PROPOSED CHANGES TO THE MEDICARE ADVANTAGE AND THE MEDICARE PRESCRIPTION DRUG BENEFIT
PROGRAMS FOR CONTRACT YEAR 2012 AND DEMONSTRATION ON QUALITY BONUS PAYMENTS
Background
This proposed rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care Education and Reconciliation Act of 2010 (the Affordable Care Act) that are related to the Medicare Advantage (MA, or Part C) and Prescription Drug Benefit (Part D) Programs. This proposed rule also sets forth programmatic and operational changes to the Medicare Advantage and Prescription Drug Benefit programs for contract year 2012 based on our continued experience with the administration of the Parts C and D programs. We are proposing to publish the final rule before the beginning of the 2012 contract year, in time to prepare plans for 2012 bids. Most provisions will be in effect 60 days after the publication of the final rule (see Tables 1 and 2 in the proposed rule for provisions with different effective dates).
In addition to the proposed rule, CMS is posting the 2011 Medicare Plan Star Ratings and announcing a Demonstration Project to accelerate quality bonus payments for four and five-star plans and add quality bonus payments for three and three ½ star plans. The Demonstration Project builds on the quality-related bonus payments authorized in the Affordable Care Act by providing stronger incentives for plans to improve their performance thereby accelerating quality improvements during the three-year period of the demonstration.
PROPOSED RULE
The proposed rule addresses the following:
· Implementing provisions of the Affordable Care Act;
· Clarifying various program participation requirements;
· Strengthening beneficiary protections;
· Strengthening Medicare’s ability to distinguish stronger health plans for participation in Medicare Parts C and D and to remove consistently poor performers; and
· Implementing other clarifications and technical changes.
