CMS proposes new regulations for Medicare Advantage Plans and Medicare Prescription Drug Plans

The Federal Government’s Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule to revise the Medicare Advantage (MA) program (Part C) regulations and prescription drug benefit program (Part D) regulations. The rule applies provisions of the Health Reform law to Medicare Advantage Plans and the Medicare prescription drug program.   

The new regulation will give CMS authority to terminate Part C and Part D sponsors which perform poorly. CMS says that the rule will also strengthen beneficiary protections; improve program efficiencies; and clarify program requirements. CMS is also considering changes to the long term care facility conditions of participation pertaining to pharmacy services.

CMS is the federal regulatory agency that administers the Medicare program and works in partnership with state governments to administer Medicaid and the State Children's Health Insurance Program (SCHIP) program. Regulatory agencies like CMS must create regulations according to processes specified in the Administration Procedure Act (APA). The APA requires agencies to publish all proposed new regulations in the Federal Register for at least 30 days before they take effect, and to allow interested parties to comment. CMS is allowing a 60 days comment period for this new Part C and Part D proposed rule. 

Joe Baker, President of the Medicare Rights Center issued a press release offering initial support for the new rule, which he says “supports continued improvements to consumer protections and quality of care in Medicare Advantage and under the Medicare prescription drug benefit, as outlined in new proposed rules from the Centers for Medicare & Medicaid Services (CMS). The rules strengthen CMS’s oversight ability and raise the quality bar by, for example, allowing the agency to terminate plans with consistently poor performance. Inspired by the experiences of the Medicare beneficiaries we counsel, who often find the private Medicare market overwhelming and difficult to navigate, the Medicare Rights Center has been a long-time advocate for policies that create meaningful, understandable choices for people with Medicare. We believe this policy improves the beneficiary experience by emphasizing the importance of the quality—rather than the quantity—of plans available.   

Also of note, the rules aim to eliminate conflicts of interest that create waste and harmful incentives to inappropriately prescribe prescription drugs in long-term care facilities. This will help protect patients whose safety is at risk as a result of improperly prescribed powerful drugs, such as anti-psychotics.”  

The proposed rule is available at http://www.ofr.gov/OFRUpload/OFRData/2011-25844_PI.pdf.  

Related post: Changes Coming to Medicare Advantage Plans