[Federal Register Volume 69, Number 104 (Friday, May 28, 2004)]
[Notices]
[Pages 30659-30660]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-12048]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-4069-N]


Medicare Program; Open Public Meeting To Discuss Definitions of 
Regions for Regional Medicare Preferred Provider Organizations and 
Prescription Drug Plans Under the Medicare Modernization Act--July 21, 
2004

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice of meeting.

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SUMMARY: This notice announces a public meeting to provide 
beneficiaries, advocacy groups, managed care organizations, trade 
associations, potential prescription drug plans (PDPs), pharmacy 
benefit managers, providers, practitioners, and other interested 
parties an opportunity to ask questions and raise issues regarding 
options for the definition of regions for Medicare Advantage (MA) 
regional plans and PDPs under provisions of the Medicare, Prescription 
Drug, Improvement and Medicare Modernization Act of 2003 (MMA). The 
legislation requires that we implement these MMA provisions in 2006. 
The purpose of the meeting is to provide information about a variety of 
region definition options being considered both for regional MA plans 
and PDPs and to allow for public comment on these options.

DATES: Meeting Date: The meeting is scheduled for Wednesday, July 21, 
2004 from 9 a.m. until 4 p.m., c.d.s.t. Comment Deadline: Written 
comments must be received by 5 p.m., August 5, 2004.

ADDRESSES: The meeting will be held in Chicago, IL, at the Rosemont 
Conference Center/Donald E. Stephens Convention Center, (located on the 
grounds of O'Hare airport) at 555 North River Road, Rosemont, IL. The 
phone number for the Rosemont Conference Center is (847) 692-2220. The 
meeting will be organized by CMS' contractor, RTI International.
    Written Statements and Requests:
    We will accept written questions about meeting logistics or 
requests for meeting materials either before the meeting or up to 14 
days after the meeting. Written submissions must be sent to: RTI 
International, ATTN: Nathan West, MPA, RTI Health Services and Social 
Policy Research, 3040 Cornwallis Rd. Research Triangle Park, North 
Carolina 27709, Telephone Number: (919) 485-2661, Fax Number: (919) 
990-8454, e-mail: [email protected].
    Public Comments: Public comments should be sent to Angela Porter 
via e-mail to [email protected] or fax to Angela Porter at (410) 786-
9963; or you may mail public comments to her at the Centers for 
Medicare and Medicaid Services, 7500 Security Boulevard, Mailstop S1-
05-06, Baltimore, Maryland 21244.

FOR FURTHER INFORMATION CONTACT: RTI International staff at 
[email protected], or Nathan West at (919) 485-2661.

SUPPLEMENTARY INFORMATION:

I. Background

    The Medicare, Prescription Drug, Improvement and Modernization Act 
(MMA) of 2003 (Pub. L. 108-173, enacted on December 8, 2003) requires a 
number of changes to the Medicare program including the addition of 
Medicare prescription drug insurance plans (PDPs), as well as the 
addition of new regional Medicare Advantage (MA) plans. To implement 
both new programs, we must define appropriate regions for MA regional 
plans under section 1858(a)(2)(D) of the Social Security Act (the Act) 
added by section 221 of the MMA, and for PDPs under section 1860(D)-
(11)(a) of the Act, added by section 101 of the MMA.

A. Medicare Advantage Regions

    Title II of the MMA makes changes to the Medicare+Choice (M+C) 
program under Part C, which it renames as the Medicare Advantage 
program. Existing M+C plans, now known as MA plans, are now referred to 
as ``local MA plans''. Title II of MMA also establishes new MA regional 
plans, which would encourage private plans to serve Medicare 
beneficiaries in larger regions.
    The new MA regional plan program will begin in 2006. The 
legislation calls for the creation of between 10 and 50 MA regions 
within the 50 States and the District of Columbia by January 1, 2005. 
Plans that opt to participate in the program are required to serve an 
entire MA region and are encouraged to offer services in more than one 
region. The legislation states that MA regions should maximize the 
availability of regional plans to all eligible individuals regardless 
of health status. The MMA conference report further clarifies these 
requirements by providing additional considerations for configuring the 
regions. To the extent possible, each MA region should include at least 
one State and not divide a State across regions.

[[Page 30660]]

Metropolitan Statistical Areas (MSAs) that span more than one State 
should be included in a single region. Furthermore, the conference 
report suggests that the required market study determine the best 
configuration of regions to maximize plan participation as well as the 
availability of plans to beneficiaries.
    These statutory requirements and MMA conference report guidelines 
have several implications for the definition of MA regional areas. 
Geographic regions must be defined to meet multiple objectives and 
satisfy multiple constraints. Demographic data on the distribution of 
the aged population must be considered in conjunction with market 
factors that would impact insurance-supplier response. Incentives 
provided for in the legislation have the potential to offset 
unfavorable factors in the MA region and must also be considered in the 
analysis of these heterogeneous regions. In addition, the sizes and 
configuration of regions will themselves impact the entry behavior of 
plans.

