CMS Updates Medicare Part C, D Policies for 2013

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CMS 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.

More Articles on Medicare Advantage and Medicare Part D:

Medicare Advantage Audits Estimated to Recover $370M

NEJM: Medicare Advantage Plans With Gym Perks Attract Healthier Seniors

HHS: Health Law Helped Medicare Beneficiaries Save $2.1B on Drugs in 2011

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