Press Releases

CMS PROPOSES NEW RULES FOR MEDICARE ADVANTAGE AND PRESCRIPTION DRUG PLANS TO BETTER SERVE BENEFICIARIES

Part C & D revisions intended to improve protections for all enrollees, including vulnerable populations, enhance transparency & clarify plan participation requirements

The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule to improve performance of prescription drug and health plans by strengthening standards to participate in the Medicare program.

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 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 CMS’s 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:

• 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 organization’s 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.  

 The comment period for this proposed rule will close on December 8, 2009.

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