(a) Definitions. In this subpart the following terms have the meanings: ++ Whether the actions referenced in § 424.535(a) are appropriate grounds for inclusion on the preclusion list. Portability: Minnesota Health Information Clearinghouse Frequently Asked Questions and Answers discusses your health care coverage when you change jobs or change from one health plan company to another. Read the Forbes profile on Kiplinger's Personal Finance § 422.752 19 documents in the last year There is no parallel to § 422.111(h)(2)(ii) in § 423.128. Instead, § 423.128(a) states that Part D sponsors must disclose the information in paragraph (b) in the manner specified by CMS. Section 423.128(d)(2)(i) requires Part D sponsors to maintain an internet Web site that includes information listed in § 423.128(b). CMS sub-regulatory guidance has instructed plans to provide the EOC in hard copy, but we believe that the regulatory text would permit delivery by notifying enrollees of the internet posting of the documents, subject to the right to request hard copies.[55] As explained previously regarding the changes to § 422.111, we intend for plans to have the flexibility to provide documents such as the Summary of Benefits, the EOC, and the provider network information in electronic format. We intend to change the relevant sub-regulatory guidance to coincide with this as well.

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Start Printed Page 56525 As discussed previously, in the November 15, 2016 final rule, we added or updated a number of other MA regulatory provisions (for example, § 422.501 and 422.510) in order to fully incorporate our new enrollment requirements. Because we are proposing to replace these enrollment requirements with an approach centered upon a preclusion list—and to help Start Printed Page 56450ensure that providers, suppliers, MA organizations, PACE organizations, and other applicable stakeholders comply with our proposed requirements—we believe that these other MA regulatory provisions must also be revised to reflect this change. To this end, we propose the following revisions: We understand there may be concerns that the direct notice identifying the specific drug substitution would arrive after the formulary change has already taken place. As explained previously, we believe generic substitutions pose no threat to enrollee safety. Also, as noted earlier, we are proposing to revise § 423.120(b)(6) to permit generic substitutions to take place throughout the entire year. This means that, under the proposed provision, a Part D sponsor meeting all the requirements would be able to substitute a generic drug for a brand name drug well before the actual start of the plan year (for instance, if a generic drug became available on the market days after the summer update). There is nothing in our regulation that would prohibit advance notice and, in fact, we would encourage Part D sponsors to provide direct notice as early as possible to any beneficiaries who have reenrolled in the same plan and are currently taking a brand name drug that will be replaced with a generic drug with the start of the next plan year. We would also anticipate that Part D sponsors will be promptly updating the formularies posted online and provided to potential beneficiaries to reflect any permitted generic substitutions—and at a minimum meeting any current timing requirements provided in applicable guidance. At this time we are not proposing to set a regulatory deadline by which Part D sponsors must update their formularies before the start of the new plan year. However, if we were to finalize this provision and thereafter find that Part D sponsors were not timely updating their formularies, we would reexamine this policy. And we would note, as regards timing, that § 423.128(d)(2)(iii) requires that the current formulary posted online be updated at least monthly. ++ We also propose to change the title of § 460.86 to “Payment to individuals and entities that are excluded by the OIG or are included on the preclusion list.” Apple Health (Medicaid) Reprints Humana Medicare Articles NEWS RELEASE The 3 months after your birthday. By PAULA SPAN Plan Quality Ratings Nyiaj Ploj Kiplinger's Boomer's Guide to Social Security It’s recommended that you buy a Medigap policy during your 6-month Medigap open enrollment period, because during this time, you can buy any Medigap policy sold in your state, even if you have health problems. This period automatically starts the month you’re 65 or older and enrolled in Medicare Part B. The Road To Health 0 Learn more Check Medicare eligibility 2. ICRs Regarding Restoration of the Medicare Advantage Open Enrollment Period (§§ 422.60, 422.62, 422.68, 423.38, and 423.40) Energy Assistance © 2018 Capital BlueCross All Rights Reserved. Speaker