This Email Alert, authored by Mintz Levin attorney Sarah Kaput for the American Health Lawyers Association, announces the release of final 2008 Medicare Advantage Applications.
Release of Final 2008 Medicare Advantage Applications
On January 31, 2007, the Centers for Medicare and Medicaid Services (CMS) posted on its website the final 2008 Medicare Advantage (MA) applications. Most of the applications are unchanged from previous years.
Five MA applications are available on the CMS website:
- MA Initial Application for Coordinated Care Plans
- MA Initial Application for Regional Preferred Provider Organization (PPO) Plans
- MA Initial Application for Private Fee for Service Plans
- MA Initial Application for Medical Savings Account Plans
- MA Service Area Expansion Application for Coordinated Care Plans, Private Fee For Service Plans, and Medical Savings Account Plans
There are three main highlights for 2008 regarding the MA applications: (1) The moratorium on new "local" PPO plans and the expansion of existing local PPO service areas is over. This means that in 2008, plans may offer a new or expand an existing local PPO product. (2) New 1876 cost-based plans are prohibited, and MA organizations may not operate 1876 cost plans in the same area in which they operate an MA product. (3) Plans must limit the number of bids submitted in a service area to those that demonstrate meaningful differences to a beneficiary and explain their compliance with this requirement.
MA coordinated care plans, which include health maintenance organizations and PPOs, must offer at least one plan containing Part D prescription drug benefits in each of its service areas. Therefore, all new or expanding coordinated care plan organizations must complete and submit a MA Prescription Drug Plan (MA-PD) Sponsor application as a condition of approval of the coordinated care plan application.
MA and MA-PD applications must be submitted to CMS by no later than 5:00 PM EST March 12, 2007.
To access the final 2008 MA applications as well as related information, click here; for the final 2008 MA-PD applications (which were posted earlier in January 2007), click here.
We would like to thank Sarah A. Kaput (Mintz Levin Cohn Ferris Glovsky & Popeo PC, Washington, DC) for providing this email alert.
The Medicare Part D Task Force is a joint endeavor of the Fraud & Abuse, Self Referrals, and False Claims; Health Information and Technology; HMOs and Health Plans; Life Sciences; Long Term Care; Regulation, Accreditation, and Payment; and Teaching Hospitals
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