Illustration: Maura Losch/Axios
Medicare Advantage and Medicare prescription drug plans could soon be subject to even tighter marketing standards under a rule proposed by CMS on Wednesday.
Why it matters: Lawmakers have started to make noise about bad Medicare Advantage marketing tactics. CMS has already tightened marketing requirements for plans, and this latest proposal sets the stage for more congressional action.
The details: CMS wants to ban ads that don’t mention a specific plan name and sales presentations that come immediately after educational events.
- CMS also seeks a crackdown on plans using the Medicare name or logo in ways that might confuse consumers.
- Under the rule, sales agents would have to ask a list of standardized questions about beneficiaries’ health history before enrolling them in a plan. They would also have to inform consumers of official information sources, like Medicare.gov.
- The rule would also impose network adequacy requirements on plans, create new requirements to provide culturally competent care and boost access to behavioral health in Medicare Advantage networks.
Between the lines: CMS is revisiting Medicare Advantage marketing in part because of comments it received in the last year.
- "It presented a good opportunity to continue to iterate in collaboration with everyone," Meena Seshamani, CMS deputy administrator and director of the Center for Medicare, told Axios in an exclusive interview.
- The Senate Finance Committee recommended that CMS increase Medicare Advantage marketing oversight in a November report.
CMS also proposed new prior authorization policies that would work in tandem with a rule on electronic prior authorization released earlier this month.
- Changes would include making prior authorization approvals valid for a patient's full course of treatment and requiring plans to create utilization management committees to annually review their policies.
