CMS Updates Medicare Part C, D Policies for 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.
More Articles on Medicare Advantage and Medicare Part D:
© Copyright ASC COMMUNICATIONS 2016. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.
To receive the latest hospital and health system business and legal news and analysis from Becker's Hospital Review, sign-up for the free Becker's Hospital Review E-weekly by clicking here.