We are proposing to allow the electronic delivery of certain information normally provided in hard copy documents such as the Evidence of Coverage (EOC). Additionally, we are proposing to change the timeframe for delivery of the EOC in particular to the first day of the Annual Election Period (AEP) rather than fifteen days prior to that date. Allowing plans to provide the EOC electronically would alleviate plan burden related to printing and mailing, and simultaneously would reduce the number of paper documents that beneficiaries receive from plans. This would allow beneficiaries to focus on materials, like the Annual Notice of Change (ANOC), that drive decision making. Changing the date by which plans must provide the EOC to members would allow plans more time to finalize the formatting and ensure the accuracy of the information, as well as further distance it from the ANOC, which must still be delivered 15 days prior to the AEP. We see this proposed change as an overall reduction of impact that our regulations have on plans and beneficiaries. In aggregate, we estimate a savings (to plans for not producing Start Printed Page 56340and mailing hard-copy EOCs) of approximately $51 million. Menu Your information contains error(s): Beginning with 2017 Star Ratings, we implemented the CAI that adjusts for the average within-contract disparity in performance associated with the percentages of beneficiaries who receive a low income subsidy and/or are dual eligible (LIS/DE) and/or have disability status. We developed the CAI as an interim analytical adjustment while we developed a long-term solution. The adjustment factor varies by a contract's categorization into a final adjustment category that is determined by a contract's proportion of LIS/DE and beneficiaries with disabilities. By design, the CAI values are monotonic in at least one dimension (LIS/DE or disability status) and thus, contracts with larger LIS/DE and/or disability percentages realize larger positive adjustments. MA-PD contracts can have up to three rating-specific CAI adjustments—one for the overall Star Rating and one for each of the summary ratings (Part C and Part D). MA-only contracts can have one adjustment for the Part C summary rating. PDPs can have one adjustment for the Part D summary rating. We propose to codify the calculation and use of the reward factor and the CAI in §§ 422.166(f)(2) and 423.186(f)(2), while we consider other alternatives for the future. © 2018 CNBC LLC. All Rights Reserved. A Division of NBCUniversal For the 2021 Star Ratings, we propose (at section III.A.12.) of the proposed rule to have measures that encompass outcome, intermediate outcome, patient/consumer experience, access, process, and improvement measures. It is important to have a mix of different types of measures in the Star Ratings program to understand how all of the different facets of the provision of health and drug services interact. For example, process measures are evidence-based best practices that lead to clinical outcomes of interest. Process measures are generally easier to collect, while outcome measures are sometimes more challenging requiring in some cases medical record review and more sophisticated risk-adjustment methodologies. The September release can be found at https://www.cms.gov/​Medicare/​Prescription-Drug-Coverage/​PrescriptionDrugCovGenIn/​Downloads/​Research-on-the-Impact-of-Socioeconomic-Status-on-Star-Ratingsv1-09082015.pdf. Home Arcade As noted previously, we are proposing to codify a regulatory framework under which Part D plan sponsors may adopt drug management programs to address overutilization of frequently abused drugs. Therefore, we propose to amend § 423.153(a) by adding this sentence at the end: “A Part D plan sponsor may establish a drug management program for at-risk beneficiaries enrolled in their prescription drug benefit plans to address overutilization of frequently abused drugs, as described in paragraph (f) of this section,” in accordance with our authority under revised section 1860D-4(c)(5)(A) of the Act. View all Motley Fool Services Jump up ^ 2012 Medicare & You handbook, Centers for Medicare & Medicaid Services. The nondiscrimination provisions of 42 U.S.C. 18116 would apply. ↩ As noted in section II. of this rule, we have chosen to propose Option 1. This approach is a cautious approach for the initial implementation year of the CARA “lock-in” provisions. We believe these provisions will result in the following savings to the program. Annual Election Tell us about your legal issue and we will put you in touch with Sabrina Winters. Take the guesswork out of health insurance. Pinterest Popular Pages Give Feedback 19. Section 422.152 is amended by removing and reserving paragraphs (a)(3) and (d). Urology / Nephrology Allen's story Footer menu (A) A beneficiary-specific point-of-sale claim edit as described in paragraph (f)(3)(i) of this section. 