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Medicare Compliance & Reimbursement

INDUSTRY NOTES:

Bill Could Clip Wings Of Drug Plan Marketers

Published on Sun Jul 22, 2007

The states should be the watchdogs, lawmakers say.

Proposed limits on how Part D prescription drugs plans (PDPs) can market their wares to seniors could mean fewer denied claims for you next year.

Provisions in the Children's Health and Medicare Protection Act of 2007 (H.R. 3162) address the need for better controls on how the PDPs, as well as managed care plans, can market themselves to seniors.

Background: Though the bill's primary aim is to reauthorize the State Children's Health Insurance Program (SCHIP), the legislation includes a number of Medicare policy and payment issues. The U.S. House of Representatives passed the bill on Aug. 1.

The bill calls for states to step up to bat to control how the PDPs and managed care contractors present their products to beneficiaries.

Specifics: The plan calls on the National Association of Insurance Commissioners to develop guidelines for the Department of Health and Human Services in five areas, including broker and agent training and certification. The standards would be published in the Federal Register for comment.
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