CMS has issued a Proposed rule containing policy and technical changes to the Medicare Advantage (MA) and Part D prescription drug plans. The proposed changes are designed to strengthen MA and Part D performance requirements, extend greater protections to enrollees, and ensure that companies offering more than one drug or health plan in the same areas offer meaningful differences between those plans.
Three specific proposals
When the Medicare Modernization Act required that the Part D benefit afford each enrollee a minimum of two choices in each plan region, CMS did not envision that each enrollee would have a choice from among dozens of plans with various benefit packages. With so many plans to choose from, many beneficiaries find the annual task of selecting one plan overwhelming and confusing. Moreover, organizations submitting bids with multiple plans have not consistently submitted plan benefit designs that are significantly different from each other, which adds to beneficiary confusion. As a result, many Part D beneficiaries do not necessarily enroll in the lowest cost plan and many eligible individuals are not enrolled in the low-income subsidy program. Finally, once beneficiaries have chosen a plan, they tend to remain in those plans, despite changes in medication use or premium increases.
As a result, CMS is making three specific proposals to simplify the program for beneficiaries: (1) to require sponsors to ensure that when they provide multiple plan offerings, those offerings sufficiently differ and thereby provide beneficiaries meaningful options; (2) to eliminate plans with persistently low enrollments, since these can add complexity to choices without adding value; and (3) to require sponsors to use standardized "templates" in their beneficiary communication materials (such as the Annual Notice of Changes (ANOC) and the Evidence of Coverage (EOC) notices), so that beneficiaries can understand how their current benefits and cost-sharing requirements will be changing and more easily compare their current plan with other plan options.
Issues offered for comment
CMS believes that more can be done to structure choices for beneficiaries to aid them in making better plan choices. Studies have suggested that providing personalized drug utilization and cost information to beneficiaries can encourage seniors to switch to plans that better meet their medication needs while reducing their overall costs. Some studies have urged that CMS can do more to provide improved individual drug utilization and cost information to beneficiaries to encourage seniors to switch to lower-cost plans. Other studies have found that some beneficiaries are not fully aware of the financial implications of deferring enrollment in drug plans. CMS invites comments on these possibilities and other improvements the agency can make, to help beneficiaries choose the plans that best suit their needs.
CMS also invites comment on the type of research that might be undertaken to help inform future regulatory and programmatic improvements and how we can best support our partners, such as states, to assist them in helping beneficiaries enroll in the best possible plans. CMS is interested in assessing the impacts of random auto-assignments on low-income beneficiaries. To the extent that States are interested in exploring non-random assignment methods, CMS invites comment on what type of information States would find most beneficial.
Additional proposals
Improving sponsor performance. Existing program rules and regulations have limited CMS actions to improve sponsoring organization performance. As a result, CMS is proposing to limit the number of plan offerings by eliminating duplicative bids, and strengthen program participation requirements.
Strengthening beneficiary protections. CMS is proposing a number of provisions aimed at strengthening existing beneficiary protections, such as strengthening the plan transition process requirements to ensure maximum transparency regarding CMS expectations of Part D plans with respect to enrollees transitioning to the plan from other drug coverage and to ensure that current subregulatory practices are codified in regulation.
Data collection expansion. CMS is proposing another set of provisions that are aimed at improving payment rules and processes, and improving data collection for oversight and quality assessment. This set of provisions would expand the collection of prescription drug event data currently limited to research and other non-payment related purposes. This additional data, would provide additional information to conduct analyses that may be used to improve policies and assist in monitoring of Part D plan sponsors. In addition, the proposal would clarify that, by 2011, both the Part C and D plans will be expected to pay for the data collection costs associated with the annual Consumer Assessment of Healthcare Providers and Systems (CAHPS) enrollee satisfaction surveys performed by independent contractors.
Formulary policy. A significant new Part D formulary policy is proposed in this rule. CMS proposes a regulatory interpretation of the MIPPA protected drug categories and classes provision previously addressed in a January 16, 2009 interim final rule (IFR) with comment period (74 FR 2881, ¶180,883). Based on comments to that IFC, CMS believes that interpretation of statutory terms is needed, along with clarification of the process used to identify the protected categories and classes of drugs that must be listed on all Part D plan formularies.
Clarifications and technical corrections. Finally, CMS proposes provisions that are designed to clarify existing policy and make technical corrections. As a result, the proposed rule outlines and clarifies some of the topic areas that were included in the 2010 call letter to Part C and D plans, the document that outlines policy clarifications and reminders for plans bidding on plan offerings in the coming contract cycle, to ensure the public has a full opportunity to comment on CMS policies.
Comments on the Proposed rule may be submitted through December 8, 2009.
Proposed rule, 74 FR 54634, Oct. 22, 2009, ¶220,738
For more information on this and related topics, consult the CCH® Medicare and Medicaid Guide.
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