January 20, 2022

AIS Health Turns to Mike Adelberg for Insight on Two Proposed CMS Rules

In AIS Health’s RADAR on Medicare Advantage publication, Faegre Drinker Consulting Principal Mike Adelberg addressed two proposed rules from the Centers for Medicare & Medicaid Services (CMS) regarding more oversight of third-party marketing organizations (TPMOs) and pharmacy direct and indirect remuneration (DIR) reform.

According to the publication, in its latest Medicare Advantage (MA) and Part D proposed rule, CMS said it believes “additional regulatory oversight” is needed to protect beneficiaries. Adelberg stated, “If finalized as proposed, CMS will have a stronger hand to hold Medicare Advantage organizations (MAOs) accountable for the activities of leads generators — and this could shake relationships between MAOs and brokers, and brokers and their sources for leads.”

RADAR on Medicare Advantage also reported on the CMS proposed rule largely aimed at increasing MA plan accountability and strengthening beneficiary protections. For the most part, the newly proposed “regulation restores Obama administration policies in many cases,” Adelberg noted. “It’s a pendulum swing toward greater oversight, but CMS pulls up short of a maximalist regulatory posture on most of the topics.”

The full article is available for RADAR on Medicare Advantage subscribers.

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