On January 5, NAMD formally commented on CMS’s Medicare Contract Year 2025 proposed rule, which included several policies that would impact care for individuals who are dually eligible for Medicare and Medicaid. These policies include changes aimed at increasing the percentage of dually eligible members who receive Medicare and Medicaid benefits through the same managed care organization, limits on out-of-network cost sharing for Dual Eligible Special Needs Plan (D-SNP) Preferred Provider Organizations, lower thresholds for D-SNP “look-alike” plans, and changes to Medicare Advantage data sharing.
NAMD strongly supports these proposed changes. The current system of care for dually eligible individuals is fragmented, which leads to worse health outcomes for members and inefficiencies in care delivery that drive increased health expenditures. The proposed changes would help address these challenges by increasing the percentage of dually eligible members who are enrolled in integrated plans, protecting members from misleading marketing, and supporting Medicaid agencies’ ability to coordinate care.