Call 612-324-8001 When Is Medicare Open Enrollment Period | Jenkins Minnesota MN 56456 Crow Wing

Journal List Bucking The Trend: Primary Care Doc Practices Solo Personal care, including help with bathing, dressing, and eating, when it is the only care you need
Can the functional mobility deficit be sufficiently resolved by the prescription of a cane or walker?
Community There has been a recent trend in the number of enrollees that have moved from lower Star Ratings contracts that do not receive a Quality Bonus Payment (QBP) to higher rated contracts that do receive a QBP as part of contract consolidations. The proposal is to modify the methodology of the Star Ratings assigned to consolidating contracts and to codify that methodology. The methodology and measures are generally from recent practice and policies finalized under the section 1853(b) of the Act Rate Announcement. With regard to consolidations, the Star Ratings assigned will be based on the enrollment weighted average of the Start Printed Page 16713measure scores of the surviving and consumed contract(s) so that the ratings reflect the performance of all contracts (surviving and consumed) involved in the consolidation. We believe that the proposal will dissuade many plans from consolidating contracts since it will be possible for some plans to lose QBPs under certain scenarios. If less contracts consolidate to higher Star Ratings, less QBPs will be paid to plans and this will result in Trust Fund transfers. Plans receiving smaller or no bonuses may reduce benefits, thus transferring the costs of benefits to the beneficiary, but we do not believe this will be widespread since plans would lose enrollees if they excessively curtailed benefits.
We also addressed how we would release our findings publicly. While the CAI would be employed, we proposed to release on CMS.gov an updated analysis of the subset of the Star Ratings measures identified for adjustment using this rule as ultimately finalized. Basic descriptive statistics posted would include the minimum, median, and maximum values for the within-contract variation for the LIS/DE differences. We also proposed that the set of measures for adjustment for the determination of the CAI would be announced in the draft Call Letter in paragraph (f)(2)(iii).
Received over 300 responses to Options Paper, including responses from NCHPC, PQLC, AAHPM, NHPCO, and other leading organizations
Comment: Many commenters supported an expansion of the measure-level hold harmless provision for a contract that receives 4 or more stars in each of the two-years for a measure. Some commenters noted the lack of alignment between the highly-rated contracts’ hold harmless provision for the application of the improvement measure(s) for the identification of a contract’s highest rating at § 422.166(g)(1) and § 423.186(g)(1) and the measure-level hold harmless provision at (§ 422.164(f)(3) and § 423.184(f)(3).
© 2018 Blue Cross Blue Shield Association. All Rights Reserved. eNewsletter The discounts during the coverage gap that are paid by the plan, meaning the 56% discount on generics and the 15% discount on brand name drugs
(1) Redesignating the existing definition as paragraph (i), and
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premiums and/or member cost share may change on January 1 of each year.
(1) The sponsor has determined that the beneficiary is not an at-risk beneficiary. The right to protection from discrimination in marketing and enrollment practices.
(2) If such a substitution should occur, affected enrollees will receive direct notice including information on the specific drugs involved and steps they may take to request coverage determinations and exceptions under §§ 423.566 and 423.578; and
Have an Agent Call Me a   Thank you! b. In paragraph (b)(25), by removing the word “marketing” and adding in its place the word “communication”; and COBRA Coverage from an Employer Plan
We proposed to delete § 460.71(b)(7). Every Medicare supplement plan includes all of the following: Paragraph (c)(5)(iii). (i) Narrow the denominator or population covered by the measure;
Other Proposed Rules, including Inpatient Hospital, Long-Term Acute Hospital, Inpatient Rehabilitation, Hospice, and Inpatient Psychiatric Facility Payment
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Improving healthcare one provider and one patient at a time Comment: A few commenters recommended that in addition to MA and Part D plans, CMS apply the SEP limitations to Medicare-Medicaid Plans Start Printed Page 16519(MMPs) as part of the Financial Alignment Initiative demonstration.
Understand different types of insurance (D) A contract with medium variance and a relatively high mean will have a reward factor equal to 0.1.
Jump to navigationJump to search share We proposed specific rules for updating and removal that would be implemented through subregulatory action, so that rulemaking would not be necessary for certain updates or removals. CMS proposed to announce application of the regulation standards in the Call Letter attachment to the Advance Notice and Rate Announcement process issued under section 1853(b) of the Act.
This document extends the comment period for the Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers proposed rule, which was published in the December 27, 2013 Federal Register (78 FR 79082 through 79200). The comment period for the proposed rule, which would have ended on February 25, 2014, is extended to March 31, 2014.
CSG API Documentation CPT® (Current Procedural Terminology) Here’s a breakdown of the underlying trends driving those numbers.  T

