Medicare Watch

New Proposed Rules on Medicare Part C and Part D

Last week, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for the 2012 plan year that includes changes to Part C, which covers Medicare private insurance plans also known as Medicare Advantage plans, and Part D, which covers the Medicare prescription drug benefit. The rule covers a broad spectrum of policies for both Part C and Part D, including codifying provisions of the Affordable Care Act (ACA), such as the prescription drug coverage gap (doughnut hole) phaseout. In addition, the rule regulates private plan marketing restrictions and consumer protections under Medicare Advantage and the prescription drug benefit. For example, proposed regulations strengthen plan obligations to respond to complaints, and individuals may be allowed to request drug coverage determinations and redeterminations online. The rule also addresses the CMS plan bid review process, including its authority to deny bids, and details the extent of cost-sharing that would be allowable, expanding limitations on cost-sharing amounts to those under Original Medicare to home health services, in addition to other high-cost services listed in the ACA, such as chemotherapy.

Furthermore, the proposed rule implements the new Medicare Advantage bonus payments program, established by the ACA, providing monetary bonuses to sponsors of plans with a quality rating of four or more stars under the CMS star rating system. The rule also proposes a new CMS demonstration based on the quality bonus payment program in the ACA, but would create a sliding scale of bonus payments tied to star ratings, expanding the availability of quality-based bonuses to three-star plans, which are considered “average” according to CMS standards.

According to the CMS press release, the rule will be open for comment until January 10, 2011.

Read the CMS Press Release on the proposed rule.

Read the Proposed Rule.

Innovation Center Aims To Increase Quality, Lower Costs

This week, the Centers for Medicare & Medicaid Services (CMS) formally introduced the Center for Medicare and Medicaid Innovation (Innovation Center). Made possible by the Affordable Care Act, the Innovation Center will serve as a hub for efforts to explore new ways to deliver and pay for health care. Demonstration projects and models for delivery and payment will arise out of conversations with a wide array of health care professionals, government officials, consumers and advocacy groups (including the Medicare Rights Center). Ultimately, successful models will be implemented throughout the Medicare and Medicaid programs. The ideal model would lower cost and result in better care and better health outcomes.

As of this week, the Innovation Center is overseeing three initiatives that will explore ways to better coordinate care for consumers: the Multi-Payer Advanced Primary Care Practice Demonstration, which will test efforts to integrate care; the Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration, which will examine the impact of care coordination for low-income consumers; and the Medicaid Health Home State Plan Option, which allows states to create a “health home” option for people with Medicaid.

Read a fact sheet on the Innovation Center.

Read CMS’s press release.

Visit the Innovation Center’s home page.

Medicare Reminder

People with Medicare can change their health and drug coverage during the Fall Open Enrollment Period, which runs from November 15 to December 31 this year. There are important questions that consumers should ask before joining a Medicare private health plan:

• Will I be able to use my doctors? Are they in the plan's network?
• How much is my monthly premium?
• How much will I have to pay out of pocket before coverage starts (what is the deductible)?
• How much is my copayment for a visit with my PCP or a visit with a specialist?
• Are there higher copays for certain types of care, such as hospital stays or home health care?
• What service area does the plan cover?
• What kind of coverage do I have if I travel outside of the service area?

Read the full list of questions at www.MedicareInteractive.org.

Spotlight

This week, the Congressional Budget Office released its preliminary analysis of a proposal by Paul Ryan and Alice Rivlin to change payments under the Medicare and Medicaid programs. The proposed changes would weaken the Medicare program and jeopardize consumers’ access to affordable care.

Tell your senators and representatives to preserve Medicare.

There are also more immediate threats to Medicare consumers’ access to care. If Congress does not act soon, payments to Medicare physicians will be cut and the Qualified Individual (QI) program and therapy caps exceptions process will be eliminated. Elected officials must put politics aside to stand up for Medicare consumers and protect access to affordable care.

Tell your senators and representatives to protect access to affordable care.