C-TAC regularly monitors and comments on federal regulations as part of our ongoing dialogue with the Biden Administration on behalf of those living with serious illness. This is a mechanism to help shape Medicare programs and measures on their behalf. Throughout the year, there are various comment opportunities including the ability to comment on proposed regulations, Requests for Information (RFIs), and on proposed or potential measures. Submitted comments are posted on the C-TAC website and in our newsletters.
Since the beginning of the year, C-TAC has advocated for those with serious illness by commenting on the following proposed regulations:
CY 2025 Medicare Advantage (MA) Proposed Rule
We supported the following proposals:
- To require that Special Supplemental Benefits for the Chronically Ill be supported by evidence as to whether benefit has reasonable expectation of improving health or overall function.
- The addition of an annual health equity analysis of utilization management policies and procedures like prior authorization to identify and address any disparities there.
- Adding enhanced guardrails for agent and broker compensation to protect beneficiaries.
- Stronger marketing and communications requirements for supplemental benefits for the chronically ill to reduce predatory practices.
MA Proposed Advance Notice Measure
We commented in support of the following proposed changes to measures for the MA program:
- Cross-cutting: Gender-Affirming Quality Measurement to include all pertinent individuals in appropriate measures
- Follow-Up After Hospitalization for Mental Illness to broaden the mental illnesses included in this measure
- Exploration of a new measure to track Social Connection Screening and Intervention
- We also suggested adding the Felt Heard and Understood communication measure and palliative care referral and hospice referral measures in the future
Proposed Rule on Patient Status Change Appeals Process
We commented in support of this proposed rule’s elements:
- The court-ordered appeals process for patients admitted but then changed to observation status. Such changes cause unanticipated bills and potential financial hardship. While the process of changing patient status was not up for comment, the now required appeals processes were.
- There are three proposed appeals processes: one for those whose status changes who want to start an appeal while still in hospital, one for those to appeal after discharge, and a third for those affected by such changes going back to 2009.
- Medicare will revise the form notifying patients of status change to include appeals information and C-TAC advocated for that form to be as clear as possible and that those affected also get help pursuing any appeals.
