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Publication Details
- Publication Date: 2011
- Pub Code: BDBEN4-11WEB
- Pages: 210
- PDF version: 1,264KB
- ISBN: 978-1-936230-15-0
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Medicare Part D: A Comprehensive Analysis of CMS Rules
Distills from thousands of pages of CMS regulations and guidance the major rules, guidelines and deadlines you need to comprehend the complex Medicare drug benefit program. It includes nine detailed chapters on sponsors, eligibility and enrollment, formularies, CMS enforcement and much more.
From the editors of Medicare Advantage News and Report on Medicare Compliance
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.
Written For
- Health plans
- Pharmacy benefit management companies
- Pharmaceutical companies
- Providers that contract with health plans
- Self-insured employers
- Attorneys and consultants
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Medicare Part D: A Comprehensive Analysis of CMS Rules
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