The Centers for Medicare and Medicaid Services will provide beneficiaries with more "meaningful choices" among Medicare Advantage and Medicare prescription drug plans as it continues to build on its oversight efforts.
“By strengthening our oversight efforts, we are protecting beneficiaries and taxpayers by ensuring that the data provided by plan sponsors is reliable and correct,” said Jonathan Blum, acting director of CMS' Center for Drug and Health Plan Choice.
The requirements are part of the annual Call Letter, issued by CMS to organizations that intend to offer Medicare Advantage and Prescription Drug plans in 2010. These organizations use this guidance to submit bids on June 1, helping to ensure that beneficiaries have the information they need to choose a plan during the annual enrollment period which begins Nov. 15.
More than 10 million beneficiaries are enrolled in Medicare Advantage plans and more than 17 million are enrolled in Part D prescription drug plans.
For 2010, CMS will be be taking new steps in reviewing Medicare Advantage plan cost-sharing to ensure that beneficiaries will be protected from discriminatory out-of-pocket charges.
CMS is also asking Medicare Advantage organizations to make sure the plans they offer in 2010 significantly differ from one another to ensure that beneficiaries aren't confused. Many plan sponsors offer multiple plans with few distinguishing characteristics and low enrollment. These low-volume plans crowd the field and make selecting a plan much more difficult.
Twenty-seven percent of total Medicare Advantage plans have fewer than 10 enrollees. Very few beneficiaries would be affected by Medicare Advantage organizations dropping the plans in question – less than 1 percent of all Medicare Advantage enrollees. CMS will assist any beneficiaries affected in enrolling in a similar Medicare Advantage plan offered by the same organization in order to avoid any disruption in benefits.
Plan improvements for 2010 are designed to enable beneficiaries to select plans that best fit their individual needs.
As part of CMS’ efforts to improve understanding of prescription drug plan options, prescription drug plan sponsors will be required to outline all the tools used by the plan to lower costs and improve outcomes, known as utilization management criteria, on their Web sites.
As part of CMS’ oversight efforts of the Medicare Advantage and prescription drug plans, sponsoring organizations are being asked to conduct audits on the data provided to CMS about the operation of their plans. These new audits will be in addition to the current CMS financial and program compliance audits. The existing program compliance audits will be strengthened by becoming more targeted, data-driven and risk-based. They will focus on high-risk areas that have the greatest potential for beneficiary harm, such as enrollment operations, appeals and grievances and marketing.
“By strengthening these data collection processes, we will have an early warning system in place to be sure beneficiaries are not at risk of losing access to prescription drugs or health care services if plans have problems,” said Blum.