Contract Year (CY) 2024 Policy and Technical Changes to the Medicare Advantage(A) and Medicare Part D Benefit Programs Utilization Requirements

Beginning Jan. 1, 2024, Centers for Medicare Care & Medicaid Services (CMS) is requiring Medicare Part C plans to offer new members a 90-day continuity of care, or transition period, for active / current treatments for Part C drugs and services. To ensure that your patients do not experience any disruption in treatment after the 90-day transition period, we may require additional information from you to determine if the drugs and / or services being provided are determined to be a continuation of an active course of treatment. 

Also, as a result of the CY 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly, changes have been made to the Blue Cross and Blue Shield of North Carolina Blue Medicare Advantage℠ Medical Policies.  

Moving forward, if there is not a National Coverage Determination (NCD) or Local Coverage Determination (LCD) in existence for the service or procedure requested, Blue Cross and Blue Shield of North Carolina Blue Medicare Advantage will provide criteria that is publicly available and meets CMS guidelines for how criteria is established. To access the Medicare Coverage Database, please visit the MCD Search page.