diagnoses or medical criteria and ascertain the necessity of service. Additionally, MA plans are prohibited from imposing any prior authorization requirements for ongoing treatments during the first 90 days of a member’s enrollment.<\/p>\n

3. Establishment of Utilization Management Committees<\/em><\/h5>\n

Medicare Advantage plans will be mandated to institute utilization management committees, responsible for an annual review of policies. This measure aims to ensure that the policies align with the requisites of traditional Medicare, thereby enhancing oversight and conformity within the system.<\/p>\n

4. Augmented Requirements for Behavioral Health Networks<\/em><\/h5>\n

CMS will enforce heightened standards concerning behavioral health networks in 2024. These requirements entail the inclusion of clinical psychologists and licensed clinical social workers in-network. Additionally, there will be codified wait time standards for behavioral health services, aimed at facilitating timely access to crucial mental health care.<\/p>\n

5. Revamped Medicare Advantage Marketing Standards<\/em><\/h5>\n

Starting in 2023, CMS introduced new marketing standards applicable to plans offering coverage in 2024. These standards prohibit ambiguous or misleading advertising practices. Specifically, the rules mandate that advertising must reference a specific plan and prevent the misuse of the Medicare logo or language in ways that could confuse or mislead potential beneficiaries.<\/p>\n

Moreover, this year saw the implementation of new auditing standards for Medicare Advantage plans, effective in April. These standards have encountered legal challenges and are currently undergoing court proceedings.<\/p>\n

The orchestrated changes in Medicare Advantage for 2024 promise substantial improvements. Phased payment adjustments, stringent prior authorization norms, bolstered network oversight, and refined marketing standards converge to fortify care access and quality. Successful implementation and compliance are pivotal in shaping beneficiaries’ experiences and the healthcare sector’s evolution. These transformations aim to forge a more efficient, transparent, and accessible Medicare Advantage landscape.<\/p>\n","protected":false},"excerpt":{"rendered":"

In 2024, Medicare Advantage undergoes pivotal changes set by CMS. Revamping risk payments, prior authorizations, and network protocols aims to… Continue Reading <\/i><\/a><\/p>\n","protected":false},"author":1,"featured_media":10400,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[1],"tags":[],"class_list":{"0":"post-10399","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-distilinfo-originals","8":"entry"},"_links":{"self":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/10399"}],"collection":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/comments?post=10399"}],"version-history":[{"count":1,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/10399\/revisions"}],"predecessor-version":[{"id":10401,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/10399\/revisions\/10401"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/media\/10400"}],"wp:attachment":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/media?parent=10399"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/categories?post=10399"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/tags?post=10399"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}