Medicare Compliance & Reimbursement

July 21 meetings will consider regional definitions for MA plans and PDPs.

Heads up, managed care plans.

The Centers for Medicare & Medicaid Services will hold a meeting on Wednesday, July 21 in Chicago on how to define new regions for Medicare Advantage plans and Prescription Drug Plans under the Medicare Modernization Act.

According to a May 28 notice in the Federal Register, CMS is encouraging attendance, comments and questions from beneficiaries, advocacy groups, managed care organizations, trade associations, potential prescription drug plans, pharmacy benefit managers, providers and practitioners. The meeting will offer a chance to learn more about various scenarios under consideration for MA regional and PDP region configurations, particularly for scenarios where PDP and regional MA definitions may overlap.

Under MMA provisions, the new MA regional plan program would create between 10 and 50 MA regions within the 50 States and the District of Columbia. MMA also establishes a prescription drug insurance plan intended to provide prescription drug coverage for beneficiaries enrolled in traditional Medicare FFS or MA plans. The PDPregions, however, do not necessarily need to match the MA regions if a different arrangement for PDPs improves beneficiary access to prescription drugs.

The issue of region size is a vital one for health plans. If Medicare establishes a small number of large regions, only large, national health plans would be able to participate. If Medicare opts for smaller regions, the exact size and location of the regions will be a huge factor in determining which plans participate -- and which plans succeed.

Appropriate regions for both must be defined by Jan. 1, 2005, with implementation scheduled for 2006.

The registration deadline is July 14, 2004. To read the notice, go to: http://www.access.gpo.gov/su_docs/fedreg/a040528c.html.

Lesson Learned: The deadline is approaching for managed care plans to weigh in on the drafting of the reform bill's new region configurations.