New Rules from CMS Toughen Requirements for Medicare
Drug and Health Plans
Says Part C & D revisions intended to improve
protections for enrollees, enhance transparency, clarify plan
requirements
Oct. 12, 2009 - The Centers for Medicare & Medicaid
Services (CMS) on Friday issued a proposed rule the agency says will
improve performance of prescription drug and health plans by
strengthening standards to participate in the Medicare program.
One of the ironies in all of this is that the
strongest critics of health care reform, and those most worried about
government involvement in health care, are seniors, who are satisfied
with their Medicare-provided health care
The proposed changes would clarify program
requirements for the more than 4000 prescription drug and health plans
offerings and improve protections for Medicare beneficiaries enrolled in
these plans.
The proposed enhancements would strengthen Part C
and Part D performance requirements, extend greater protections to
people with Medicare, and ensure that companies offering more than one
drug or health plan in the same areas offer meaningful differences
between those plans.
Jonathan Blum, acting director of CMSs Center for
Health and Drug Plan Choice, said the agency is seeking to improve the
overall performance of the program to ensure that the program remains
strong and that Medicare beneficiaries have meaningful drug and health
plan choices to make the best possible decisions about their coverage.
CMS is strengthening and simplifying the drug and
health plan program in order to deliver a level of service that is more
responsive to Medicare beneficiary needs, Blum said.
While CMS made important improvements through the
2010 contracting process, these rules will enable the agency to make
further improvements.
Specifically, among other things, CMS is proposing
to:
Medicare's Annual Open Enrollment is from Nov. 15 -
Dec. 31
Each year drug and other plans change what they cost and what they
cover. The next general open enrollment starts on November 15, 2009.
During this time, people with Medicare can add, drop or change their
prescription drug coverage. They can also select a health plan for their
2010 coverage.
You'll find helpful Medicare tools and information
on this page. Use these resources to compare the cost or benefits of
Medicare health plans in your area.
Get answers to your Medicare
questions. Learn how to lower health care costs and stay healthy.
● Strengthen CMS ability to identify and
approve qualified drug and health plans;
● Improve Medicare beneficiary protections from
discriminatory cost sharing by clarifying health plan requirements
relating to out-of-pocket costs and cost-sharing, and
● Eliminate duplication in drug and health plan
bids submitted by the same organization by requiring a meaningful
difference between an organizations product offerings with regard to
premiums, beneficiary out-of-pocket costs, plan types, and formulary
offerings.
Additional clarifications include a proposal to
collect all prescription drug event data elements for non-payment
purposes, to provide more accurate information for analysis of how
people with Medicare are using their Part D plan benefits.
The proposed rule would also clarify that, by 2011,
both Part C (MA) and Part D plans will be expected to pay for the data
collection costs associated with the annual Consumer Assessment of
Healthcare Providers and Systems (CAHPS) enrollee satisfaction surveys
performed by independent contractors.
The proposed rule would also clarify protected drug
categories and classes under the Medicare Improvements for Patients and
Providers Act of 2008 (MIPPA), and issue that was previously addressed
in a January 2009 interim final rule.
Finally, the proposed rule also would make other
several refinements and technical changes to the Part C and Part D
regulations.
This rule will publish on Oct 22, 2009 at the
Federal Register.
Over the next 60 days, CMS will receive comments on
the proposed revisions to the Medicare Advantage (MA) program (Part C)
and Prescription Drug benefit program (Part D).
The comment period for this proposed rule will
close on December 8, 2009.
Keep up with the latest news for senior citizens, baby
boomers
Oct. 12, 2009 - The Centers for Medicare & Medicaid
Services (CMS) on Friday issued a proposed rule the agency says will
improve performance of prescription drug and health plans by
strengthening standards to participate in the Medicare program.
