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Document ID: CMS-2008-0033-0004
Document Type: Public Submission
Agency: Centers For Medicare & Medicaid Services
Received Date: May 02 2008, at 12:50 PM Eastern Daylight Time
Date Posted: May 16 2008, at 12:00 AM Eastern Standard Time
Comment Start Date: March 17 2008, at 12:00 AM Eastern Standard Time
Comment Due Date: May 16 2008, at 11:59 PM Eastern Standard Time
Tracking Number: 805424c3
View Document:

This is comment on Proposed Rule

Medicare Program; Application of Certain Appeals Provisions to the Medicare Prescription Drug Appeals Process

View Comment

file code CMS-4127-P EVIDENCE The proposed rule states that when an enrollee wishes to have evidence on changes in their condition since the coverage determination considered in the appeal, an ALJ or the MAC will, instead, remand the case to the Part D plan sponsor. We recommend that the proposed rule provide clear guidance on the timeframe the Part D plan sponsor is expected to respond to the appeal, who receives the response (the ALJ or the MAC), and who is responsible for responding to the enrollee. It is unclear what the next step in the process is should the Part D plan sponsor return an unfavorable determination - would the enrollee continue on to the IRE or proceed with their appeal through the ALJ or the MAC?