Medicare Changes

Instead, the new Medicare cards have an 11-character Medicare Beneficiary Identifier made up of random numbers and uppercase letters. That makes them a more secure replacement for the SSN-based Health Insurance Claim Number (HICN) you’re used to right now.
Can the functional mobility deficit be sufficiently resolved by the prescription of a cane or walker? Applying for Medicare at the correct time can save you money. Learn more about the application process and important deadlines.
Limited Medicare coverage: long-term care services **Note: If you need to have a colonoscopy as a result of another type of screening test being positive (abnormal), this is considered a diagnostic (not screening) colonoscopy, so you might have to pay some of the costs, such as those listed above.
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The 21st Century Cures Act (the Cures Act) amended section 1851(e)(2) of the Act by adding a new continuous open enrollment and disenrollment period (OEP) for MA and certain PDP members. Elsewhere in this final rule (section II.B.1 (Restoration of the Medicare Advantage Open Enrollment Period (§§ 422.60, 422.62, 422.68, 423.38 and 423.40)), we finalize that revision to the MA regulations. As part of establishing this OEP, the Cures Act prohibits unsolicited marketing and mailing marketing materials to individuals who are eligible for the new OEP. We proposed to add a new paragraph (b)(10) [74] to both proposed §§ 422.2268 and 423.2268 to apply this prohibition on marketing. We also requested comment on how the agency could implement the statutory requirement. The new OEP is not available for enrollees in Medicare cost plans; therefore, these limitations apply to MA enrollees and to any PDP enrollee who was enrolled in an MA plan the prior year. CMS expressed concern in the proposed rule that it may be difficult for a sponsoring organization to limit marketing to only those individuals who have not yet enrolled in a plan during the OEP. We noted that one mechanism could be to limit marketing entirely during that period, but were concerned that such a prohibition would be too broad. We proposed a “knowing” standard instead, believing that it would both effectuate the statutory provision and avoid against overly broad Start Printed Page 16628implementation. We solicited comment on how a sponsoring organization could appropriately control who would or should be marketed to during the new OEP, such as through as mailing campaigns aimed at a more general audience.
Doctor visits a. By redesignating paragraphs (a) introductory text and paragraphs (a)(1) and (2) as paragraphs (a)(1), (2), and (3), respectively; Learn more about surety bail bonds
(ii) For the appeals measures, CMS will use statistical criteria to estimate the percentage of missing data for each contract (using data from multiple sources such as a timeliness monitoring study or audit information) to scale the star reductions to determine whether the data at the independent review entity (IRE) are complete. CMS will use scaled reductions for the Star Ratings for the applicable appeals measures to account for the degree to which the IRE data are missing.
Are You Covered By An Employer Group Health Plan? MEDICARE PART B
Court of Appeals Lower privacy 0.76 (0.36, 1.59) 1.53 (0.64, 3.64) Value Based Insurance For more information about observation status, including pending legislation   see: http://www.medicareadvocacy.org/medicare-info/observation-status/.
Hospitals, nursing homes, home health agencies, medical item suppliers, health care providers, health and drug plans, dialysis facilities.
Cologuard® stool DNA test once every 3 years (at this time, this is the only stool DNA test covered by Medicare) » Caregivers & Family
Loose ends By law, Medicare Cost plans are closing in counties served by two or more competing Medicare Advantage plans that meet set enrollment criteria. This includes counties in several states and the District of Columbia. Cost plans currently operating in affected counties will not be offered for 2019.
As noted previously, we proposed 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 proposed 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.
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17 Replies to “Call 612-324-8001 When Is Medicare Open Enrollment Period | Jenkins Minnesota MN 56456 Crow Wing”

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    if you go to a non-network provider, the services are covered under the Original Medicare Plan. You would pay the Medicare Part A and Part B Coinsurance and Deductibles.
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    Great! Enter your ZIP code to find the AARP® Medicare Supplement Insurance Plans, insured by UnitedHealthcare Insurance Company (UnitedHealthcare) that are available to you. Read moreIf you have questions, just call the number at the top of the page. UnitedHealthcare is here to help you.

