Tag Archives: 3209

Subtitle C – Provisions relating to Part C

What a ridiculous title. They are clearly running out of steam here in the PPACA.

Ok, sorry for the delay. This document is really dull. Plus, I had other work to do. But mostly, this is dull. I really hope you appreciate the sacrifice I’m making for you all here. J

Section 3201 was repealed and replaced before it even got started. Oh boy! It relates to Medicare Advantage (MA) payments. This is a private insurance plan that provides both Medicare Part A (the hospital portion) and Part B (the doctor portion). The government pays the insurance company, which can then set the rules for out-of-pocket costs and referrals. Not everyone is eligible for these types of plans. Section 3201 adjusts the payments for it.

Section 3202 – Benefit Protection and Simplification – this specifically calls out a few benefits (such as chemotherapy, renal dialysis, ad skilled nursing) and limits the ability of plans to alter the cost-sharing for these benefits. It also adjusts the rebates for certain plans, and identifies some quality categories that adjust the percentage of rebates that a plan will receive.

Section 3203 regarding the Application of Coding Intensity During MA Payment Transition – this section adjusts some of the payment requirements of the MA plan.

Section 3204 changes the disenrollment period from MA to regular Medicare to the first 45 days of the calendar year, from whatever complicated version it was before. Since 3204 is supposed to simplify things.

Section 3205 extends certain specialized MA plans for special needs individuals. They were supposed to have transitioned by 2013, so I guess that’s done.

Section 3206 extended Reasonable Cost Contracts to January 1, 2013. I think we can all agree that Reason has fled Washington.

Section 3207 is a technical correction. The government calls a technical!

Section 3208 makes permanent the Senior Housing Facility Demonstration Project.

Section 3209 gives the DHHS the ability to deny MA plan bids.

Section 3210 creates new standards for Medigap plans. The new standards will attempt to use nominal cost sharing to encourage use of physician services.


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