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From Health Law Daily, May 20, 2014

Medicare Parts C and D 2015 Final rule released

By Melissa Skinner, JD

CMS announced the release of a final rule involving technical and policy changes to the Medicare Advantage (MA or Part C) and Medicare Prescription Drug Benefits Programs (Part D) for contract year 2015. According to CMS, the purpose of this final rule is to clarify participation requirements, improve payment accuracy, and to make other clarifications and technical changes as well as to implement certain provisions of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). The rule finalizes certain provisions that were proposed earlier this year in “Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs” (79 FR 1918). CMS also announced which provisions identified in the proposed rule will not be finalized at this time.

Finalizing proposed rule. CMS received approximately 7,600 pieces of correspondence associated with the proposed rule. In drafting the final rule, CMS took the comments included in those communications into consideration and specifically addressed many of the responses in the final rule. However, CMS did not address comments that were outside the scope of the proposed or final rule and did not address comments that pertained to the aspects of the proposed rule that are not confirmed in the final rule.

Major provisions. CMS highlighted major provisions of the final rule which will affect the following issue areas: (1) agent/broker requirements and compensation; (2) the implementation of overpayment provisions pursuant to the ACA; and (3) risk adjustment data requirements. In terms of the agent and broker requirements and compensation, the final rule will replace the former regulatory compensation structure, which required MA organizations and Part D sponsors to pay independent agents an initial compensation rate for new enrollees in year one of a six year cycle then, for the following five years in the cycle, pay the agents a renewal rate of 50 percent of the initial fee. The system proposed in the initial rule released earlier this year by CMS would abolish the six year cycle and allow MA organizations and Part D sponsors to pay agents 35 percent of the fair market value designated by CMS for the second year and any subsequent year. However, due to comments received as to this provision with respect to the proposed lowered compensation rates for independent agents, CMS changed the proposed 35 percent rate back to a 50 percent referral rate in the final rule.

Provisions not finalized. CMS classified the proposed provisions that were not included in the final rule according to whether the provision was proposed to clarify requirements, improve payment accuracy, or to strengthen beneficiary protections. Of the proposals made to clarify participation requirements the following were among those not finalized in this rule: (1) changes to audit and inspection; (2) exceptions to drug categories or cases of clinical concern; (3) business continuity for MA organizations and Part D plan sponsors; and (4) quality improvement program regulations. In regard to improving payment accuracy, proposed changes to the determination of payments, reopening, payment appeals, payment processes for Part D sponsors, and the proposal of an annual deadline for some risk adjustment data requirements were not included in the final rule. Finally, in terms of beneficiary protections, CMS choose not to impose final rules in certain areas including good drug processes. The full list of provisions that were not finalized is included in the final rule and CMS stated that those provisions that are not noted but were included in the proposed rule have been withdrawn.

MainStory: TopStory ReimbursementNews HealthCareReformNews CMSNews PartCNews PartDNews

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