Proposed Rule Would Allow CMS to Exclude Poor-Performing Medicare Advantage, Part D Participants

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A new proposed rule could give CMS the ability to eliminate Medicare Advantage and Medicare Part D participants that fail to achieve at least a three-star rating under CMS' five-star plan rating system for a period of three years.

Other conditions of the proposed rule include the following:

•    Implementation of the Part D coverage gap discount program.
•    Expansion of Part D drug coverage to include benzodiazepines and, for specified health conditions, barbiturates.
•    Expansion of benefits for dual-eligible patients.
•    Ability for physicians to request reconsiderations with the Independent Review Entity on their patient's behalf without obtaining a signed authorized representative form if a prescription is denied by a Part D plan.
•    Requirement of Part D sponsors to provide, in certain cases, the option of a daily prorated cost-sharing rate for prescriptions for fewer than 30 days.

The proposed rule is open to a 60-day comment period.

Related Articles on CMS Proposed Rules:

HHS Publishes 2 Proposed Rules Regarding Affordable Health Coverage
CMS Issues Final IPPS Rule, Net Medicare Reimbursements to Increase 1.1%
CMS Releases Proposed Standards for CO-OP Insurance Plans

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