CMS Updates Medicare Part C, D Policies for 2013
announced a final rule (pdf) on changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs, also known as Medicare Part C and Part D, effective Jan. 1, 2013.
One of the largest changes in the final rule includes a provision that gives CMS the authority to terminate the contracts of Part C and D sponsors that fail to achieve quality ratings. MA health plans and Part D drug sponsors that do not achieve at least a three-star plan rating for three straight years, beginning in 2015, could be removed from Medicare.
Other provisions of the final rule include:
• An estimated annual average reimbursement growth rate of 3.07 percent. CMS said this increase in reimbursement for MA plans will keep the area sustainable for next year.
• Improved coverage for Medicare beneficiaries in the Part D coverage gap, also known as the doughnut hole. The Patient Protection and Affordable Care Act gradually eliminates the coverage gap by 2020.
• More flexibility for physicians to assist Medicare beneficiaries in drug coverage appeals with the Independent Review Entity.
• Limits on year-over-year cost increases for MA beneficiaries.
• The ability for MA plans to limit durable medical equipment to specific "preferred" brands and manufacturers as long as the MA plan sponsor complies with government DME regulations.
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