Audio CD and written materials of AIS's audioconference on February 9, 2005

Implications of Recent Final Regulations for Medicare Advantage and Part D

On January 21, CMS released comprehensive final regulations for Medicare Advantage (MA) and the new Part D drug benefit that contain significant changes from rules proposed in August, particularly for MA. These regulations will have a huge impact on the feasibility of participation in MA and Part D, and organizations have very limited time to analyze them before key deadlines for applications begin to kick in (e.g., Feb. 15 for some MA applications). Understanding the nuances of these lengthy, complex new rules is urgent if your organization is exploring becoming a regional PPO, prescription drug plan, or MA prescription drug plan, or is planning to expand or start a local MA PPO.

Sponsored by Atlantic Information Services, Inc., publisher of Managed Care Week, Medicare Advantage News and Drug Benefit News, and A Guide to the Medicare Drug Benefit

Speakers Designed For Shipping Information Written Materials Print an order form: If you do not wish to place your order online, click here to download a printable order form (PDF file), then submit your order via fax or mail, as directed on the form.

Order Now (Secure Site) Audio CD and Printed Materials ($267) Pub code: CMADT View Cart

Many organizations have been waiting for these final regulations to decide whether and how to participate in the $400-billion-plus Medicare drug benefit that begins Jan. 1, 2006. The final regs are out, the deadlines are set, and the time is NOW for health plans, PBMs, employer groups and labor unions, and pharmaceutical companies to understand these new rules and position their companies accordingly.

“I was very impressed with your conference. It was the best audioconference I have attended in a long time.” — Edward J. McAdam Sr., Director Contract Administration, Sankyo Pharma Inc., who listened to a recent AIS audioconference on Part D by John Gorman.

Among the numerous changes on the MA side: CMS made it easier for regional PPOs to provide coverage in rural and other areas with limited hospital availability; revised its interpretation of the moratorium on local PPOs in a way that may cause an immediate rethinking of intentions not just for 2006 but also for 2007; and gave MA plans the authority to make mid-year benefit enhancements — but only during specific parts of the year.

On the drug-benefit side, CMS modified the processes by which beneficiaries will be able to get non-formulary drugs in a timely manner; changed the way pharmacy access standards are applied; accelerated the implementation of e-prescribing standards; provided more flexibility in applying the "actuarial equivalence" standard for employers that keep offering a drug benefit to retirees; and provided new specifics on the transition of dual eligibles from Medicaid to Medicare for purposes of drug coverage.

You need experts to help you determine what these and other significant changes in the final regulations mean and, given the tight deadlines, you need those experts RIGHT AWAY.

Listen to John Gorman and Maureen Miller — two of the foremost experts in Medicare managed care and Part D — interpret the final regulations and provide your organization with sound business strategies for the future. You'll get all of the details on:

 

Speakers

JOHN GORMAN is president and CEO of Gorman Health Group, the leading consulting firm specializing in Medicare managed care and the new Part D regulations. Before starting his company in 1996, Mr. Gorman served as assistant to the director of CMS-predecessor HCFA's Office of Managed Care. Prior to that, he was staff director for U.S. Rep. John Conyers, Jr., then chairman of the House Government Operations Committee. Mr. Gorman specializes in strategic planning and business development for the health care industry, with particular emphasis on federal programs and regulation.

MAUREEN MILLER, senior consultant at Gorman Health Group, was in key positions at HCFA for 20 years before joining John Gorman's company. Most recently, she was senior policy analyst for HCFA's Medicare managed care program and had an integral role in the agency's development of Medicare Advantage and provider-sponsored organization regulations. A registered nurse with a master's degree in public health, Ms. Miller's roles at HCFA included product development, legislative reform and regulatory affairs specifically pertaining to Medicare managed care.

Moderator: Jim Gutman, vice president and executive editor of Atlantic Information Services, Inc.

 

Designed Especially For

 

Shipping Information

Audio CDs and written materials are shipped via UPS. Please give us your street address when you order (UPS does not deliver to PO boxes). You should receive your order within 5-7 business days.* Shipping cost is $5.

Rush Orders: Please call us at 800-521-4323 to place a rush order.* We will overnight your order for an additional charge of $30, or you can give us your FedEx or UPS account number and we will charge the shipping to your account. Rush orders placed after 3:00pm EST will not be shipped out until the next business day.

Written Materials