Oversight Activities Signing up for Medicare online — and you can sign up for Medicare on the Social Security website — may be convenient, but it doesn't work effectively in all circumstances. These are situations in which you need to produce documents as evidence of eligibility. For example: Medicare & PEBB Program benefits 1. Implementation of the Comprehensive Addiction and Recovery Act of 2016 (CARA) Provisions A public bike-share program in Metro-Boston FEHB and Medicare Booklet HealthMarkets offers Medicare Advantage, Medicare Part D, and Medigap plans, and we know how to help you choose the best option. We have licensed agents ready to talk to you at (800) 488-7621. You can also find a local agent online. If you’re ready to find the right Medicare Advantage or Medicare Supplement plan that fits your needs, call today! ANCILLARY CLAIMS FILING MANDATE (6) Clear instructions that explain how the beneficiary can contact the sponsor, including how the beneficiary may submit information to the sponsor in response to the request described in paragraph (f)(5)(ii)(C)(4) of this section. eHealth's Medicare website is operated by eHealthInsurance Services, Inc., a licensed health insurance agency. (3) Net Costs and Savings Psoriasis 6.  Please note that CMS will use the term “MME” going forward instead of morphine equivalent dose (MED), which CMS has used to date. CMS used the term MED in a manner that was equivalent to MME. We will update CMS documents that currently refer to MED as soon as practicable.

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Individuals & Families Start Here If I'm traveling, can I go to any doctor? 11 Legislation and reform If you joined a Medicare Advantage plan when you were first eligible for Medicare and you aren’t happy with the plan, you’ll have special rights to buy a Medigap policy if you return to Original Medicare within 12 months of joining. (C) The PDP (or its agent, representative, or plan provider) materially misrepresented the plan's provisions in communication materials as outlined in subpart V. Consumer Fact Sheets June 5, 2018 About the RAE Flash Report Austin Frakt, “Medicare Advantage Is More Expensive, but It May Be Worth It,” The New York Times, August 14, 2014, available at https://www.nytimes.com/2014/08/19/upshot/medicare-advantage-is-more-expensive-but-it-may-be-worth-it.html. ↩ Similar to the introduction of an abbreviated approval pathway for generic drugs provided by the Hatch-Waxman Act in 1984 to spur more competition through quicker approvals and introduction of lower cost therapeutic alternatives in the marketplace, Congress enacted the “Biologics Price Competition and Innovation Act of 2009” to balance innovation and consumer interests. Specifically, section 7002 of the ACA amended section 351 of the Public Health Service Act (PHS Act) (42 U.S.C. 262), adding a subsection (k) to create an abbreviated licensure pathway for follow-on biological products that are demonstrated to be either “biosimilar” to or “interchangeable” with a United States Food and Drug Administration (FDA) licensed reference biological product. According to the FDA, “a biosimilar product is a biological product that is approved based on a showing that it is highly similar to an FDA-approved biological product, known as a reference product, and has Start Printed Page 56417no clinically meaningful differences in terms of safety and effectiveness from the reference product. Only minor differences in clinically inactive components are allowable in biosimilar products.” However, “an interchangeable biological product is biosimilar to an FDA-approved reference product and meets additional standards for interchangeability. An interchangeable biological product may be substituted for the reference product by a pharmacist without the intervention of the health care provider who prescribed the reference product.” (See http://www.fda.gov/​Drugs/​DevelopmentApprovalProcess/​HowDrugsareDevelopedandApproved/​ApprovalApplications/​TherapeuticBiologicApplications/​Biosimilars/​ ) Biosimilar biological products are, by definition, not interchangeable, and are not substitutable without a new prescription. Follow-on biological products are listed in the FDA's Purple Book: Lists of Licensed Biological Products with Reference Product Exclusivity and Biosimilarity or Interchangeability Evaluations, available at http://www.fda.gov/​Drugs/​DevelopmentApprovalProcess/​HowDrugsareDevelopedandApproved/​ApprovalApplications/​TherapeuticBiologicApplications/​Biosimilars/​ucm411418.htm. Part D plan sponsors are also encouraged to monitor the FDA's Web site for new biologic (BLA) approvals at http://www.accessdata.fda.gov/​scripts/​cder/​drugsatfda/​index.cfm?