MCOs weigh Medicare rules, options

September 1, 2004

In late July, Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mark McClellan unveiled a massive proposed regulation for implementing the Medicare Modernization Act. The hundreds of pages of fine print (published in the Aug. 3, 2004, Federal Register) describes requirements for Medicare Advantage (MA) plans, subsidies for employers who continue retiree drug benefits, and rules to ensure that prescription drug plans (PDPs) provide adequate and appropriate medicines for seniors. There is considerable detail on PDP operations and benefit design, including copays and quality improvement programs, which apply to MA plans providing drug coverage to Medicare beneficiaries.