CMS seeks to revise key parts of MA plans, Part D

CMS plans to install the newest round of health reform changes for Medicare Advantage (MA) and Part D plans such as closing the donut hole and more MA benefits set to take effect in 2013 via the Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs proposed rule, an Oct. 3 CMS news release says. 

Some of the proposed changes are:

• Coverage Gap Discount program. CMS will codify existing sub-regulatory guidance for the program and address any operational issues.
• Part D coverage expansion. Increase number of drugs required covered by Part D plans including benzodiazepines and barbiturates for specified health conditions.
• Less red tape for providers. Permit physicians to request reconsiderations if a drug is denied under Part D with the Independent Review Entity on patient’s behalf without obtaining a signed authorized representative form.
• Higher standards for MA plans. CMS will have the authority to terminate poor performing MA and Part D carriers for three years if they have less than a three-star rating under CMS’s five-star plan rating system.
• More benefits for dually qualified patients. Give the Fully Integrated Dual Eligible Special Needs Plans the flexibility to offer supplemental benefits beyond those allowed for current MA plans including home health non-skilled nursing activities and in-home food delivery. 
• More flexibility for Part D prescriptions. Require Part D carriers to allow a cost-sharing rate for prescriptions for fewer than 30 days in certain cases in order to order trial fills for initial prescriptions and for patients to synchronize when their multiple prescription drugs are available for refill.
• Streamline Claims Filing. Allow Part D carriers to submit prescription drug event records with the prescribers’ national provider identifiers.

NOTE: CMS is accepting public comments on the rule and you can submit yours www.regulations.govfor 60 days after the rule is published in the Federal Register.