REGULATION MAKES TECHNICAL CORRECTIONS TO MEDICARE D

The Centers for Medicare & Medicaid Services this month issued a final regulation that clarifies certain coverage and procedural questions under the Part D benefit.

According to the final rule, weight loss drugs are categorically excluded from Part D even when they are used to treat “morbid obesity” rather than for cosmetic purposes.

The rule also clarified that Part D drug plans must provide coverage to people with Medicare and Medicaid who reside in Institutions for Mental Disease and residents in long-term care hospitals who have used up all their Medicare hospital days. Starting in 2009, drug plans must also provide access to home infusion services within 24 hours of discharge from a hospital or other facility. CMS did not agree with advocates' request to require plans to arrange for home infusion services in time for the next medically scheduled infusion.

The regulation also states that advocates and counselors who act as appointed representatives for people with Medicare can file grievances with Part D plans on their behalf. In addition, Part D plans are required to inform enrollees, or their appointed representatives, in writing within three days when they deny a request for an expedited appeal for coverage of a Part D drug.

-Adapted from MEDICARE WATCH, a biweekly electronic newsletter of the Medicare Rights Center, Vol. 11, No. 8: April 15, 2008.

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