CMS Finalizes Key Beneficiary Protections in Medicare Advantage and Part D
Late last week, the Centers for Medicare & Medicaid Services (CMS) finalized Medicare Advantage (MA) and Part D regulations. Under the new provisions, which were first proposed in January 2014, MA and Part D prescription drug plans are affected in a number of ways. Some parts of the January 2014 proposed rule were finalized in May, 2014. Some of most recently finalized rules include the following:
• Prevention of inappropriate practices by private health insurance companies that submit applications (known as bids) to CMS to offer Part D prescription coverage to Medicare beneficiaries where they later withdraw their bid after learning that CMS will not automatically enroll potentially more profitable Medicare beneficiaries into their plan. Plans that withdraw will not be allowed to bid to offer Part D coverage for two years.
After CMS’s release of the proposed rule in January 2014, Medicare Rights Center President Joe Baker testified about it to the House Energy and Commerce Committee. Mr. Baker encouraged regulatory policy makers at CMS to adopt parts of the proposed regulation that strengthened beneficiary protections in MA and Part D plans. At the same time, Mr. Baker warned against finalizing some of the proposed changes—including a proposal to relax protections that help ensure access to certain medications for Medicare beneficiaries with serious health conditions. That proposal was not finalized in May or in this most recently released final rule.
• Medicare Advantage Prescription Drug (MAPD) private health plans, which offer managed hospital (under Medicare Part A), medical (under Part B), and prescription drug benefits (under Part D) to their enrollees, must establish a process to ensure that prescription drugs which may be covered under either Medicare Part A or Part B, or under Part D, are properly processed and approved for coverage by the plan. The Medicare Rights Center regularly receives calls to its national helpline from beneficiaries enrolled in MAPD plans whose plans deny coverage for a medication under Part D because it was coverable under another part, and whose plans did not then authorize or provide a process to authorize coverage for that same medication under the MAPD plan’s Part A or Part B benefit. Under the new rules, MAPD plans are directed to resolve these issues with little or no beneficiary involvement.
• Changes to CMS’ ability to require MA and Part D plans to hire an independent auditor to verify certain data MA and Part D plans submit to CMS in response to required corrective actions.
The CMS Press Relase