(iii) The sponsor must inform the beneficiary of the selection in— We propose to more appropriately implement the statute by narrowing the definition of marketing to focus on materials and activities that aim to influence enrollment decisions. We believe this is consistent with Congress’s intent. Moreover, the new definition differentiates between factually providing information about the plan or benefits (that is, the Evidence of Coverage (EOC)) versus persuasively conveying information in a manner designed to prompt the beneficiary to make a new plan decision or to stay with their current plan (for example, a flyer that touts a low monthly premium). As discussed later, the majority of member materials would no longer fall within the definition of marketing under this proposal. The EOC, subscriber agreements, and wallet card instructions are not developed nor intended to influence enrollment decisions. Rather, they are utilized for current enrollees to understand the full scope of and the rules associated with their plan. We believe the proposed new marketing definition appropriately safeguards potential and current enrollees while not placing an undue burden on sponsoring organizations. Moreover, those materials that would be Start Printed Page 56436excluded from the marketing definition would fall under the proposed definition of communication materials, with what we believe are more appropriate requirements. CMS notes that enrollment and mandatory disclosure materials continue to be subject to requirements in §§ 422.60(c), 422.111, 423.32(b), and 423.128.
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(iii) In subsequent years following the first year after the consolidation, CMS will determine QBP status based on the consolidated entity’s Star Ratings displayed on Medicare Plan Finder.
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(MORE: How to Prepare to Enroll in Medicare) States must provide Medicaid services for individuals who fall under certain categories of need in order for the state to receive federal matching funds. For example, it is required to provide coverage to certain individuals who receive federally assisted income-maintenance payments and similar groups who do not receive cash payments. Other groups that the federal government considers “categorically needy” and who must be eligible for Medicaid include:
Stage 3: Coverage Gap (also called “Donut Hole”) (c) Total revenue included as part of the MLR calculation must be net of all projected reconciliations.
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Licensed Insurance Zip Code PREVENTIVE HEALTH SERVICES (iii) CMS determines that the underlying conduct that led to the revocation is detrimental to the best interests of the Medicare program. In making this determination under this paragraph, CMS considers the following factors:
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Colin Seeberger 12:01 PM ET Wed, 4 July 2018 (2) A description, of all State and Federal public health resources that are designed to address prescription drug abuse to which the beneficiary has access, including mental health and other counseling services and information on how to access such services, including any such services covered by the plan under its Medicare benefits, supplemental benefits, or Medicaid benefits (if the plan integrates coverage of Medicare and Medicaid benefits).
Individual and Family Plans A good start is critical. David Littell, retirement income program co-director at the American College of Financial Services in Bryn Mawr, Penn., says that the biggest mistake that individuals can make under Medicare is not signing up for Parts A and B on a timely basis.
The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
We are also proposing technical changes to the MLR provisions at §§ 422.2420 and 423.2420. In § 422.2420(d)(2)(i), we are replacing the phrase “in § 422.2420(b) or (c)” with the phrase “in paragraph (b) or (c) of this section”. In § 423.2430, the regulatory text includes two paragraphs designated as (d)(2)(ii). We propose to resolve this error by amending § 423.2420 as follows:
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12. Eliminating the Requirement To Provide PDP Enhanced Alternative (EA) to EA Plan Offerings With Meaningful Differences (§ 423.265) (7) Contact information for other organizations that can provide the beneficiary with assistance regarding the sponsor’s drug management program.
105. Section 423.2264 is revised to read as follows: Jump up ^ Joynt, KE; Jha, AK (2012). “Thirty-day readmissions–truth and consequences”. The New England Journal of Medicine. 366 (15): 1366–9. doi:10.1056/NEJMp1201598. PMID 22455752.
Medicare Part B – Medical Insurance Finding Health Insurance 42. Section 422.752 is amended by revising paragraphs (a)(11) and (13) and (b) to read as follows:
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(b) Timeframe for filing a request. Except as provided in paragraph (c) of this section, a request for a redetermination must be filed within 60 calendar days from the date of the notice of the coverage determination or the at-risk determination under a drug management program in accordance with § 423.153(f).
Determining reasonable access may be complicated when an enrollee has multiple addresses or his or her health care necessitates obtaining frequently abused drugs from more than one prescriber and/or more than one pharmacy. Section 1860D-4(c)(5) addresses this issue by requiring the Part D plan sponsor to select more than one prescriber to prescribe frequently abused drugs and more than one pharmacy to dispense them, as applicable, when it reasonably determines it is necessary to do so to provide the at-risk beneficiary with reasonable access.
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