  2. (ii) Personnel and systems sufficient for the Part D plan sponsor to organize, implement, control, and evaluate financial and communication activities, the furnishing of prescription drug services, the quality assurance, medical therapy management, and drug and or utilization management programs, and the administrative and management aspects of the organization.
    b. In paragraph (b)(1)(i) by removing the phrase “the coverage determination, redetermination,” and adding in its place the phrase “the coverage determination or at-risk determination, redetermination,”.
    No network rules. You can see any doctor that accepts Medicare. Some plans won’t cover care you get outside their network.
    Measure score means the numeric value of the measure or an assigned `missing data’ message.
    Final Decisions
    Response: Small, community and regional pharmacies have complained to us about excessive barriers to entry, and Start Printed Page 16598alleged that they only underwent accreditation because they were forced to do so. Otherwise, they would have been cut out of approximately 75 to 80 percent of the market. While we support the use of third party accreditation, we are concerned that Part D plan sponsors may require or do not recognize one accreditation certification versus another when pharmacies have already obtained an accreditation certification from a different organization, voluntarily or as a requirement from another plan sponsor or PBM. We believe it is unrealistic to expect pharmacies to obtain multiple accreditation certifications, which would be required if multiple Part D sponsors require accreditation by a specific accrediting organization.
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  3. Reward factor means a rating-specific factor added to the contract’s summary or overall ratings (or both) if a contract has both high and stable relative performance.
    Publications and Brochures
    (10) The individual is making an election within 3 months after notification of a CMS or State-initiated enrollment action or that enrollment action’s effective date, whichever is later.
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    (14) Use providers or provider groups to distribute printed information comparing the benefits of different health plans unless the providers, provider groups, or pharmacies accept and display materials from all health plans with which the providers, provider groups, or pharmacies contract. The use of publicly available comparison information is permitted if approved by CMS in accordance with the Medicare marketing guidance.

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    Response: The use of a consistent methodology and a data-driven approach precludes the possibility of an increase in the adjustment in a subset of the final adjustment categories. The CAI is designed from a quality measurement perspective and not payment. (The CAI methodology is detailed in the CAI Supplement available at http://go.cms.gov/​partcanddstarratings.)
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  5. Because Part D drug management programs will be integrated with the current policy/OMS beginning in 2019, there will be no separate OMS criteria in 2019 and beyond. For plan year 2019, we proposed the clinical guidelines to be the OMS criteria established for plan year 2018. The clinical guidelines for use in drug management programs we proposed for 2019 are: Use of opioids with an average daily MME greater than or equal to 90 mg for any duration during the most recent 6 months and either: 4 or more opioid prescribers and 4 or more opioid dispensing pharmacies OR 6 or more opioid prescribers, regardless of the number of opioid dispensing pharmacies.
    We proposed to continue to employ the LIS/DE indicator for contracts operating solely in Puerto Rico while the CAI is being used as an interim analytical adjustment. Further, we proposed that the modeling results would continue to be detailed in the appendix of the Technical Notes and the modified LIS/DE percentages would be available for contracts to review during the plan previews.
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    Comment: A few commenters expressed concern regarding the lack of any proposed review criteria that would be used by plans to evaluate these appeals based on the at-risk determination. Commenters stated that appeal requests for opioid restrictions do not fit in any existing utilization management criteria (for example formulary and tiering exceptions criteria) and request additional guidance from CMS. These commenters are concerned that if the beneficiary appeals the limitation beyond the plan, the IRE or ALJ/attorney adjudicator will likely review these restrictions similar to a formulary or tiering exception and not based on the at-risk determination. A commenter indicated that this type of review may have an adverse impact on plans’ D03 STARS Ratings, and if approved, an exception must be effectuated through the end of the plan year, which could remove the enrollee from case management for the rest of the year even if they meet the criteria for such.
    (10) Knowingly target or send unsolicited marketing materials to any MA enrollee during the Open Enrollment Period.
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    If I’m getting health coverage from an employer through the SHOP Marketplace, can I delay enrollment in Part B without a penalty?

