Medicare Part D: A Comprehensive Analysis of CMS Rules

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Place an order or get more information at 800-521-4323 Price: $124 Pages: 217 ISBN:1-933801-32-8 © 2008 Pub Code: BDBEN

The complexity and confusion surrounding Medicare's drug benefit has never been greater. Medicare Part D: A Comprehensive Analysis of CMS Rules distills from thousands of pages of government regulations and guidance the major rules, guidelines and deadlines you need to comprehend this confusing program.

With nine detailed chapters on sponsors, eligibility and enrollment, formularies, CMS enforcement and much more, this valuable analytical tool provides answers to questions such as:

• How does CMS guidance affect marketing?
• How are MA PPOs offering Rx drugs treated under Part D?
• How does enrollment of Medicare/Medicaid dual eligibles affect Part D plans?
• What requirements should Part D sponsors follow when their formularies change?
• What areas does CMS focus on during Part D audits?
• What data do plans need to submit to CMS and when?
• How do e-prescribing standards affect Part D drug plans?
• When should employers continue to provide retiree prescription drug benefits as supplemental, wrap-around coverage? When should they become a PDP, or take the federal retiree drug subsidy?
• What are the implications of the enrollment “lock-in” for Part D marketing?

Arm yourself with the intelligence you need to understand and participate successfully in complex Medicare drug benefit program. Order Medicare Part D: A Comprehensive Analysis of CMS Rules today!

Table of Contents

Chapter 1: Part D Sponsors
Types of Part D Sponsors
Applications
Bids
Part D Waivers
Contract Requirements
Marketing Part D Plans
CMS Payments to Sponsors
Cost Control and Quality Improvement

Chapter 2: Part D Prescription Drug Coverage
Standard Prescription Drug Coverage
Actuarially Equivalent Standard Coverage
Coordination of Benefits
True Out-of-Pocket Costs

Chapter 3: Medicare Advantage Prescription Drug Plans
Types of Plans
Special Needs Plans
Election and Enrollment
Benefits and Beneficiary Protections
Bids
Financial Incentives for Regional MA Plans

Chapter 4: Eligibility and Enrollment
Enrollment
Auto and Facilitated Enrollment
Enrollment Periods
Disenrollment

Chapter 5: Low-Income Subsidy Program
Eligibility Determinations
Subsidies
Administration of Subsidy Program
Payment Provisions for States

Chapter 6: Formulary Requirements
Part D Covered Drugs
Changes to Formularies
Review Process
Model Formulary Guidelines

Chapter 7: Retiree Prescription Drug Benefit
Retiree Prescription Drug Coverage Application
Employer Waivers
Retiree Drug Subsidy Option

Chapter 8: Electronic Prescribing
Use of Electronic Prescribing Standards
E-Prescribing Standards
HIPAA Issues
Anti-Kickback Statute and Stark Exception

Chapter 9: CMS Oversight and Enforcement
Reporting Requirements
Prescription Drug Event Data
Fraud, Waste, and Abuse Compliance Program
Auditing

Written By

Medicare Part D: A Comprehensive Analysis of CMS Rules was researched and written by Barbra Golub, an attorney who's spent more than 10 years writing highly technical publications on taxation, employee benefits and other complex regulatory issues.

 

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Shipping Information

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Related Publications

Medicare Part D Compliance News
Medicare Advantage News
Managed Medicare & Medicaid Factbook
Health Plan Week
Drug Benefit News

 

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