Press Releases

CMS PROPOSES REFORMS OF COMPLIANCE REQUIREMENTS FOR MEDICARE ADVANTAGE PLANS

CMS PROPOSES REFORMS OF COMPLIANCE REQUIREMENTS FOR MEDICARE ADVANTAGE PLANS
PROVISIONS ALSO EXTEND TO PART D PRESCRIPTION DRUG PLANS

To further safeguard Medicare beneficiaries, the Centers for Medicare and Medicaid Services (CMS) today proposed strengthening its current oversight requirements and penalties for Medicare Advantage plans and Part D prescription drug plans.

In its rule, CMS proposes clarifications to Medicare program provisions relating to contract determinations involving Medicare Advantage organizations and Medicare Part D prescription drug plan sponsors, including:

• New steps to help expose potential fraud or misconduct through mandatory self-reporting; and
• Changes to streamline the process relating to intermediate sanctions and contract determinations (including non-renewals) and to better clarify the process for imposing civil money penalties.

“While the majority of Medicare Advantage and Medicare Prescription Drug Plans that offer important benefits to beneficiaries are conducting themselves professionally, it is important for CMS to be able to take swift action to safeguard beneficiaries from unlawful or questionable business practices,” Acting Administrator Leslie V. Norwalk commented.  “There should be no uncertainty -- complete compliance with Medicare rules is essential to the integrity of the program. We want to have every enforcement tool available to ensure that Medicare beneficiaries are protected.”

The proposed rule will go through a 60 day period of public notice and comment and a final rule is expected to be released later this year.

 “Medicare managed care plans and prescription drug plans have been very popular among older, disabled, low income and minority Americans,” Norwalk said. “With a growing program, it is important to ensure that the plans under contract to Medicare meet the high standards necessary to handle the health care needs of Medicare beneficiaries.”

CMS is also releasing another proposed rule which makes technical changes to the regulations implementing the Part D prescription drug benefit.  In general, the proposal makes certain technical corrections and clarifications to the January 28, 2005 final rule.  Areas addressed in the regulation include inhaled insulin, coordination of benefits, and the retiree drug subsidy, among others.

CMS also proposes, effective, 2009, to refine certain rules relating to the determination and reporting of prescription drug costs. CMS is also proposing to update the requirements of Part D sponsors to ensure adequate access to home infusion pharmacies.