This week, the Medicare Rights Center (Medicare Rights) submitted comments in response to the Centers for Medicare & Medicaid Services (CMS) 2018 Advance Rate Notice and Draft Call Letter (2018 Call Letter). CMS announces proposed changes to the Medicare Advantage (MA) and Part D programs through a yearly call letter, and every year Medicare Rights provides feedback to the agency on proposals we support and where we have concerns.
The 2018 Call Letter held few surprises but provided many opportunities for Medicare Rights to encourage or raise caution with certain proposals. For example, we continue to encourage CMS to look carefully at the issue of “upcoding”—a practice that results in overpayments to MA plans relative to Traditional Medicare. We also continue to urge CMS to ensure the validity and usefulness of the Star Ratings Program, which may allow plans that performed poorly in audits to receive high star ratings.
We were pleased that CMS asked for comments on Part D tiering exceptions in the 2018 Call Letter. Through a tiering exception, a person has a right to request lower cost-sharing for a high-cost prescription drug, if a similar, lower-cost medicine is also covered by their plan. Through the Medicare Rights national helpline, we find this process can be complicated and confusing for beneficiaries. Our comments include several recommendations about how to minimize these burdens.
In addition to the above issues, we also call out several unaddressed issues that should stay on CMS’ radar. These include streamlining Part D appeals, improving consumer protections in seamless conversion arrangements, and strengthening MA provider directories and network adequacy oversight.
Read the comments.
Sign up to receive Medicare news, policy developments, and other useful updates from the Medicare Rights.