Draft Part C and Part D Appeals Guidance for Industry Comment

On October 1, 2018, the Centers for Medicare & Medicaid Services (CMS) released consolidated draft chapter guidance based on Chapter 13 of the Medicare Managed Care Manual and Chapter 18 of the Prescription Drug Benefit Manual.

CMS requests comment on the revisions, structure and format by close of business, Monday, October 22. In a new publication, I summarize notable revisions and provide suggestions and points to ponder based on my experience with this beneficiary-impacting area of plan operations.

Whether you are a new or experienced in your role – be it Compliance Officer, VP of Operations, Appeals Director – and whether you are at a plan sponsor or entity delegated to perform these functions, my summary provides key considerations to supplement your review.

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