Statement on Medicare Advantage and Medicare Prescription Drug Benefit Proposed Rule

By Soumi Saha, Senior Vice President, Government Affairs

Premier applauds the Centers for Medicare & Medicaid Services (CMS)’ efforts to put in place more prescriptive policies to streamline the prior authorization process and ensure that health plans are not inappropriately delaying or denying coverage for necessary services. Taken together, these changes will empower providers' clinical decision-making and protect beneficiaries’ access to care. Coupled with CMS’ recent proposal to require electronic prior authorization, these protections will go far in modernizing what is now a burdensome, highly-manual and costly process that can lead to wasted time, resources and harm to patients.

Premier also supports CMS’ proposals aimed at advancing health equity, including by establishing a health equity index in the Star Ratings program to reward plans that are improving care for underserved populations. This should serve as an effective lever to incentivize plans to identify and then address disparities in care provided to enrollees with a particular social risk factor, with the goal of eliminating these gaps.

Finally, Premier is encouraged to see in the proposed rule provisions to strengthen network adequacy requirements for providing behavioral health services. The pandemic has underpinned the dire need to remove barriers and improve access to behavioral health. Reaffirming Medicare Advantage organization’s responsibilities to provide behavioral health services is an important component to ensuring that all Americans can find the care they need.

Premier looks forward to working with CMS to refine these and other policies.