Requests Browse any 2018 Drug Formulary Your ID Card The proposed provision would amend the regulation so that first-tier, downstream and related entities (FDR) no longer are required to take the CMS compliance training, which lasts 1 hour, and so that MA organizations and Part D sponsors no longer have a requirement to ensure that FDRs have compliance training. However, it is still the sponsoring organization's responsibility to manage relationships with its FDRs and ensure compliance with all applicable laws, rules and regulations. Furthermore, we would continue to hold sponsoring organizations accountable for the failures of its FDRs to comply with Medicare program requirements. In instances where an individual is not able to utilize the dual SEP because of the proposed limitations, we anticipate that there will be no change in burden. Under current requirements, if a beneficiary uses the dual SEP to disenroll from their plan, the plan would send a notice to the beneficiary to acknowledge the voluntary disenrollment request. If the beneficiary is subject to the dual SEP limitation, the plan would send a notice to deny their voluntary disenrollment request. The requirement to acknowledge the beneficiary request and address the resolution would be the same in both scenarios, but the content of the notice would be different. Enrollment processing and notification requirements are codified at § 423.32(c) and (d) and are not being revised as part of this rulemaking. Therefore, no new or additional information collection requirements are being imposed. Moreover, the requirements and burden are currently approved by OMB under control number 0938-0964 (CMS-10141). Since this rule would not impose any new or revised requirements/burden, we are not making any changes to that control number. ++ How narrowly or broadly the requests are framed (for example, whether the request is for a single visit, a specific condition, and for what timeframe). Hospital In § 422.503(b)(4)(ii), we propose to replace the term “marketing” with the term “communication.” (A) Respond to CMS within 30 days of receiving a report about a potential at-risk beneficiary from CMS. SHRM Lawyers 23-1011 67.25 67.25 134.50 Your spouse will continue to be covered under in a GIC non-Medicare plan if he/she is under age 65 until he or she becomes eligible for Medicare. See the Benefit Decision Guide for under and over age 65 health insurance products.  If your spouse is over age 65, he/she must enroll in the same Medicare supplemental plan that you have joined. If you enroll at your local Social Security office, ask for a written receipt. Weighted variance Weighted mean (performance) Reward factor Any Willing Pharmacy Standard Terms and Conditions and Better Define Pharmacy Types Various 0 0 0 0 0 0 Premium Investing Tools Get Free Newsletters U.S. Qualification Standards FOR YOUR HEALTH The Medicare Prescription Drug Plan Finder can help you determine whether you’ll land in the doughnut hole based on your prescriptions. Once you find out, you can then decide whether the additional coverage is worth the extra premium. Don’t have a MyBlue account? PDP Fact sheets Medicaid Title XIX Advisory Committee Hiring Process ©1998-2018 BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the Blue Cross Blue Shield Association. BlueCross BlueShield of Tennessee is a Qualified Health Plan issuer in the Health Insurance Marketplace. 1 Cameron Hill Circle, Chattanooga TN 37402-0001 Download Acrobat Reader (A) One, or, if the sponsor reasonably determines it necessary to provide the beneficiary with reasonable access, more than one, network prescriber who is authorized to prescribe frequently abused drugs for the beneficiary, unless the plan is a stand-alone PDP and the selection involves a prescriber(s), in which case, the prescriber need not be a network prescriber; and Connecticut Hartford $23 $64 178% $201 $206 2% $262 $347 32% Learn how to avoid pitfalls and save money by enrolling at the right time for you Organizational & Employee Development Blue Cross and Blue Shield of Montana Compare health plans Social Entrepreneurship Ryder Andrake retires from HCA’s Infants at the Workplace Program Randball Account Access Medical BenefitsDrug InformationAll Medicare FormsHealth and Wellness Read more opinion Follow @karlbykarlsmith on Twitter Group Health Insurance for Travelers Transgender Health Services Program Part D covers prescription medications. Optional Part D drug coverage with access to 64,000 pharmacies nationwide We are proposing in §§ 422.166(e) and 423.186(e) to continue the current weighting of measures in the Part C and D Star Ratings program by assigning the highest weight (5) to improvement measures, followed by outcome and intermediate outcome measures (weight of 3), then by patient