Font size:
Release of Operational Guidance on Creditable Coverage Period Determinations, Late Enrollment Penalty, and more
This week, the Centers for Medicare & Medicaid Services (CMS) released the attached operational guidance on creditable coverage period determinations, the late enrollment penalty, and late enrollment penalty reconsiderations.
Guidance on creditable coverage period determinations and the late enrollment penalty will constitute Chapter 4 of the Medicare Prescription Drug Benefit Manual, and will be available on CMS’ website at: http://www.cms.hhs.gov/MedicarePresDrugEligEnrol/ . Chapter 4 describes the plan’s responsibilities in making creditable coverage period determinations, reporting creditable coverage information to CMS, and billing and collecting the late enrollment penalty.
We have also attached a new Section 80.7.1 of Chapter 18, along with Appendices 14 and 15, which describe the plan’s role in the late enrollment penalty reconsideration process. A revised version of Chapter 18 reflecting this new material will be available on the Medicare Prescription Drug Appeals and Grievances Page of the CMS website at http://www.cms.hhs.gov/MedPrescriptDrugApplGriev/11_Guidance.asp .
As the instructions explain, plans are expected to implement these procedures for new enrollments received on or after August 1, 2007. Reporting on applicable current enrollees should be completed by October 1, 2007. However, plans are permitted to implement any/all of the guidance changes prior to this date.
For more information, please see the attached documents.
Guidance on creditable coverage period determinations and the late enrollment penalty will constitute Chapter 4 of the Medicare Prescription Drug Benefit Manual, and will be available on CMS’ website at: http://www.cms.hhs.gov/MedicarePresDrugEligEnrol/ . Chapter 4 describes the plan’s responsibilities in making creditable coverage period determinations, reporting creditable coverage information to CMS, and billing and collecting the late enrollment penalty.
We have also attached a new Section 80.7.1 of Chapter 18, along with Appendices 14 and 15, which describe the plan’s role in the late enrollment penalty reconsideration process. A revised version of Chapter 18 reflecting this new material will be available on the Medicare Prescription Drug Appeals and Grievances Page of the CMS website at http://www.cms.hhs.gov/MedPrescriptDrugApplGriev/11_Guidance.asp .
As the instructions explain, plans are expected to implement these procedures for new enrollments received on or after August 1, 2007. Reporting on applicable current enrollees should be completed by October 1, 2007. However, plans are permitted to implement any/all of the guidance changes prior to this date.
For more information, please see the attached documents.
| Attachment | Size |
|---|---|
| CC-LEPmemo-20070612.pdf | 19.57 KB |
| CC-LEP Guidance 061207.pdf | 81.4 KB |
| CC-LEP-Appeals Guidance-06-12-07.pdf | 54.66 KB |
