Fact sheets: CMS finalizes program changes for Medicare Advantage and Prescription Drug Benefit Programs for Contract Year 2015 (CMS-4159-F)

cms.gov: 2014-05-19

CMS finalizes program changes for Medicare Advantage and Prescription Drug Benefit Programs for Contract Year 2015 (CMS-4159-F)

On May 19, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that will revise the Medicare Advantage (MA) and Part D prescription drug benefit programs regulations to implement statutory requirements, improve program efficiencies, clarify program requirements, and improve payment accuracy for Contract Year (CY) 2015 in general.   These regulations implement MA and Part D program changes based on over 7,500 public comments to a proposed rule that was displayed on January 6, 2014.  This fact sheet discusses the major provisions of the final rule and CMS’ efforts to combat fraud and abuse in Part D.  The final rule is projected to save approximately $1.615 billion over the next ten years 2015 – 2024.

Summary of Final Provisions

Improving payment accuracy: The final regulation would implement the Affordable Care Act requirement that MA plans and Part D sponsors report and return identified Medicare overpayments.  After the final risk adjustment deadline for a payment year, MA organizations will be allowed to submit data to correct overpayments but cannot submit diagnosis codes for additional payment.  The provision codifies and clarifies rules regarding when Part D and MA plan sponsors must report and return overpayments.  Read more