Medicare Watch

Medicare Rights Offers Comments on Part C and D Rules

Last week, the Medicare Rights Center submitted comments developed with fellow consumer advocates to the Centers for Medicare and Medicaid Services (CMS) on its proposed rules governing Part C Medicare private health plans, also known as Medicare Advantage (MA) plans, and the Part D Medicare prescription drug benefit for plan year 2013. The comments are generally supportive of the proposed regulations, which encourage increased transparency and greater plan accountability, though they also urge CMS to further strengthen some of these policies.

Specifically, the comments ask CMS to strengthen a proposed rule that codifies CMS’s authority to terminate contracts with poorly performing plans that receive a one or two star rating for three consecutive years. The comments urge CMS to decrease the number of years after which it can terminate plan contracts on the basis of poor ratings. In addition, the comments suggest the creation of probationary periods for plans that avoid termination by increasing their quality ratings, but have a history of poor performance.

Furthermore, the comments address issues that may arise as MA plans implement new coverage policies for durable medical equipment (DME). As CMS allows MA plans to create preferred DME brands and suppliers and to limit coverage to those brands and suppliers, CMS must ensure that an easily accessible exceptions process exists for patients. The exceptions process should include, for instance, coverage of equipment from a non-preferred provider when DME from the non-preferred provider is medically necessary.

Medicare Rights’ comments also applaud CMS for proposed regulations that seek to eliminate conflicts of interest for consultant pharmacists working in long term care settings. Recent reports demonstrate that associations with drug companies and other entities may cause pharmacists to favor prescribing certain drugs, even when these drugs are potentially inappropriate or dangerous for patients.

Among other topics also discussed in the comments are the need for clarification of rules around Special Needs Plans and extra benefits they may offer, as well as suggested improvements to rules implementing the coverage gap discount program for the Part D benefit.

Read Medicare Rights’ comments to CMS on proposed changes to Parts C and D.

Medicare Doctor Payments and Other Programs Hang in the Balance

Surprise action by the majority in the House of Representatives this week derailed a compromise reached over the weekend that would prevent a Medicare physician payment cut of 27.4 percent and the expiration of the Qualifying Individual (QI) benefit on January 1, 2012. The Medicare physician payment cut is the result of the Sustainable Growth Rate (SGR) formula passed in 1997, and the QI benefit assists Medicare beneficiaries with limited incomes in paying their Part B premiums.

The compromise that was overwhelmingly passed in the Senate on Saturday would prevent a decrease in physician payments, and extend programs such as the QI benefit, the Medicare therapy caps exceptions process, the payroll tax cut holiday, and unemployment benefits for two months. On Tuesday, however, the House of Representatives rejected the plan mostly along party lines.

The two-month extension would allow benefits to continue while Congress works to come to an agreement on a longer-term deal that would prevent Medicare physician payment cuts and extend programs for at least a full year. Dispute remains over the details of a longer-term package, including how to pay for the extension of these programs and appropriate reimbursement levels for Medicare physicians. For example, a bill passed by the House of Representatives in early December included more controversial measures intended to offset temporary fixes. The bill would have made permanent changes to Medicare, including further means-testing premiums, a policy that would increase premiums for 25 percent of the Medicare population over time.

Pressure continues to mount on Representatives to vote for the two-month package. President Obama, Senate Majority Leader Harry Reid and Senate Minority Leader Mitch McConnell have all called on the House of Representatives and House Majority Leader John Boehner to take action. At time of press, breaking news reports state that Majority Leader Boehner may back down from his current position and consider the two-month extension as called for by the President earlier today.

If the measure does not pass, the Centers for Medicare and Medicaid Services (CMS) has stated that it will hold physician claims for the first ten business days of the year. Historically, when Congress has not acted in time to extend the QI benefit, most states have continued to administer the program in anticipation that Congress will eventually act to fund the program for another year. However, the details of the administration of policies affected by the impasse still remain unclear.

Read Medicare Rights Center President Joe Baker’s statement on the looming Medicare physician cut.

Read Politico’s breaking news, “On payroll tax cut, GOP ready to cave.”

Medicare Reminder

The Medicare Rights Center and AgeOptions (on behalf of the Make Medicare Work Coalition) have released “How Medicare Works with Employer-Based Health Insurance,” a toolkit of educational materials designed for Medicare beneficiaries and the professionals who serve them. The toolkit, which aims to help individuals understand how to transition from employer-based health insurance to Medicare, comes at a time when millions of baby boomers are aging into Medicare, but still working past the age of 65.

Using PowerPoint trainings, frequently asked questions, common scenarios, and a glossary of terms, the toolkit explains how Medicare coordinates with different kinds of employer-based health insurance, including current employer coverage, retiree or union coverage, and COBRA.

Medicare Rights and AgeOptions anticipate that this toolkit will be useful not only for older adults turning 65 today, but also for future Medicare beneficiaries as people continue to extend the age at which they retire. The project was made possible by funding from the Retirement Research Foundation.

Read Medicare Rights and AgeOptions’ “How Medicare Works With Employer-Based Health Insurance: A Guide for Employers, Professionals and Consumers”.

Spotlight

A recent poll conducted by the Allstate/National Journal Heartland Monitor found that Americans nearing retirement are concerned about whether their income and savings will be sufficient to cover future health care costs, especially for long term care or assisted living. The survey, one of an ongoing series exploring the effect of current economic downturn, also found that a majority of respondents want to protect the Medicare program as it currently stands.

Read the Kaiser Health News article about the poll.