CMS issues additional guidance to clarify new MA regulations

9 minute read

On April 5, 2023, the Centers for Medicare & Medicaid Services (CMS) published an expansive final rule amending Medicare Advantage (MA) regulations related to, among other things, coverage criteria and prior authorization.[1] Publication of the final rule was applauded by healthcare providers, which for years have expressed frustration about MA organizations (MAOs) inappropriately delaying and denying coverage for medically necessary care.[2] The rule took effect on June 5, 2023, with the provisions in the final rule applicable to coverage beginning January 1, 2024.[3]

On February 6, 2024—nearly a year after the final rule was published—CMS issued a set of FAQs to clarify how it expects MA plans to comply with the new regulations.[4] This article provides an overview of the guidance set forth in those FAQs.

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