​fuseaction=​Reports.ReportsMenu. We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. We also provide language assistance. Read our Nondiscrimination and Language Assistance notice. Join Our Mailing List Early and periodic screening, diagnostic, and treatment services for children Prime Solution Thrift + Flu Shots Cancer Insurance Reward factor means a rating-specific factor added to the contract's summary or overall (or both) rating if a contract has both high and stable relative performance. Username Multi-State Plan Program Health Care and Network Management Pro In the April 2010 final rule (75 FR 19677), CMS indicated concern that MA organizations were choosing QIPs and CCIPs that did not address QI areas that best reflected enrollee needs. Additionally, there were concerns that some projects focused more on improving processes rather than improving clinical outcomes. Therefore, we modified the regulation to provide for CMS to identify focus areas for QIPs and population areas for CCIPs. MA organizations retained the flexibility to identify topics for development of QIPs and CCIPs based on the needs of their population, but also had to implement QIPs and CCIPs as directed by CMS, which could identify general areas of focus that supported CMS quality strategies and initiatives. Budget & Performance The MMA sought to strike a balance of promoting beneficiary plan choice, but also ensuring that FBDE beneficiaries who did not make an active election would still have Part D coverage. The statute directed the Secretary to enroll FBDE beneficiaries into a PDP if they did not enroll in a Part D plan on their own. (As noted previously, CMS extended the SEP through rulemaking to make it available to all other subsidy-eligible beneficiaries.) When the automatic enrollment of subsidy-eligible beneficiaries was originally proposed in rulemaking, we noted that beneficiaries would have the option to use the SEP if they determined there was a better plan option for them, and codified a continuous SEP (that is, that was available monthly). ++ Change the title of § 422.224 from “Payment to providers or suppliers excluded or revoked” to “Payment to individuals and entities excluded by the OIG or included on the preclusion list.” Do I Need to Renew My Medicare Plan? When to register for Medicare Parts A, B and D depends on whether Medicare will be your primary coverage, or whether you still have employer coverage. Medicaid (Title XIX) State Plan I Buy My Own Insurance PENALTY A. You can choose how you would like to enroll: online, by mail, and other options. Practice transformation support hub Working at the U Broker Dealer We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227. A federal law passed in 2003 created a “competition” requirement for Medicare Cost plans, which stipulated the plans could not be offered in service areas where there was significant competition from Medicare Advantage plans. Congress delayed implementation of the requirement several times until a law passed in 2015 that called for the rule to take effect in 2019. (vii) A linear regression model is developed to estimate the percentage of LIS/DE for a contacts that solely serve the population of beneficiaries in Puerto Rico. As stated earlier in reference to prescribers, the preclusion list would be updated on a monthly basis. Individuals and entities would be added or removed from the list based on CMS' internal data or other informational sources that indicate, for instance— (1) persons eligible to provide medical services who have recently been convicted of a felony that CMS determines to be detrimental to the best interests of the Medicare program; and (2) entities whose reenrollment bars have expired. As a particular individual's or entity's status with respect to the preclusion list changes, the applicable provisions of § 422.222 would control. Medicare & the Marketplace Chat Offline Educating the Consumer We note that our proposed implementation of the statutory requirements for the initial notice would permit the notice also to be used when the sponsor intends to implement a beneficiary-specific POS claim edit for frequently abused drugs. This is consistent with our current policy and would streamline beneficiary notices about opioids since we propose frequently abused drugs to consist of opioids for 2019.Start Printed Page 56351 Disability Insurance Generic Member Login Find a Doctor Job next Note that if you're not already receiving Social Security benefits at age 65, you will not be notified when it's time for you to enroll in Medicare. And if you let your enrollment deadline trickle past and then get hit with late penalties, you can't appeal on the basis that you "didn't know." Ignorance of the law is not considered a defense. Sustainability $10 for primary care visits and $30 for specialist visits Want to explore on your own? 72. Section 423.508 is amended by revising paragraph (a) to read as follows: Select your state below or choose from one of these links to other tools