Last month, Senators Maggie Hassan (D-NH) and Roger Marshall, M.D. (R-KS) introduced the Medicare & You Handbook Improvement Act (S.5117), which would improve the information that Medicare beneficiaries receive during the annual open enrollment period. If enacted, the bill would require the Centers for Medicare and Medicaid Services (CMS) to explain the different kinds of utilization management to beneficiaries, as well as inform beneficiaries how they can find out which of these tactics apply in the various Medicare Advantage (MA) or Part D plans they might be considering enrolling in.
Critically, CMS would also be required to explain to beneficiaries that, if they choose to leave traditional Medicare for MA, they may be limited in their supplemental coverage, should they decide to switch back to traditional Medicare at a later time. (Many beneficiaries are unaware of this when they first enroll in MA and only become aware when they try to return to traditional Medicare but can no longer obtain wraparound coverage, which is why this is a critical piece of information, particularly for beneficiaries with chronic, high-cost illnesses, including rheumatoid arthritis.)
Given that the Senate bill was introduced so late in the year, it is unlikely that it will become law before the Congress adjourns. However, both of the lead sponsors will return in the next Congress and hold memberships on the Committees with jurisdiction over healthcare issues. CSRO will remain engaged with these offices in the new Congress on this and other efforts related to utilization management, and will continue to keep you updated.
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