1 Analyses of this federal-register by attorneys

  1. Increased Scrutiny into Agents & Brokers in the Medicare Advantage Space

    Sheppard Mullin Richter & Hampton LLPApril 17, 2024

    For more information on the final rule’s changes to the Part C and Part D marketing rules as well as other provisions of the final rule, please read our other blog post available here.[i] 42 CFR 422.2274, available here; An MAO is defined as “a public or private entity organized and licensed by a State as a risk-bearing entity (with the exception of provider-sponsored organizations receiving waivers) that is certified by CMS as meeting the MA contract requirements.” An “MA Plan” means “health benefits coverage offered under a policy or contract by an MA organization that includes a specific set of health benefits offered at a uniform premium and uniform level of cost-sharing to all Medicare beneficiaries residing in the service area of the MA plan. See 42 CFR 422.2, available here.[ii] 42 CFR 422.2274(d), available here.[iii] 42 CFR 422.2274(e), available here.[iv]Id.[v] 42 CFR 422.2274(f), available here.[vi]Id.[vii] Medicare Program; Contract Year 2025 Policy and Technical Changes, 88 Fed. Reg. 78476 (proposed Nov. 15, 2023), available here.[viii]https://public-inspection.federalregister.gov/2024-07105.pdf[ix]Id.[x]Id.[xi]Id.[xii]Id.[xiii]Id.[xiv]Id.; see also Levinson, Daniel R., Beneficiaries Remain Vulnerable to Sales Agents’ Marketing of Medicare Advantage Plans, Dept. of Health & Human Servs., March 2010, available here.[xv]Id.[xvi]Id.[xvii]https://www.regulations.gov/document/CMS-2023-0187-0376/comment[xviii]https://mobile.reginfo.gov/public/do/eoDetails?rrid=416811[xix]https://www.federalregister.gov/d/E8-21686[xx]https://www.finance.senate.gov/imo/media/doc/Deceptive%20Marketing%20Practices%20Flourish%20in%20Medicare%20Advantage.pdf[xxi]https://www.ecfr.gov/current/title-42/part-422/subpart-V[xxii]https://www.finance.senate.gov/hearings/medicare-advantage-annual-enrollment-cracking-down-on-deceptive-practices-and-improving-senior-experiences[xxiii]https://www.finance.senate.gov/chairmans-news/wyden-questions-medicare-marketers-business-tactics[xxiv]https://www.justice.gov/opa/speech/principal-depu