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Groups Challenge CMS on Part D Appeals Process

By CQ Staff

October 4, 2006 -- Advocates for Medicare beneficiaries have asked Centers for Medicare and Medicaid Services (CMS) Administrator Mark B. McClellan to make the drug benefit's appeals process work "more fairly and efficiently" before the 2007 enrollment period begins.

In a letter sent on Tuesday to McClellan, the groups noted problems they said beneficiaries have incurred in the Part D appeals process. The groups—which include the National Senior Citizens Law Center, the Center for Medicare Advocacy, and the Medicare Rights Center—encouraged CMS to take action to correct problems with the appeals process.

"Without mandated minimum protections for beneficiaries, advocates and CMS caseworkers have no means of ensuring that plans meet their obligations," the groups wrote McClellan.

The groups said they wrote the letter based on a Sept. 8 letter from McClellan that "does not correspond either to the requirements CMS had established for Part D plans or to the reality of the situation on the ground."

Jeffrey A. Kelman, chief medical officer for CMS' Center for Beneficiary Choices, said a March 30 guidance document from CMS deals with many of the groups' concerns.

"It's important for us that everybody get to use the transition process and the appeals and exceptions process appropriately and that nobody has the necessary drugs withheld," Kelman said.

The groups that wrote to McClellan "may not have the whole picture. We put out a lot of guidance. It's a complicated benefit," Kelman said. He also said CMS has asked the groups to refer specific cases to the agency for action.

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