CMS Revises Creditable Coverage Guidance and Model Disclosure Notices
The Centers for Medicare and Medicaid Services (CMS) recently updated the creditable coverage guidance and model disclosure notices that group health plans can use to meet the annual Medicare Part D Employee Notification requirements. The revised creditable and non-creditable coverage disclosure notices, intended for use as of January 1, 2009, now include an optional insert that can be completed to provide a more personalized disclosure notice.
Employers may continue sending general disclosure notice mailings without the optional personalized insert. However, the revised creditable coverage guidance recommends that employers use the optional insert when an individual requests a copy of a disclosure notice.
The new notices are intended to replace the prior model notices issued in June/July 2008, and the revised creditable coverage guidance replaces the prior document that was issued in 2007. All new materials can be found online at the CMS website.
As a reminder, these creditable coverage disclosure notices are part of the requirements under the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA). Under this regulation, employers and union group health plan sponsors offering prescription drug coverage are required on an annual basis to not only notify Medicare-eligible plan participants whether such coverage is “creditable,” but also disclose this information to CMS. Please note the following important details regarding these mandatory communications:
Creditable Coverage Employee Notice
The MMA regulations specify that all Medicare-eligible individuals with prescription drug coverage must be notified of their employer’s health plan status as a creditable plan. CMS believes such information is necessary to an individual’s decision to enroll in a Medicare Part D prescription drug plan.
The regulations under 42 CFR §423.56(f) specify the times when creditable coverage disclosures must be made to Part D eligible individuals. At a minimum, disclosure must be made at the following times:
- Prior to the Medicare Part D Annual Coordinated Election Period (ACEP) – Nov. 15 through Dec. 31 each year;
- Prior to an individual’s Initial Enrollment Period (IEP) for Part D, as described under 423.38(a);
- Prior to the effective date of coverage for any Medicare eligible individual that joins the plan;
- Whenever prescription drug coverage ends or changes so that it is no longer creditable or becomes creditable; and
- Upon a beneficiary’s request.
If the creditable coverage disclosure notice is provided to all plan participants, CMS will consider items 1 and 2 to be met. This guidance clarifies that “prior to” means the beneficiary must have been provided the Disclosure Notice within the past 12 months.
Creditable Coverage Disclosure to CMS
Entities that provide prescription drug coverage to Medicare Part D eligible individuals must also disclose to CMS whether the coverage is "creditable prescription drug coverage" regardless of whether the entity's coverage is primary or secondary to Medicare. This disclosure can be made using the online Creditable Coverage Disclosure Form, which can be found on the CMS website at www.cms.hhs.gov.
It should be noted that while the initial creditable coverage Disclosure to CMS Form was completed by all entities that were required to provide a disclosure by March 31, 2006, for plan years that ended in 2006, this is an annual requirement. For all subsequent plan years, the Disclosure to CMS Form is due no later than 60 days following the beginning of the entity’s plan year (renewal year, contract year, filing year, etc.).
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January 26, 2009
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