CMS Publishes CY 2025 Medicare Advantage Proposed Rule

Reimbursement; Regulations; Skilled Nursing Facilities (SNF)

The Centers for Medicare & Medicaid Services (CMS) recently published its contract year (CY) 2025 Medicare Advantage and Part D proposed rule. The proposed rule furthers beneficiary protections by including an independent, fast-track appeals process for non-hospital services, curbs inappropriate marketing practices, expands access to behavioral health services, promotes health equity and further advances Medicare-Medicaid integration. 

Comments are due by 5 PM Eastern on January 5, 2024.

AHCA/NCAL has developed a member-only summary of the proposed rule (member log-in required) and will continue analyzing it prior to submitting comments. Please reach out to Nisha Hammel for additional information on this topic or to provide feedback within the comment period.

In addition to this effort, AHCA/NCAL has been working as part of a coalition with other post-acute care associations and the Center for Medicare Advocacy. This group recently submitted a letter​ to CMS on the CY2024 MA Final Rule requesting subregulatory guidance to ensure that the constraints around prior authorizations and medical necessity provisions included in the final rule are adhered to and plans are held accountable.