Under the "Contract Year 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(88 FR 22120)" Final rule issued April 12, 2023 by the Department of Health & Human Services, Centers for Medicare & Medicaid Services, MA organizations must comply with new requirements pertaining to the development, appropriateness, and public accessibility of internal coverage criteria. The point of the release of these policies has nothing to do with communication to employees or plan participants, but instead, in the name of transparency, this rule requires MA organizations to publicize their coverage policies their utilization management program uses to determine coverage and make that available to the public.
The following list of services are reviewed for medical necessity here. Memorial Hermann Health Plan utilizes InterQual® criteria which can be found here.