This week, the Centers for Medicare & Medicaid Services (CMS) released proposed rules for the 2013 plan year governing Medicare Part C, which covers Medicare private insurance plans known as Medicare Advantage plans, and Part D, the Medicare prescription drug benefit. The rules cover a variety of issues within Part C and Part D, including plan quality, increased transparency, and further elimination of fraud, waste, and abuse.
For example, the proposed rules grant CMS regulatory authority to terminate Medicare contracts with plans that consistently perform poorly—in other words, plans that fail to receive at least three stars (on a quality scale of one to five) in three consecutive years. In addition, the rules also address conflicts of interest that create incentives for the inappropriate use of prescription drugs, such as anti-psychotics in long-term care facilities. Such improper prescribing practices may not only result in waste in the Medicare program, but also potentially put patients’ safety at risk, according to a recent report by the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG). In an effort to further eliminate waste in the program and save money for beneficiaries, the rules allow providers and patients in certain situations the option of requesting and paying cost-sharing for a short-term supply (less than 30 days) of a drug—for example, when a doctor prescribes a trial fill of a treatment.
In addition, the proposed rules codify parts of the Medicare Improvements for Patients and Providers Act (MIPPA) that expand access to benzodiazepines and, for certain health conditions, barbiturates, and important improvements to Medicare included in the Affordable Care Act (ACA), such as the closure of the Medicare prescription drug coverage gap. As a result of the ACA, from January to August of this year nearly 1.8 million people with Medicare received discounts on brand-name drugs during the coverage gap, with total savings over that period reaching almost $1 billion.
Read the proposed rule.
Read Medicare Rights Center President Joe Baker’s statement on the rule.
Read CMS’s release on the closure of the Medicare prescription drug coverage gap and the increasing popularity of new preventive benefits.
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Another good post John! I came across this post while searching Medicare Part d plans.
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