  6. CCFBANK (2)
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    There are two ways to obtain Medicare coverage. One way is to choose Medicare Parts A and B, also known as Original Medicare. In this case, an enrollee can typically receive care from the doctors and other medical providers of their choosing.
    § 423.2022
    This story is part of NPR’s reporting partnership with WBUR and Kaiser Health News.
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    Response: While we appreciate these comments, we disagree with the suggestion to permit Part D plans to have a preferred and a non-preferred specialty tier. As discussed above, CMS limits specialty tier cost sharing to the statutorily mandated amount for the defined standard Part D benefit. While we did not propose to allow plans to establish multiple specialty tiers, we are making significant changes to existing tiering exceptions policy through this final rule, including removal of the generic tier exclusion and addition of the brand-to-brand limitation discussed above in subsection b. Additionally, while the plan’s cost for a drug must exceed a CMS-specified monthly cost threshold in order to be placed on the specialty tier, CMS does not require all drugs exceeding that threshold be placed on the specialty tier. In other words, if plans wish to encourage the use of certain specialty drugs over others, they can do so within existing formulary benefit designs. As such, we are not making additional changes in this policy area before having an opportunity to consider the effects of the changes in this rule. CMS will continue to disallow plan benefit packages with more than one specialty tier.
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    We proposed that the current quality Star Ratings system and procedures for revising it remain in place for the 2019 and 2020 Star Ratings. Section 1853(b) of the Act authorizes an advance notice and rate announcement to announce and solicit comment for proposed changes to the MA payment methodology, which CMS has interpreted to include the Part C and D Star Ratings program because of the payment consequences of Star Ratings under section 1853(o) of the Act. The statute identifies specific notice and comment timeframes, but that process does not require publication in the Federal Register. We have used the draft and final Call Letter, which are attachments to the Advance Notice and final Rate Announcement respectively,[33] to propose for comment and finalize changes to the quality Star Ratings system since the ratings became a component of the payment methodology for MA and MA-PD plans. (76 FR 21487 through 89). Because the Star Ratings system has been integrated into the payment methodology since the 2012 contract year (as a mechanism used to determine how much a plan is paid, and not the mechanism by which [or a rule about when] a plan is paid), the Star Ratings are part of the process for setting benchmarks and capitation rates under section 1853 of the Act, and the process for announcing changes to the Star Ratings system falls within the scope of section 1853(b) of the Act. Although not expressly required by section 1853(b) of the Act, CMS has historically solicited comment on significant changes to the ratings system using a Request for Comment process before the Advance Notice and draft Call Letter are released; this Request for Comment [34] provides MAOs, Part D sponsors, and other stakeholders an opportunity to request changes to and raise concerns about the Star Ratings methodology and measures before CMS finalizes its proposal for the Advance Notice. We intend to continue the current process at least until the 2019 measurement period that we proposed as the first measurement period under these new regulations, but we may discontinue that process at a later date as the Advance Notice/Call Letter process and rulemaking process may provide sufficient opportunity for public input. In addition, CMS issues annually the Technical Notes [35] that describe in detail how the methodology is applied from the changes in policy adopted through the Advance Notice and Rate Announcement process. We intend to continue the practice of publishing the Technical Notes during the preview periods. Our proposed rule included continued use of the draft and final Call Letters as a means to provide subregulatory application), Start Printed Page 16525interpretation, and guidance of the final version of these proposed regulations where necessary. Our proposed regulation text does not detail these plans for the RFC and Technical Notes because we believe such regulation text will be unnecessary. We proposed to codify the first performance period (2019) and first payment year (2022) to which our proposed regulations will apply at § 422.160(c) and § 423.180(c).