available to review 2018 Medicare Part D Plans: We propose to codify our new policy at §§ 422.162(b)(3) and 423.182(b)(3). First, we propose generally, at paragraph (b)(3)(i) of each regulation, that CMS will assign Star Ratings for consolidated contracts using the provisions of paragraph (b)(3). We are proposing in § 422.162(b)(3) both a specific rule to address the QBP rating following the first year after the consolidation and a rule for subsequent years. As Part D plan sponsors are not eligible for QBPs, the Part D regulation text is proposed without the QBP aspect. We propose in § 422.162(b)(3)(iv) and § 423.182(b)(3)(ii) the process for assigning Star Ratings for posting on the Medicare Plan Finder for the first 2 years following the consolidation. Provider termination and exclusion list Log in to BlueAccessSM Upload file IRAs Complete an Application for Enrollment in Part B (CMS-40B). Get this form and instructions in Spanish. Remember, you must already have Part A to apply for Part B.   Close+ Log In to... 888-345-0823 Toll-free Aasaasyada Caymiska Guriga Getting Help with Costs Quality Blue Directory Zip* Beneficiary Notices Initiative (BNI) Violations for which CMS may impose sanctions. Monroe Notices We propose to codify regulation text, at §§ 422.160 and 423.180, that identifies the statutory authority, purpose, and applicability of the Star Ratings System regulations we are proposing to add to part 422 subpart D and part 423 subpart D. Under our proposal, the existing purposes of the quality rating system—to provide comparative information to Medicare beneficiaries pursuant to sections 1851(d) and 1860D-1(c) of the Act, to identify and apply the payment consequences for MA plans under sections 1853(o) and 1854(b)(1)(C) of the Act, and to evaluate and oversee overall and specific performance by plans—would continue. To reflect how the Part D ratings are used for MA-PD plan QBP status and rebate retention allowances, we also propose specific text, to be codified at § 423.180(b)(2), noting that the Part D Star Rating will be used for those purposes. However, beneficiaries select a plan, rather than a contract, so we have considered whether data should be collected and measures scored at the plan level. We have explored the feasibility of separately reporting quality data for individual D-SNP PBPs, instead of the current reporting level. For example, in order for CAHPS measures to be reliably scored, the number of respondents must be at least 11 people and reliability must be at least 0.60. Our current analyses show that, at the PBP level, CAHPS measures could be reliably reported for only about one-third of D-SNP PBPs due to sample size Start Printed Page 56380issues, and HEDIS measures could be reliably reported for only about one-quarter of D-SNP PBPs. If reporting were done at the plan level, a significant number of D-SNP plans would not be rated and in lieu of a Star Rating, Medicare Plan Finder would display that the plan is “too small to be rated.” However, when enough data are available, plan level quality reporting would better reflect the quality of care provided to enrollees in that plan. Plan-level quality reporting would also give states that contract with D-SNPs plan-specific information on their performance and provide the public with data specific to the quality of care for dual eligible (DE) beneficiaries enrolled in these plans. For all plans as well as D-SNPs, reporting at the plan level would significantly increase plan burden for data reporting and would have to be balanced against the availability of additional clinical information available at the plan level. Plan-level ratings would also potentially increase the ratings of higher-performing plans when they are in contracts that have a mix of high and low performing plans. Similarly, plan-level ratings would also potentially decrease the ratings of lower-performing plans that are currently in contracts with a mix of high and low performing plans. Measurement reliability issues due to small sample sizes would also decrease our ability to measure true performance at the plan level and add complexities to the rating system. We are soliciting comments on balancing the improved precision associated with plan level reporting (relative to contract level reporting) with the negative consequences associated with an increase in the number of plans without adequate sample sizes for at least some measures; we ask for comments about this for D-SNPs and for all plans as we continue to consider whether rating at the plan level is feasible or appropriate. In particular, we are interested in feedback on the best balance and whether changing the level at which ratings are calculated and reported better serves beneficiaries and our goals for the Star Ratings System. Jump up ^ "Overview HPSA/PSA (Physician Bonuses)". Cms.gov. Retrieved February 