Medicare Rights Offers Comments on Part C and D Rules

Last week, the Medicare Rights Center submitted comments developed with fellow consumer advocates to the Centers for Medicare and Medicaid Services (CMS) on its proposed rules governing Part C Medicare private health plans, also known as Medicare Advantage (MA) plans, and the Part D Medicare prescription drug benefit for plan year 2013. The comments are generally supportive of the proposed regulations, which encourage increased transparency and greater plan accountability, though they also urge CMS to further strengthen some of these policies.

Specifically, the comments ask CMS to strengthen a proposed rule that codifies CMS’s authority to terminate contracts with poorly performing plans that receive a one or two star rating for three consecutive years. The comments urge CMS to decrease the number of years after which it can terminate plan contracts on the basis of poor ratings. In addition, the comments suggest the creation of probationary periods for plans that avoid termination by increasing their quality ratings, but have a history of poor performance.

Furthermore, the comments address issues that may arise as MA plans implement new coverage policies for durable medical equipment (DME). As CMS allows MA plans to create preferred DME brands and suppliers and to limit coverage to those brands and suppliers, CMS must ensure that an easily accessible exceptions process exists for patients. The exceptions process should include, for instance, coverage of equipment from a non-preferred provider when DME from the non-preferred provider is medically necessary.

Medicare Rights’ comments also applaud CMS for proposed regulations that seek to eliminate conflicts of interest for consultant pharmacists working in long term care settings. Recent reports demonstrate that associations with drug companies and other entities may cause pharmacists to favor prescribing certain drugs, even when these drugs are potentially inappropriate or dangerous for patients.

Among other topics also discussed in the comments are the need for clarification of rules around Special Needs Plans and extra benefits they may offer, as well as suggested improvements to rules implementing the coverage gap discount program for the Part D benefit.