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CMS
regulation would eliminate premiums for some
low-income Medicare Prescription Drug Plan
beneficiaries; Agency seeks comment on
proposed quality measures for Special Needs
Plans
Jan 08, 2008--CMS
on Monday announced a proposed regulation
that would allow Medicare drug benefit plans
to offer reduced premiums to some
beneficiaries who qualify for the program's
low-income subsidy,
CQ HealthBeat reports.
The eligible plans
would be located in regions where there are
fewer than five "zero-premium" plans
available.
The regulation would
allow eligible low-income beneficiaries in
those areas to stay on their current drug
plan without having to pay a premium and
would ensure that there are enough plans
offered for subsidy-eligible beneficiaries.
According to CMS, the regulation is
necessary because changes in premiums and
the low-income subsidy can cause a
beneficiary's drug plan to be fully covered
one year but not the next year.
Currently, CMS
during the open enrollment period each year
reassigns low-income subsidy-eligible
beneficiaries to a different zero-premium
drug plan if their current plan will not be
completely covered by the subsidy.
Acting CMS
Administrator Kerry Weems in a statement
said that he expects the final rule, with
any adopted changes, to be effective for the
2009 drug benefit year.
Weems in a statement said, "Through this
proposed rule, we are seeing comment on a
means of reducing the number of
beneficiaries subject to random reassignment
while maintaining the integrity of the
annual bid process."
The proposed regulation announcement comes
as
Consumers Union released an
analysis of data from the
Medicare.gov Web site that found
75% of Medicare drug plans raised their
costs for 2008.
The analysis found that
five of the most commonly used drugs between
December 2007 and January 2008 saw increases
that averaged $369. It also found that one
in six plans increased prices on those five
drugs by more than $500 during the same
period (Carey [1],
CQ
HealthBeat, 1/7).
Special Needs Plans
Quality Measures
CMS and the
National Committee for Quality Assurance
have released for public comment a proposed
series of quality measurements for Medicare
special needs plans,
CQ
HealthBeat reports.
The measures would
examine how SNPs handle case management and
improve care for beneficiaries with complex
medical needs. In addition, CMS would
require SNPs to report on 13 measurements of
care quality.
The proposed measures
are open for public comment on the NCQA Web
site through Jan. 18.
Legislation (S
2499) signed by President Bush
last month placed a moratorium on new SNPs
and expansions through Dec. 31, 2009.
Beyond the moratorium,
HHS and the
Medicare Payment Advisory Committee
have called for increased regulation of SNPs.
NCQA President Margaret O'Kane said,
"Special needs plans must demonstrate that
they are providing quality care and
protecting the rights of Medicare and
Medicaid beneficiaries" (Carey [2],
CQ
HealthBeat, 1/7).
