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CMS Regulation Would Eliminate Premiums For Some Low-Income Medicare Beneficiaries

Armen Hareyan's picture

CMSon Monday announced a proposed regulation that would allow Medicaredrug benefit plans to offer reduced premiums to some beneficiarieswho qualify for the program's low-income subsidy, CQHealthBeat reports. The eligible plans would be located inregions where there are fewer than five "zero-premium"plans available. The regulation would allow eligible low-incomebeneficiaries in those areas to stay on their current drug planwithout having to pay a premium and would ensure that there areenough plans offered for subsidy-eligible beneficiaries.

Accordingto CMS, the regulation is necessary because changes in premiums andthe low-income subsidy can cause a beneficiary's drug plan to befully covered one year but not the next year. Currently, CMS duringthe open enrollment period each year reassigns low-incomesubsidy-eligible beneficiaries to a different zero-premium drug planif their current plan will not be completely covered by the subsidy.Acting CMS Administrator Kerry Weems in a statement said that heexpects the final rule, with any adopted changes, to be effective forthe 2009 drug benefit year.

Weems in a statement said,"Through this proposed rule, we are seeing comment on a means ofreducing the number of beneficiaries subject to random reassignmentwhile maintaining the integrity of the annual bid process."

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Theproposed regulation announcement comes as ConsumersUnion released an analysis of data from the Medicare.govWeb site that found 75% of Medicare drug plans raised their costs for2008. The analysis found that five of the most commonly used drugsbetween December 2007 and January 2008 saw increases that averaged$369. It also found that one in six plans increased prices on thosefive drugs by more than $500 during the same period (Carey [1], CQHealthBeat, 1/7).

Special Needs Plans Quality Measures

CMS and the NationalCommittee for Quality Assurance have released for public commenta proposed series of quality measurements for Medicare special needsplans, CQ HealthBeat reports. The measures would examinehow SNPs handle case management and improve care for beneficiarieswith complex medical needs. In addition, CMS would require SNPs toreport on 13 measurements of care quality. The proposed measures areopen for public comment on the NCQA Web site through Jan.18.

Legislation (S 2499) signed by President Bush last monthplaced a moratorium on new SNPs and expansions through Dec. 31, 2009.Beyond the moratorium, HHSand the MedicarePayment Advisory Committee have called for increased regulationof SNPs. NCQA President Margaret O'Kane said, "Special needsplans must demonstrate that they are providing quality care andprotecting the rights of Medicare and Medicaid beneficiaries"(Carey [2], CQ HealthBeat, 1/7).

Reprinted with permission fromkaisernetwork.org.You can view the entire KaiserDaily Health Policy Report, search the archives, andsign up for email delivery at kaisernetwork.org/email. The Kaiser Daily Health Policy Report ispublished for kaisernetwork.org, a free service of The Henry J.Kaiser Family Foundation.