CMS Proposes New Medicare Advantage and Prescription Drug Plan Rule

CMS issued today a proposed rule that would affect Medicare Advantage Organizations and Prescription Drug Plan Sponsors. The proposed rule would incorporate into regulation a number of requirements that CMS previously imposed through operational guidance and is based on "lessons learned since 2006." Among other changes, the proposed rule would impose new restrictions on MA marketing and sales activities including commission structures. The proposed rule would also codify CMS' guidance on best available evidence to determine low income subsidy eligibility, impose additional requirements on Special Needs Plans to ensure the plans focus on the needs of their target population, and expand CMS’ flexibility in determining penalties against Medicare Advantage Organizations and Prescription Drug Plan Sponsors.

A copy of the proposed rule has been submitted for publication in the Federal Register and is available on CMS’ website. Comments must be submitted by 5:00 pm ET on July 15, 2008.