10,000 Takes Special enrollment period Medicare Health Plans for Your Needs and Budget Docket RIN More Wellness Tips Medical Policy Updates Claim Forms About FEP® (2) Ensure that reasonable efforts are made to notify the prescriber of a beneficiary who was sent a notice under paragraph (c)(6)(iv)(B)(1)(ii) of this section. Part C Cost The Medicare Rights Center's Medicare Interactive If you are eligible for Railroad Retirement benefits, enroll in Medicare by calling the Railroad Retirement Board (RRB) or contacting your local RRB field office. 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Employee Spotlights An alternative method of ensuring beneficiaries have access to opioids as necessary would be to require the sponsor immediately provide a transfer to a new provider when the first provider is on the preclusion list. The new provider should be able to make an assessment and either provide appropriate SUD treatment or continue the opioid or pain management regimen, as medically appropriate. We are interested to hear from commenters how to operationalize this and whether there is a better method to ensure appropriate medication is provided without transferring the beneficiary to a new provider. We are proposing a 90-day provisional coverage period in lieu of a 3-month drug supply/90-day time period established in existing § 423.120(c)(6), which was described on page 6 in the Technical Guidance on Implementation of the Part D Prescriber Enrollment Requirement (Technical Guidance) issued on December 29, 2015.[59] Under the existing regulation (which, as noted above, we have not enforced), a sponsor or MA-PD must track a separate 90-day consecutive time period for each drug covered as a provisional supply from the initial date-of-service; the sponsor or MA-PD must not reject a claim or deny a beneficiary's request for reimbursement until the 90-day time period has passed or a 3-month supply has been dispensed, whichever comes first. Under our proposal, however, a beneficiary would have one 90-day provisional coverage period with respect to an individual on the preclusion list. Accordingly, a sponsor/PBM would track one 90-day time period from the date the first drug is dispensed to the beneficiary pursuant to a prescription written by the individual on the preclusion list. This dispensing event would trigger a written notice and a 90-day time period for the beneficiary to fill any prescriptions from that particular precluded prescriber and to find another prescriber during that 90-day time period. Washington, DC 20036 Accelerator Programs SNP Special Needs Plan Jump up ^ "What Is the Role of the Federal Medicare Actuary?," American Academy of Actuaries, January 2002 In paragraph (iv), we propose that with respect to requests for reimbursement submitted by Medicare beneficiaries, a Part D sponsor may not make payment to a beneficiary dependent upon the sponsor's acquisition of an active and valid individual prescriber NPI, unless there is an indication of fraud. If the sponsor is unable to retrospectively acquire an active and valid individual prescriber NPI, the sponsor may not seek recovery of any payment to the beneficiary solely on that basis. If I cancel my group health insurance, may I re-enroll at a later date? Anthem lets you choose from quality doctors and hospitals that are part of your plan. Our Find a Doctor tool helps identify the ones that are right for you. Medicare Education MyFlorida.com Maurie Backman Questions c. Specific Regulatory Changes OUR TEAM Seguro para inquilinos Section 422.752(a) lists certain violations for which CMS may impose sanctions (as specified in § 422.750(a)) on any MA organization with a contract. One violation, listed in paragraph (a)(13), is that the MA organization “(f)ails to comply with § 422.222 and 422.224, that requires the MA organization to ensure that providers and suppliers are enrolled in Medicare and not make payment to excluded or revoked individuals or entities.” We propose to revise paragraph (a)(13) to read: “Fails to comply with §§ 422.222 and 422.224, that requires the MA organization not to make payment to excluded individuals or entities, nor to individuals or entities on the preclusion list, defined in § 422.2.” Life & Annuities The same helpful information as before, just in a new place. Helpful Resources MarketSmith Premium Password Reset for Consumers Comments that violate the above will be removed. Repeat violators may lose their commenting privileges on StarTribune.com. (ii) The beneficiary's right to, and conditions for, obtaining an expedited redetermination. PDP and MAPD Overview by State Type the first 2 numbers of 746610? Prove you're not a robot: Type the first 2 numbers of 746610? Government procurement 11 7 31. Section 422.501 is amended by revising paragraphs (c)(1)(iv) and (2) to read as follows: Your Phone Products & Services Services Covered by Medicare Part A & Part B State Policy Disclosures, Exclusions and Limitations Student Reporting Labs If you want to return to Original Medicare, Part A and Part B, you can do this during the Medicare General Enrollment Period, which runs from January 1 to March 31 each year. Call 612-324-8001 Aarp | Minneapolis Minnesota MN 55472 Hennepin Call 612-324-8001 Aarp | Minneapolis Minnesota MN 55473 Carver Call 612-324-8001 Aarp | Minneapolis Minnesota MN 55474 Hennepin
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