Officials at the federal Centers for Medicare & Medicaid Services (CMS) want the authority to terminate Medicare Advantage and Medicare Part D drug plan sponsors that have received low performance ratings for 3 years in a row.
CMS has included a plan termination provision in a proposed Medicare program rule that is set to appear in the Federal Register Oct. 11.
In the 298 pages of proposed regulations, officials would be implementing provisions of the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA) as well as the Patient Protection and Affordable Care Act of 2010 (PPACA).
The proposed rule includes many different provisions, such as a provision that would let a physician help a patient appeal a plan prescription denial without getting a signed authorized representative form the plan.
Another provision would add benzodiazepines and, for some conditions, barbiturates, to the list of drugs a Medicare Part D plan must cover.
The section on “Excluding Poor Performers” calls CMS to get explicit authority to terminate health care prepayment plans whose administration does not meet specified financial, reporting and provider access requirements.
If plan fails to provide adequate access to providers, or to document access, it should face the possibility of program termination, officials said.
CMS also wants to use the plan rating system it developed to give beneficiaries information about the quality and performance of health and drug plans to winnow out plans with consistently poor ratings.