CMS’ Medicare Benefit Policy Manual
The Medicare Benefit Policy Manual is published online by the U.S. Centers for Medicare & Medicaid Services, or CMS. Its used by health care providers, contractors, Medicare Advantage companies and…
Discussed are concerns about access to care, enforcement of rules, and transparency in the current MA system and how the priorities of the incoming administration and Congress may prioritize growing MA plans over addressing these foundational issues.
In this episode, Nicole Fallon, vice president of integrated services and managed care for LeadingAge, breaks down what we know about the future of MA.
First up: What happens to updated rules for MA plans proposed by the Centers for Medicare & Medicaid Services in November? They called for more limits on artificial tools and automated denials of care, strategies that a 2024 Senate report found were being employed frequently to cut off access to post-acute services, particularly in nursing homes.
What happens next with those proposals is unknown, says Fallon, noting that such policy updates are not required annually, although payment updates (also still pending approval for 2026) are.
O’Connor, J. (2025, February 5). Mid-stream shift: Trump team to weigh unfinished Medicare Advantage coverage rules, program’s future. McKnight’s Long-Term Care News. https://www.mcknights.com/podcasts/mid-stream-shift-trump-team-to-weigh-unfinished-medicare-advantage-coverage-rules-programs-future/
Gain clarity on the Medicare Advantage payer rates and contract terms bogging down your team and affecting reimbursements.
