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dmprograms.com • Medicare Advantage Quality Improvement Programs • Other Statutory Provisions

Medicare Advantage Quality Improvement Programs

The following provisions are referenced in Section 722.

Amendment to the Requirements for Treatment of Accreditation

This section is amended in MMA Section 722 (a)(3)(A). The following text shows the amendments. MMA replaced the first three paragraphs of Sec. 1852 (e) (see MMA Statutory Language: Section 722) and amended paragraph (4) as follows:

Social Security Act
Sec. 1852 (e) QUALITY IMPROVEMENT PROGRAM —

(4) TREATMENT OF ACCREDITATION. —

(B) REQUIREMENTS DESCRIBED.—The provisions described in this
subparagraph are the following:

(i) Paragraphs (1) through (3) of this subsection (relating to quality improvement programs).
(ii) Subsection (b) (relating to antidiscrimination).
(iii) Subsection (d) (relating to access to services).
(iv) Subsection (h) (relating to confidentiality and accuracy of en- rollee records).
(v) Subsection (i) (relating to information on advance directives).
(vi) Subsection (j) (relating to provider participation rules).
(vii) The requirements described in section 1860D-4(j) to the
extent such requirements apply under section 1860D-21(c).

Requirements Under Treatment of Accreditation

The following is referenced in MMA Section 722 (a)(3)(B).

Social Security Act
Sec. 1860D-4(j) TREATMENT OF ACCREDITATION —

Subparagraph (A) of section 1852(e)(4) (relating to treatment of accreditation) shall apply to a PDP sponsor under this part with respect to the following requirements, in the same manner as it applies to an MA organization with respect to the requirements in subparagraph (B) (other than clause (vii) thereof) of such section:

(1) Subsection (b) of this section (relating to access to covered part D drugs).
(2) Subsection (c) of this section (including quality assurance and medica- tion therapy management).
(3) Subsection (i) of this section (relating to confidentiality and accuracy of enrollee records).

Requirements Under Part D Rules for Prescription Drug Coverage

The following is referenced in MMA Section 722 (a)(3)(B).

Social Security Act
Sec. 1860D-21

(c) APPLICATION OF PART D RULES FOR PRESCRIPTION DRUG COVERAGE —With respect to the offering of qualified prescription drug coverage by an MA organization under this part on and after January 1, 2006 —

(1) IN GENERAL. —Except as otherwise provided, the provisions of this part shall apply under part C with respect to prescription drug coverage provided under
MA-PD plans in lieu of the other provisions of part C that would apply to such coverage under such plans.
(2) WAIVER. —The Secretary shall waive the provisions referred to in paragraph (1) to the extent the Secretary determines that such provisions duplicate, or are in conflict with, provisions otherwise applicable to the organization or plan under part C or as may be necessary in order to improve coordination of this part with the benefits under this part.
(3) TREATMENT OF MA OWNED AND OPERATED PHARMACIES. —The Secretary may waive the requirement of section 1860D-4(b)(1)(C) in the case of an MA-PD plan that provides access (other than mail order) to qualified prescription drug coverage through pharmacies owned and operated by the MA organization, if the Secretary determines that the organization’s pharmacy network is sufficient to provide comparable access for enrollees under the plan.