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    The accuracy of our estimate of the information collection burden.

  9. (4) Unless otherwise specified by CMS based on their use or purpose, materials that are required under § 422.111; or
    9.  Currently, for OMS, the following beneficiaries are excluded from OMS reporting: Those with ICD-10-CM codes associated with American Medical Association (AMA) Physician Consortium for Performance Improvement (PCPI) ICD-10 cancer diagnoses in the Common Working File (CWF) data during the 12 months prior to the end of the measurement period or cancer RxHCCs in the latest Risk Adjustment Processing System (RAPS). Note, this is currently aligned with the Pharmacy Quality Alliance opioid overuse measure specifications.
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    We talked to Customer Support Manager, Andrew Pickle, to learn more about how we take care of you after you enroll. […]
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      Comment: CMS received one comment that this composite penalizes Part D plans where patients do not prefer to fill prescriptions by mail.
    Response: While we did not propose new beneficiary communications requirements specific to the content of formularies posted online or provided on paper, current regulations continue to apply. However, as noted in our proposed rule, we decided not to require a regulatory deadline because we anticipate that Part D sponsors will be promptly updating the formularies posted online. At a minimum, Part D sponsors must comply with § 423.128(d)(2)(ii) which still requires Part D sponsors to update their websites to reflect their current formularies at least monthly. Additionally, we are finalizing revisions to § 423.128(d)(2)(iii), which currently requires Part D sponsors to provide notice online to current and prospective enrollees regarding midyear formulary changes, to require that the notice be provided timely under § 423.120(b)(5).We further believe that Part D sponsors would have the incentive to update their formularies timely to encourage beneficiaries to move to the newly substituted drugs and to avoid beneficiary confusion.

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    Response: We appreciate the concern that these commenters have about Medicare beneficiaries’ ability to access electronic documents. We believe that the hard copy notification of the ability to request a hard copy as well as the Start Printed Page 16624electronic status and availability of the documents should mitigate this as enrollees who want or need hard copies will be able to call the plan to request them. Additionally, we know from our experience administering the program that many of these beneficiaries rely on family members and friends to review important documents for them, and that these family members and friends will be more likely to have access to electronic versions of the required documents. As an additional measure, we intend to suggest in our subregulatory guidance regarding use of electronic delivery, that when a beneficiary requests hard copy delivery of a required document in place of electronic delivery, the plan may wish to continue to provide hard copies to that beneficiary on an ongoing basis, so that the beneficiary does not have to request hard copy format again. Finally, as we indicated earlier, the number of beneficiaries who have access to electronic mediums such as broadband internet access is growing every year. We believe we have placed sufficient protections in place and have addressed the growing desire for electronic versions of required documents.
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  12. All Genetics & Medicine Resources…
    c. Comments Received
    When the person performs SGA, the beneficiary will receive benefits for the Cessation month and two grace months before benefits stop. Medicare, however, will continue for at least 80 months after the person performs SGA.
    Collins SM. S.2554—Patient Right to Know Drug Prices Act. 115th Congress (2017–2018)March 14, 2018 Available at: http://www.congress.gov/bill/115th-congress/senate-bill/2554/text. Accessed May 24, 2018
    After consideration of these comments, we are finalizing the provision on the CARA duals’ SEP limitation at § 423.38(c)(4) with a modification to specify that beneficiaries that have been notified that they are potentially at-risk or at-risk as defined in § 423.100, and such identification has not been terminated in accordance with § 423.153(f)), will not be able to use the duals’ SEP.
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  13. Obamacare
    31.  http://go.cms.gov/​partcanddstarratings (under the downloads).
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    Selecting the right treatment depends on a variety of clinical factors, as well as needs, characteristics and preferences specific to an individual patient. Medicare Part B was set up to allow physicians to make the best decisions for their patients, offering a wide range of treatment options for patients suffering from serious illnesses, including cancer, rheumatoid arthritis, autoimmune disorders and more. 
    (2) Case management/clinical contact/prescriber verification—(i) General rule. The sponsor’s clinical staff must conduct case management for each potential at-risk beneficiary for the purpose of engaging in clinical contact with the prescribers of frequently abused drugs and verifying whether a potential at-risk beneficiary is an at-risk beneficiary. Except as provided in paragraph (f)(2)(ii) of this section, the sponsor must do all of the following:
    CMS does not believe this change will have a significant impact on health care providers. The number of plans offered by organizations in each county are not expected to increase significantly as a result of this change and health care provider contracts with MA organizations typically include all of the organization’s plans. In addition, CMS does not expect a significant increase in time spent on bid review as a result of eliminating meaningful difference requirement nor does CMS expect this change will increase provider burden.
    The 1997 law fashioned a “post institutional home health service” benefit, which provides coverage under Part A for the first 100 visits per “spell of illness” and then shifts all other coverage during the same spell of illness to Part B.

