Department of Health and Human Services, Centers for Medicare & Medicaid Services: Medicare Program; Medicare Advantage and Prescription Drug Benefit Programs
GAO-11-947R, Sep 16, 2011
GAO reviewed the Department of Health and Human Services, Centers for Medicare and Medicaid Services' (CMS) new rule on the Medicare Program; Medicare Advantage and prescription drug benefit programs. GAO found that (1) the final rule finalizes revisions to the regulations governing the Medicare Advantage (MA) program (Part C), prescription drug benefit program (Part D) and section 1876 cost plans, including implementing statutory requirements regarding special needs plans, private fee-for-service plans, regional preferred provider organizations plans. This final rule also revised the regulations governing Medicare medical savings accounts plans; cost-sharing for dual-eligible enrollees in the MA program; prescription drug pricing, coverage, and payment processes in the Part D program; and requirements governing the marketing of Part C and Part D plans. These changes clarify various program participation requirements, strengthen beneficiary protections, strengthen CMS's ability to identify strong applicants for Part C and Part D program participation and remove consistently poor performers, and make other clarifications and technical changes; and (2) CMS complied with applicable requirements in promulgating the rule.