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Medicare Unveils Final Rule on Changes to Advantage, Part D Plans

By Kerry Young, CQ HealthBeat Associate Editor

May 19, 2014 -- Medicare recently announced a final rule that will make changes to two programs through which private insurance companies are paid to manage medical services for the elderly: the Advantage general heath and the Part D prescription-drug plans.

The rules are projected to save about $1.62 billion in the decade that ends in 2024, the Centers for Medicare and Medicaid Services (CMS) said in a statement.

"The final rule will give CMS new and enhanced tools in combating fraud and abuse in the Medicare Part D program so that we can continue to protect beneficiaries and taxpayers," said CMS Administrator Marilyn Tavenner in a statement.

CMS had drawn more than 7,500 public comments on a draft version of planned changes that was released in January. The final version includes a requirement that doctors who prescribe medicines covered by the Part D program enroll in Medicare or have a valid record of opting out, a step that CMS says will ensure that medicines are only prescribed by qualified individuals.

The rule also will allow CMS to revoke doctors and other prescribers' rights to Medicare enrollment, or their authorization to bill the program, if they are found to have abusive prescribing practices.

The new rule also expands the release of unencrypted, prescriber, plan and pharmacy identifiers contained in prescription drug event records, a move that will give the public broader access to such data while still preserving the privacy of Medicare beneficiaries. The rule will not finalize any new criteria regarding drug categories or classes of clinical concern, and "will maintain the existing six protected classes," CMS said.

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