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PACE, MAP, and Medicare Advantage

PACE, MAP, and Medicare Advantage

CMS Proposal Projects 3.7 Percent Payment Increase for Medicare Advantage

The Advance Notice makes methodology changes and proposes CY 2025 payment levels for Medicare Advantage plans.

February 15, 2024

PACE, MAP, and Medicare Advantage

DOH, Deloitte Review Update to PACE Rates

The update incorporates the impact of minimum wage increases and other State policy changes into April 2023 rates.

January 30, 2024

PACE, MAP, and Medicare Advantage

CMS Issues Interoperability and Prior Authorization Final Rule and Medicare Advantage RFI

The Interoperability and Prior Authorization Rule is intended to improve health information sharing among payers, providers, and patients, and improve prior authorization turnaround times for Medicare Advantage, Medicaid fee-for-service, and Medicaid managed care. The Request for Information seeks input into the collection and publication of Medicare Advantage data.

January 29, 2024

PACE, MAP, and Medicare Advantage

Guidance for PACE and Part D Sponsors on COVID-19 Prescription Antivirals

The guidance is intended to ensure that claims for oral antivirals are processed appropriately to serve the goals of ensuring beneficiary access to these medications at no cost sharing for as long as possible and utilizing supply that has already been procured by the U.S. government.

January 16, 2024

PACE, MAP, and Medicare Advantage

DOH Finalizes Supplemental PACE Rates

Revised April 2023 Medicaid rates reflect minimum wage increases, as well as hospital, nursing home, and behavioral health rate updates.

January 9, 2024

PACE, MAP, and Medicare Advantage

Medicare Advantage Regulations Impose Limits on Utilization Management

Key provisions of the regulations take effect on Jan. 1, 2024 and require Medicare Advantage coverage decisions to be no more restrictive than fee-for-service Medicare, limit the uses of prior authorization, and require physician-ordered sites of service to be honored.

December 18, 2023

PACE, MAP, and Medicare Advantage

Proposed Medicare Advantage and PACE Regulations Offer Additional Beneficiary Protections

On Nov. 6, 2023, CMS posted a proposed rule that would revise the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, PACE, and certain health information technology standards. The proposed regulations are intended to strengthen beneficiary protections and ensure that Medicare Advantage plans meet the needs of beneficiaries.

November 13, 2023

PACE, MAP, and Medicare Advantage

CMS Issues Various Memos for Medicare Advantage and PACE Plans

Plans should preview their 2024 "Medicare and You" Handbook data and verify their HPMS crosswalk data for accuracy and completeness.

August 7, 2023

PACE, MAP, and Medicare Advantage

DOH Prepares PACE Program Payments

Initiative backed by enhanced federal HCBS funding is aimed at supporting and growing PACE.

June 6, 2023

PACE, MAP, and Medicare Advantage

Updates to PACE Quality Reporting and Monitoring Forthcoming

CMS updates quality reporting requirements for PACE and Medicare Advantage for 2024 and notifies PACE organizations of upcoming changes to the Quality Monitoring module.

May 16, 2023
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