HHS finalizes rule to crack down on MA marketing, streamline PA processes

WASHINGTON – The Department of Health and Human Services has finalized a rule that it says will strengthen Medicare Advantage and hold health insurance companies to higher standards by cracking down on misleading marketing. 

Per the rule, ads will be prohibited if they do not mention a specific plan name, or if they use the Medicare name, CMS logo and products or information issued by the federal government, including the Medicare card, in a misleading way. The rule also strengthens accountability for plans to monitor agent and broker activity. 

“At HHS, we put seniors and people with disabilities first,” said HHS Secretary Xavier Becerra. “That is exactly what we are doing today. In our latest effort to strengthen Medicare and hold insurance companies accountable, we are putting protections in place so that Medicare Advantage works for beneficiaries and they get the quality care they deserve. We will continue our efforts to deliver on the President’s vision to strengthen this program for the millions of people with Medicare and for future generations to come.” 

Additionally, the rule streamlines prior authorization requirements and reduces disruption for enrollees by requiring that a granted prior authorization approval remains valid for as long as medically necessary to avoid disruptions in care, requiring Medicare Advantage plans to annually review utilization management policies, and requiring that denials of coverage based on medical necessity be reviewed by health care professionals with relevant expertise before a denial can be issued.