experience/complaints and access measures (weight of 1.5), and finally process measures (weight of 1). We are considering increasing the weight of the patient experience/complaints and access measures and are interested in stakeholder feedback on this potential change in order to reflect better the importance of these issues in plan performance. If we were to increase the weight, we are considering increasing it from a weight of 1.0 to between 1.5 and 3 similar to outcome measures. This increased weight would reflect CMS' commitment to serve Medicare beneficiaries by putting the patients first, including their assessments of the care received by plans. We solicit comment on this point, particularly the potential change in the weight of the patient experience/complaints and access measures. The Affluent Are Paying a Bigger Share Returning Shopper Early and periodic screening, diagnostic, and treatment (EPSDT) services for children under age 21 (C) The measure is scheduled to be retired or revised. We propose to codify the data disclosure and information sharing process under the current policy, with the expansion just described, by adding the following requirement to § 423.153: (f)(15) Data Disclosure. (i) CMS identifies each potential at-risk beneficiary to the sponsor of the prescription drug plan in which the beneficiary is enrolled. (ii) A Part D sponsor that operates a drug management program must disclose any Start Printed Page 56360data and information to CMS and other Part D sponsors that CMS deems necessary to oversee Part D drug management programs at a time, and in a form and manner, specified by CMS. The data and information disclosures must do all of the following: (A) Respond to CMS within 30 days of receiving a report about a potential at-risk beneficiary from CMS; (B) Provide information to CMS about any potential at-risk beneficiary that a sponsor identifies within 30 days from the date of the most recent CMS report identifying potential at-risk beneficiaries; (C) Provide information to CMS within 7 business days of the date of the initial notice or second notice that the sponsor provided to a beneficiary, or within 7 days of a termination date, as applicable, about a beneficiary-specific opioid claim edit or a limitation on access to coverage for frequently abused drugs; and (D) Transfer case management information upon request of a gaining sponsor as soon as possible but no later than 2 weeks from the gaining sponsor's request when: (1) An at-risk beneficiary or potential at-risk beneficiary disenrolls from the sponsor's plan and enrolls in another prescription drug plan offered by the gaining sponsor; and (2) The edit or limitation that the sponsor had implemented for the beneficiary had not terminated before disenrollment. MA-only and PDPs would have the hold harmless provisions for highly-rated contracts applied for the Part C and D summary ratings, respectively. For an MA-only or PDP that receives a summary rating of 4 stars or more without the use of the improvement measure and with all applicable adjustments (CAI and the reward factor), a comparison of the rounded summary rating with and without the improvement measure and up to two adjustments, the reward factor (if applicable) and CAI, is done. The higher summary rating would be used for the summary rating for the contract's highest rating. For MA-only and PDPs with a summary rating of 2 stars or less without the use of the improvement measure and with all applicable adjustments (CAI and the reward factor), the summary rating would exclude the improvement measure. For all others, the summary rating would include the improvement measure. MA-PDs would have their summary ratings calculated with the use of the improvement measure regardless of the value of the summary rating. We estimate that the CARA provisions would result in a net savings of $10 million (the estimated savings of $13 million less the total estimated costs of $2,836,651 = $10,163,349, rounded to the nearest million) in 2019. The following are details on each of these savings. Apr 5, 2018 at 3:06PM Shopping for Car Insurance About UsAbout Us (ii) Are based on the acquisition of frequently abused drugs from multiple prescribers, multiple pharmacies, the level of frequently abused drugs used, or any combination of this factors; SNP Special Needs Plan Storm Damage Administrative hearings Short-Term / Temporary Plans Administers its own Medicaid program. ++ Frequency of requests for providers to submit medical records. A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency. Call 612-324-8001 Aetna | South Haven Minnesota MN 55382 Wright Call 612-324-8001 Aetna | Norwood Minnesota MN 55383 Carver Call 612-324-8001 Aetna | Spring Park Minnesota MN 55384 Hennepin
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