Monthly Archives: February 2015

CMS Finalizes Changes to Medicare Advantage, Rx Drug Programs

On Friday, CMS finalized several minor changes to Medicare Advantage and Medicare’s prescription drug programs, including emergency procedure requirements in the event of natural disasters, Modern Healthcare reports.
The rule finalizes some of the proposals CMS released in January 2014, which garnered more than 7,000 comments. Several of the provisions were finalized by CMS in May 2014 (Demko/Herman, Modern Healthcare, 2/6).
Details of Changes
Under the changes finalized last week, MA organizations and Medicare Part D sponsors must have plans in place to restore essential operations within 72 hours of an emergency (Viebeck, The Hill, 2/6). CMS earlier had proposed that contractors should have services operational within 24 hours (Modern Healthcare, 2/6).
CMS said the rule was prompted partly by Hurricane Sandy. “It became apparent (after the storm) that a few entities, particularly those with operational centers and/or information technology sources physically located in the affected areas, did not have consistent continuity plans or back-up systems and processes to ensure ongoing coordinated deployment of critical staff to alternate locations,” according to the rule (The Hill, 2/6).
CMS also finalized new regulations that give the agency the authority to require insurers and pharmacy benefit managers to hire independent auditors when challenging Medicare audit findings.
According to Modern Healthcare, CMS omitted from the rule several proposals that had been included in an earlier version. For example, CMS did not:
Remove the “protected status” of antidepressant, antipsychotic and immunosuppressant drugs; or
Include a proposal to require plans to include in their networks any pharmacies that accept their terms (Modern Healthcare, 2/6).