New Changes Proposed for the Medicare Advantage and Prescription Drug Benefit Programs (CMS-4159-P)

Richard P. Kusserow | March 2014

The Part D Medicare prescription drug benefit was enacted as part of the Medicare Modernization Act of 2003 and provides extensive drug coverage for seniors and the disabled, allowing them to get prescriptions as quickly as possible. In the time since Part D was enacted, some have argued that Medicare’s focus on speedy delivery has its downsides. On January 6, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule designed to strengthen protections, improve health care quality, and reduce costs for Medicare beneficiaries with private Medicare Advantage (MA) and Part D prescription drug plans in contract year 2015. (1)  It is intended to bring extensive reforms to the Medicare Advantage (“Part C”) and Medicare Prescription Drug Benefit Program (“Part D”), partly through regulations implementing provisions of the Affordable Care Act (ACA).

1. Proposed rule was published in the Federal Register on January 10, 2014. CMS will accept comments on the proposed rule until March 7, 2014.

About the Author

Richard P. Kusserow established Strategic Management Services, LLC, after retiring from being the DHHS Inspector General, and has assisted over 2,000 health care organizations and entities in developing, implementing and assessing compliance programs.