B. Regional Definition for PDPs

    Title I of the MMA establishes a prescription drug insurance 
benefit under a new Part D of Medicare and is intended to provide 
prescription drug coverage for beneficiaries enrolled in traditional 
Medicare FFS or MA plans. The law also provides for premium, 
deductible, and co-payment subsidies for certain low-income 
beneficiaries. The PDPs are effective in 2006.
    To provide access to options for Medicare beneficiaries in all 
geographic areas, Medicare PDPs are intended to be regional in scope. 
Since private companies (with a public subsidy) will operate the PDPs, 
offering a plan in a region will be voluntary on the part of the plan 
operators. A plan must offer the same benefits and charge the same 
premiums and co-payments to all eligible beneficiaries in its region 
regardless of how the plan's costs vary within a region. If less than 
two full-risk plans are offered in a region (one of which must be a 
PDP), then we will approve any reduced risk plans that have applied to 
serve the region. In any regions or parts of regions that still lack 
two plans, we will arrange for a non-risk-bearing fallback plan to be 
offered.
    The success of the Part D benefit will depend on the willingness of 
private plan operators to offer plans in the various regions and 
therefore, at least in part, on the region definitions selected by CMS. 
Implications for regional definition for PDPs include the trade-off of 
conforming to existing markets versus encouraging plan choice in areas 
projected to be underserved.
    The MMA mandates that there be between 10 and 50 PDP regions. In 
addition, we will establish regions for the territories as required in 
section 1860D-11(a)(2)(C) of the Act. We must define these regions by 
January 1, 2005. The legislative guidelines for the definition of 
regions are the same for regional MA plans. The MMA requires that PDP 
regions be the same as with MA regions ``to the extent practicable.'' 
However, the PDP regions do not necessarily need to be identical to the 
MA regions if it can be shown that a different configuration of regions 
for PDPs improves beneficiaries' access to prescription drugs.

II. Meeting Topics and Format

    The meeting will address the following topics:
     A presentation of proposed regional definitions for MA 
Regional Plans, followed by public comments and a question and answer 
period.
     A presentation of proposed regional definitions for PDPs, 
followed by public comments and a question and answer period.
    Time for participants to ask questions or offer individual comments 
will be limited according to the number of registered participants.
    The agenda will include presentations by CMS and RTI International 
(CMS'' contractor) staff. We are interested in an open dialogue on the 
topic of defining regions for regional MA plans and PDPs under the MMA 
legislation, and believe that an active discussion will help us more 
clearly identify the key issues for consideration. In this public 
meeting, we plan to engage in a discussion of the scenarios for MA 
regional and PDP region configurations, particularly on regional 
scenarios where PDP and regional MA definitions may, or may not, 
overlap.

III. Registration

    Registration for this public meeting is required and will be on a 
first-come, first-served basis, limited to two attendees per 
organization up to the 1,000 person capacity of the meeting room. A 
waiting list will be available for additional requests. The 
registration deadline will be July 14, 2004. Registration can be 
accomplished through three mechanisms:
    1. A special on-line meeting Web site set up specifically for this 
meeting: https://register.rti.org/medicaremeeting/.
    2. A specific meeting e-mail address: [email protected].
    3. By contacting Nathan West, RTI International, at (919) 485-2661.
    A confirmation notice will be sent to attendees upon finalization 
of registration. Information on hotel accommodations will be provided 
to registered individuals as part of their confirmation notice. General 
information regarding meeting logistics will also be available on the 
meeting Web site at https://register.rti.org/medicaremeeting/.
    Persons who are not registered in advance will not be guaranteed 
attendance due to space limitations. Attendees will be provided with 
meeting materials at the time of the meeting.
    To submit written questions regarding logistics of the meeting or 
to requests material before the meeting, see instructions for Written 
Statements and Requests under the ADDRESSES section of this notice.
    Written public comments are preferred following the meeting and 
will be accepted until August 5, 2004. See instructions for Public 
Comments under the ADDRESSES section of the notice.

(Authority: Sections 1851 through 1859 of the Social Security Act 
(42 U.S.C. 1395w-21 through 1395w-28)) (Catalog of Federal Domestic 
Assistance Program No. 93.773 Medicare--Hospital Insurance Program; 
and No. 93.774, Medicare--Supplementary Medical Insurance Program)

    Dated: May 19, 2004.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 04-12048 Filed 5-27-04; 8:45 am]
BILLING CODE 4120-01-P