Medicare Pilot Programs To Begin This Year

Posted on Wednesday, August 5, 2015 2:15 PM

CMS officials are finalizing details for three Medicaid pilot programs set to start this year. CMS states that providers should be able to test new approaches and analyze results by participating in any of the three pilots, but the overall audit score will not negatively impact their survey process. The three pilot programs include the following:

  1. Adequacy audits will be run through the pilot to see if sponsor organizations are inappropriately denying services to beneficiaries
  2. A medication therapy management pilot audit will analyze how programs are implementing enrollment and targeted and comprehensive medication reviews. The results of this audit process will be used to improve sponsors’ performance in the program.
  3. Drugstore counter prescription rejections under Part D. Sponsors will be tested on problem solving strategies for when a prescription cannot be filled as written. This pilot will help weigh options for resolving rejections without an enrollee requesting a coverage determination from a plan.

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