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    (C) Adding additional instructions to identify services or procedures; or
    Response: CMS does not interfere in private contractual matters or written arrangements between sponsoring organizations and their FDRs. CMS’ contract is with the sponsoring organization and sponsoring organizations are ultimately accountable for the performance of their FDRs compliance with applicable statutes, regulations and standards. Sponsoring organizations are required to develop an effective oversight structure for their FDRs. As part of routine monitoring activities, sponsoring organizations should evaluate whether regulatory requirements and accountability measures are included in contractual agreements. The burden of monitoring and documenting an FDR’s compliance with applicable standards ultimately rests with the sponsoring organization.
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    (2) If made during or after the month of entitlement to both Part A and Part B, it is effective the first day of the calendar month following the month in which the election is made.

  15. Click to Read the Full Review
    Response: The Star Ratings are designed to incentivize contracts to provide the best quality and care to beneficiaries. The methodology employed to determine the improvement measure-level Star Ratings is designed to align with the underlying principles of the Star Ratings methodology. The use of statistical significance allows the changes of each individual measure used for the determination of the improvement measure score to be assessed for meaningful differences. The use of the clustering algorithm to determine the cut points and ultimately, the assignment of the measure-level Star Ratings, allows a contract’s performance to be assessed relative to all contracts that are required to report. The determination of the measure-level Star Ratings is done in a manner to minimize misclassification. The clustering for the improvement measures is done twice to ensure that a contract with average or above average performance, demonstrated by an improvement measure score of zero or above, will receive a measure-level Star Ratings of at least 3 stars. A contract whose performance declined, demonstrated by an improvement measure score of less than zero, will receive a measure-level Star Rating less than 3 stars. Further, CMS designed the hold harmless provisions as a safeguard for contracts maintaining high performance at the measure-level or at the contract’s highest Star Rating to ensure that the improvement measure-level Star Ratings provide a true signal.
    Additional Comments and Responses
    Section 1860D-4(c)(5)(D)(v) of the Act requires that, before selecting a prescriber or pharmacy, a Part D plan sponsor must notify the prescriber and/or pharmacy that the at-risk beneficiary has been identified for inclusion in the drug management program, which will limit the beneficiary’s access to coverage of frequently abused drugs to selected pharmacy(ies) and/or prescriber(s) and that the prescriber and/or pharmacy has been selected as a designated prescriber and/or pharmacy for the at-risk beneficiary. We proposed § 423.153(f)(13) to codify this statutory requirement.
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  16. In late August 2017 the government published the new Jimmo-webpage on the CMS website to comply with the Corrective Action Plan.  The webpage can be found here.  The webpage includes court-approved affirmative disavowal of the Improvement Standard in a blue box titled “Important Message About the Jimmo Settlement.” The webpage also contains links to Jimmo-related documents, such as the transmittals of the revised Manual provisions, and a new set of Frequently Asked Questions. The imprimatur of CMS on these materials will help beneficiaries and their advocate who are arguing against inappropriate coverage denials or service terminations.
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    3) Medicare Part C, also referred to as Medicare Advantage Plans, allows private companies like HMOs and PPOs to offer health insurance that provide at least the same benefits of Parts A & B, but usually more like dental and vision. Most also offer cover prescription drugs. To manage costs, they offer a limited choice of providers.

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