Medicare private plans may see more regulation

Washington The Centers for Medicare & Medicaid Services issued a proposed rule Oct. 9 that seeks to improve the performance of Medicare prescription drug and health plans.

The changes to Medicare Advantage and Part D would clarify program requirements for the more than 4,000 plan offerings and improve protections for beneficiaries enrolled in these plans, CMS said. Officials said the agency is seeking to improve the overall performance of the programs to ensure that beneficiaries have the best choices available when making decisions about their coverage.

"CMS is strengthening and simplifying the drug and health plan program in order to deliver a level of service that is more responsive to Medicare beneficiary needs," said Jonathan Blum, acting director of the agency's Center for Health and Drug Plan Choice. "While CMS made important improvements through the 2010 contracting process, these rules will enable the agency to make further improvements."

Among other revisions, CMS is proposing to:

• Increase its ability to identify and approve qualified drug and health plans.
• Improve protections from discriminatory cost-sharing by clarifying plan requirements on out-of-pocket costs and cost-sharing.
• Eliminate duplication by requiring meaningful differences between an insurer's various product offerings with regard to premiums, beneficiary out-of-pocket costs, plan types and drug formularies.

Additional policy revisions include a proposal to collect all prescription drug event data elements to provide more accurate information for analysis of how Medicare beneficiaries are using their Part D plan benefits.

The proposed rule was published in the Federal Register Oct. 22. The public comment period is set to close Dec. 8.