Welcome to the Medicare Modernization Update Web site.  On December 8, 2003, President George W. Bush signed into law the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (Pub. L. 108-173).  This landmark legislation provides seniors and individuals with disabilities with a prescription drug benefit, more choices, and better benefits under Medicare.

CMS has created this Update to provide the public and other interested parties with up-to-date information on CMS’ efforts to implement the new legislation.  This update will be published monthly.  It will contain information on what CMS accomplished in the past month as well as major activities scheduled for the coming month, such as key implementation dates and regulations being published.

What's New?

Accomplishments*

9/30/04:  Section 731-Improvements in National and Local Determination Process to Respond to Changes in Technology

CMS hosted a workshop to support the development of guidance documents and to ensure that CMS is appropriately engaging interested stakeholders early in this process.  This workshop served to open up a discussion on the various factors that need to be incorporated into useful coverage guidance.  An open comment and question period followed from both the panel and from CMS leadership.

9/30/04:  CMS Special Open Door Forum on Coordination of Benefits Part D under MMA

On September 30^th, the Centers for Medicare & Medicaid Services hosted a Special Open Door Forum to discuss the coordination of benefits requirements between Part D prescription drug plans and other payers as outlined in the MMA.

9/24/04:  Section 731-Procedure for Producing Guidance Documents Describing Medicare's Coverage Process (CMS-3141-N)

CMS published a notice (CMS-3141-N), which describes the factors considered in making national coverage determinations of whether an item or service is reasonable and necessary.

9/24/04:  Section 935-Recovery of Overpayments

CMS issued manual instructions (CR 3441) that describe the rights of a provider when under audit by a Medicare contractor, including the right to written notice, review and explanation of the audit, and appeal rights.  MMA provision 935 requires the Secretary to establish a standard methodology for Medicare contractors to use when selecting a probe sample of claims for review in the presence of an aberrant billing pattern.

9/22/04:  Section 417-Extension of Telemedicine Demonstration Project

CMS awarded an evaluation contract that extends the current telemedicine demonstration project by 4 additional years, and authorizes an additional $30 million in funding.

9/16/04:  Section 303-Average Sale Price Data for Part B Drugs

CMS published a final rule (CMS-1380-F), which requires manufacturers to submit average sale price data on Medicare Part B drugs.

9/14/04:  Special Open Door Forum:  Quality and the Medicare Modernization Act

CMS hosted an Open Door Forum on Quality and the Medicare Modernization Act.  CMS requested broad input regarding the development of the quality-based provisions of the proposed MMA regulations in to ensure quality within the new benefits.

9/10/04:  Section 921-Provider Education and Technical Assistance

CMS issued manual instructions (CR 3376), which requires Medicare contractors to take into consideration the special needs of small providers when conducting education and training activities.  MMA section 921 directs the Secretary to coordinate the education activities provided through Medicare contractors to maximize the effectiveness of Federal education efforts for providers.

*Use this link to go to our Provisions page to view implemented items previously listed here.

*Use this link to go to our Table of Contents for the Summary of the Provisions of Public Law 108-173.

What to Expect

• Final Rule:  Power Operated Vehicles (POVs) (CMS- 3017-IFC)
  
  This final rule will expand who can prescribe power-operated vehicles functioning as a wheel chair.  MMA section 302 requires the expansion of the list of practitioners that can prescribe POVs and requires a face-to-face examination of the beneficiary by a physician.
  
  Targeted Release Date Fall 2004
• Proposed Rule:  Hospice Care Conditions of Participation (CMS-3844-P)
  
  This proposed rule will revise existing Hospice conditions of participation for participation in the Medicaid and Medicare programs.  This proposed rule includes sections 408 and 946 within the MMA.
  
  Targeted Release Date Fall 2004
• Final Rule:  Physician Fee Schedule Rule for 2005 (CMS-1429-FC)
  
  This final rule will make several changes affecting Medicare Part B payment.  It will also include several provisions on preventive care from the MMA:  Section 611, which provides an initial preventive physical examination, Section 612, which provides coverage for cardiovascular screening blood tests, and Section 613, which provides coverage for diabetes screening tests.
  
  Targeted Release Date Fall 2004
• Final Rule:  Hospital Outpatient Prospective Payment System and Calendar Year 2005 Payment Rates (CMS-1427-FC)
  
  This final rule revises the Medicare hospital outpatient prospective payment system beginning 01/01/2005.  It also responds to comments received from the 2004 Outpatient PPS update.  This proposed rule includes sections 611, 614 and 621 within the MMA.
  
  Targeted Release Date Fall 2004
• Final Rule:  Home Health Prospective System Rate Update for Calendar Year 2005 (CMS-1265-F)
  
  This final rule updates the 60-day national episode rates and the national per-visit amounts under the Medicare Prospective Payment System for home health agencies.  It implements sections 421 of the MMA which provides a one year increase in rural areas and 701 moves updates to a calendar year.
  
  Targeted Release Date Fall 2004

Hot Links! Hot Links! Hot Links!

• Quarterly Provider Update (QPU) - Contains a quarterly listing of regulations and manual instructions that affect providers.
• CMS Manuals System - Provides links to the CMS manuals and transmittals.
• CMS Regulations E-Comments Page - Allows the public to submit comments on CMS regulations.
• Medicare Modernization Update Feedback - Submit feedback related to the Medicare Modernization Update
.
• Open Door Initiative - Specifies CMS’s implementation of the Medicare Prescription Drug, Improvement and Modernization Act of 2003.
• Medicare Learning Network (MedLearn) - Presents educational initiatives and resources related to the Medicare program.