Medicare Part D: Complaint Rates are Declining, But Operational and Oversight Challenges Remain
DIANE Publishing, 2009 - 38 pages
Medicare Part I coverage is provided through plan sponsors that contract with CMS. As of April 2008, 26 million beneficiaries were enrolled in Part D. When beneficiaries encounter problems with Part D, they can either file a complaint with CMS or a grievance with their plan sponsors. CMS tracks complaints data and plan sponsors report data on grievances. This report provides info. on: (1) complaints and what they indicate about beneficiaries¿ experiences with Part D; (2) whether grievances data provide additional insight about beneficiaries¿ experiences; and (3) CMS¿s oversight of the complaints and grievances processes. Illus. (This report was changed as of 7/1/08 to add Appendix II, which is the agency comment letter that was left out of the report.)
What people are saying - Write a review
We haven't found any reviews in the usual places.
1,000 beneficiaries According to CMS agency annual coordinated election audit average resolution calendar days Centers for Medicare CMS and plan CMS officials indicated CMS provided CMS’s oversight complaints and grievances complaints filed complaints process complaints related complaints were related contracts coordinated election period copayments coverage determinations CTM categories customer service dual-eligible beneficiaries enrollment and disenrollment enrollment/disenrollment ensure example file a complaint grievances data reported grievances processes grievances reported immediate need complaints July June MA-PD Medicare & Medicaid Medicare Part D Medicare Prescription Drug medication supply monthly complaint rate noncompliance November 15 number of complaints number of grievances October 31 oversee the complaints pharmacy pharmacy benefit managers plan sponsor-reported grievances plan sponsors report premium withholding pricing and coinsurance problems processing beneficiaries related to beneficiaries reported by plan reported grievances data require plan sponsors resolving complaints reviewed plan sponsor Social Security Administration social security payments Specifically sponsor-reported grievances data subcategories