CMS Regulation Would Eliminate Premiums For Some Low-Income Medicare Prescription Drug Plan Beneficiaries

Main Category: Medicare / Medicaid / SCHIP
Article Date: 09 Jan 2008 - 6:00 PDT

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CMS on Monday announced a proposed regulation that would allow Medicare drug benefit plans to offer reduced premiums to some beneficiaries who qualify for the program's low-income subsidy, CQ HealthBeat reports. The eligible plans would be located in regions where there are fewer than five "zero-premium" plans available. The regulation would allow eligible low-income beneficiaries in those areas to stay on their current drug plan without having to pay a premium and would ensure that there are enough plans offered for subsidy-eligible beneficiaries.

According to CMS, the regulation is necessary because changes in premiums and the low-income subsidy can cause a beneficiary's drug plan to be fully covered one year but not the next year. Currently, CMS during the open enrollment period each year reassigns low-income subsidy-eligible beneficiaries to a different zero-premium drug plan if their current plan will not be completely covered by the subsidy. Acting CMS Administrator Kerry Weems in a statement said that he expects the final rule, with any adopted changes, to be effective for the 2009 drug benefit year.

Weems in a statement said, "Through this proposed rule, we are seeing comment on a means of reducing the number of beneficiaries subject to random reassignment while maintaining the integrity of the annual bid process."

The proposed regulation announcement comes as Consumers Union released an analysis of data from the Medicare.gov Web site that found 75% of Medicare drug plans raised their costs for 2008. The analysis found that five of the most commonly used drugs between December 2007 and January 2008 saw increases that averaged $369. It also found that one in six plans increased prices on those five drugs by more than $500 during the same period (Carey [1], CQ HealthBeat, 1/7).

Special Needs Plans Quality Measures
CMS and the National Committee for Quality Assurance have released for public comment a proposed series of quality measurements for Medicare special needs plans, CQ HealthBeat reports. The measures would examine how SNPs handle case management and improve care for beneficiaries with complex medical needs. In addition, CMS would require SNPs to report on 13 measurements of care quality. The proposed measures are open for public comment on the NCQA Web site through Jan. 18.

Legislation (S 2499) signed by President Bush last month placed a moratorium on new SNPs and expansions through Dec. 31, 2009. Beyond the moratorium, HHS and the Medicare Payment Advisory Committee have called for increased regulation of SNPs. NCQA President Margaret O'Kane said, "Special needs plans must demonstrate that they are providing quality care and protecting the rights of Medicare and Medicaid beneficiaries" (Carey [2], CQ HealthBeat, 1/7).

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