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Reinterpretation of the Uniformity Requirement

Posted on Friday, May 4, 2018 3:41 PM

In April, CMS announced the reinterpretation of the uniformity requirement for Medicare Advantage (MA). 

“Under this reinterpretation, CMS determined that providing access to services (or reductions in specific cost sharing and/or deductibles for services or items) that are tied to health status or disease state in a manner that ensures that similarly situated individuals are treated uniformly is consistent with the uniformity requirement in the MA regulations. These targeted benefits must provide for equal treatment of enrollees with the same health status or disease state for whom such services and benefits are useful and consistent with equal access and antidiscrimination provisions.

The requirement for uniform bids and premiums of the Act remains applicable, and therefore, plan premium and Part B premium buy-down amounts must be the same for all enrollees in the plan or plan segment. CMS’s reinterpretation of the uniformity requirements applies only to Part C benefits.”

Click here to read the full CMS memo.


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