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Medicare Officials Release Drug And PPO Regs

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The federal government has published 2 mammoth sets of regulations that will help implement the Medicare Modernization Act of 2003.[@@]

The Centers for Medicare and Medicaid Services prepared the regulations, which spread out over more than 2,000 pages of paper and take up more than 4 megabytes of computer storage space.

One set of regulations is supposed to implement the MMA Medicare prescription drug provisions.

Another set applies to the MMA section that updates the Medicare managed care program. Through the Medicare Advantage program, the federal government now will encourage regional preferred provider organizations to offer PPO coverage to all Medicare beneficiaries. In the past, Medicare officials focused on encouraging health maintenance organizations to participate in the Medicare program.

The regulation also implements MMA provisions that would let insurers offer cheaper Medicare supplement coverage options.

The CMS already has posted drafts of the regulations on its Web site. Public comments are due Oct. 4.

Employer and insurer groups issued statements welcoming the drafts.

“Today’s proposed rules come at a critical time for employers and millions of retirees who have faced serious challenges in keeping retiree health coverage as affordable and comprehensive as possible,” says Paul Dennett, a vice president at the American Benefits Council, Washington. “We are particularly encouraged that CMS has underscored its openness to working closely with employers over the next few months to make sure the proposed rules work as effectively as possible.”

Karen Ignagni, president of America’s Health Insurance Plans, Washington, also praised the proposed rules, as well as the CMS for acting swiftly to implement the new law.

“We believe that CMS is working to create a sound regulatory framework in the 2 parts of the program announced today, including the Medicare Advantage local and regional plans and the prescription drug benefit,” Ignagni says. “We commend CMS for working to develop a public-private partnership that provides better benefits and better health care options for Medicare beneficiaries.”

Drafts of the proposed regulations are on the Web at


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