19, 2011. Share our content 1-800-MEDICARE Claims and Reimbursement 77. Section 423.564 is amended by revising paragraph (b) to read as follows: ABOUT Saving Money 2021: Performance period and collection of data for the new measure and collection of data for posting on the 2023 display page. Legal & Privacy Combines Medicare and Medical Assistance in one plan Small Businesses ++ Enrollment choice for beneficiaries. Combines Medicare and Medical Assistance in one plan Receive Email Updates Medicare Summary Notices Question Title Where you go and who you see for treatment is a big part of getting quality healthcare while saving money. (H) The Part C Calculated Error is determined using the quotient of number of cases not forwarded to the IRE and the total number of cases that should have been forwarded to the IRE. (The number of cases that should have been forwarded to the IRE is the sum of the number of cases in the IRE during the data collection or data sample period and the number of cases not forwarded to the IRE during the same period.) 8. The authority citation for part 422 continues to read as follows: Fort Worth, TX 76137 Is my test, item, or Have family members who qualify for benefits, a delay means you would lose some of the benefits they might have received. However, delaying benefits also increases the maximum monthly survivors benefit your spouse may receive. find missing money? Part B requires a monthly premium ($96.40 per month in 2009), and patients must meet an annual deductible ($135.00 in 2009) before coverage actually begins. Enrollment in Part B is voluntary. Philip Moeller Philip Moeller (A) The measure is already case-mix adjusted for socioeconomic status. Ouch! RELATED TERMS Retirees By Associated Press Compare HSA Plans The Health of America We propose that sending a second notice to an at-risk beneficiary so identified in the most recent plan would be permissible only if the new sponsor is implementing a beneficiary-specific POS claim edit for a frequently abused drug, or if the sponsor is implementing a limitation on access to coverage for frequently abused drugs to a selected pharmacy(ies) or prescriber(s) and has the same location of pharmacy(ies) and/or the same prescriber(s) in its provider network, as applicable, that the beneficiary used to obtain frequently abused drugs in the most recent plan. Otherwise, we propose that the new sponsor would be required to provide the initial notice to the at-risk beneficiary, even though the initial notice is generally intended for potential at-risk beneficiaries, and could not provide the second notice until at least 30 days had passed. This is because even though there would also be a concern for the at-risk beneficiary's health and safety in this latter case as well, this concern would be outweighed by the fact that the beneficiary had not been afforded a chance to submit his or her preference for a pharmacy(ies) and/or prescriber(s), as applicable, from which he or she would have to obtain frequently abused drugs to obtain coverage under the new plan's drug management program. And that can lead to costly errors. SHRM CONFERENCES Additional adjustments to the Star Ratings measures or methodology that could further account for unique geographic and provider market characteristics that affect performance (for example, rural geographies or monopolistic provider geographies), and the operational difficulties that plans could experience if such adjustments were adopted. Log into your MyMedicare.gov account and request one. Provider Resources 1-866-745-9919 (TTY: 711) JOBS TMP Timeliness Monitoring Project Ethics & Compliance OptumRx • Pharmacy Portal (2) Do not include information about measuring or ranking standards (for example, star ratings); Ideas for improving the process around MA organizations requesting medical records and/or attestations that are not directly pursuant to CMS-conducted RADV audits. Specify the type of change the idea would necessitate: a statutory, regulatory, subregulatory, operational, or CMS-issued guidance such as best practices for MA organizations when requesting medical records and/or attestations, and how such a change may interact with other provisions, such as state law or Joint Commission requirements. If the ideas involve novel legal questions, analysis regarding our authority is welcome for our consideration. For each idea, describe the extent of provider burden reduction, quantitatively where possible, and any other consequences that implementing the idea may have on beneficiaries, providers, MA organizations, or CMS. Further, we encourage all relevant parties to respond to this request: MA organizations, providers, associations for these entities, and companies assisting MA organizations, providers, and hospitals with handling medical record requests. 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