OF CERTAIN PROVISIONS OF THE MEDICARE ACT OF 2003
December 8, 2003
QI 1 program, which provides assistance with Medicare Part B premium to low-income individuals, extended until November 15, 2004. A further extension has been issued through 9/30/2005.
The moratorium on the annual $1500 payment cap on the amount Medicare pays for certain outpatient therapy services was continued; the payment limit is lifted through December 31, 2005.
January 1, 2004
Allowed Medicare Part B coverage for intravenous immune globulin for in-home treatment of primary immune deficiency diseases if medically necessary.
Increased payments to Medicare managed care plans.
Marketing for and enrollment in prescription drug discount cards began.
Prescription drug discount card program began. Discount card program terminates on December 31, 2005. However, enrollees may continue using their cards through a Atransition period@ which ends either when they enroll in a Medicare prescription drug plan under Medicare Part D or on May 15, 2006, the end of the initial enrollment period for Part D.
October 1, 2004
A new expedited appeals process for certain claims filed on or after 1/1/2004 to be in place. The relevant claims are those for which the Departmental Appeals Board lacks authority to decide a question of law or regulation relevant to the issue and in which there is no material issue of fact in dispute.
January 1, 2005
Part B deductible increased from $100 to $110. Hereafter, the deductible will increase yearly by the annual percentage increase in the monthly actuarial value of benefits payable under Part B.
Coverage began for one physical exam, performed within 6 months after a beneficiary first enrolls in Part B.
Coverage began for cardiovascular screening blood tests such as a cholesterol test, up to once every two years.
Coverage began for diabetes screening via a fasting plasma glucose test for individuals at high risk for diabetes.
Allows annual increase in the jurisdiction amount for requesting an administrative law judge hearing or for requesting judicial review of a denied claim. Amount to be increased by the percentage increase in the medical care component of the consumer price index for urban consumers rounded to the nearest $10.
June 1, 2005
The date by which the Department of Health and Human Services (DHHS) is supposed to establish a limited prior determination process for physician services designated by the Secretary of DHHS as eligible for review.
October 1, 2005
The latest date by which the Social Security Administration (SSA) and DHHS are supposed to effectuate the transfer of administrative law judges from SSA to DHHS. The transfer may occur as early as July 1, 2005.
Name change effective for entities that review Medicare claims. Fiscal Intermediaries and Carriers become known as “Medicare Administrative Contractors” (MACs).
November 15, 2005
Start of initial enrollment period in Medicare prescription drug plans under the new Part D. The initial enrollment period lasts for 6 months and ends on May 15, 2006.
January 1, 2006
Effective date of Medicare prescription drug coverage under Medicare Part D.
No new Medigap plans H, I, and J, which provide prescription drug coverage, may be sold.
Two new Medigap polices are expected to be available in 2006. These policies will provide less coverage for Medicare co-payments and deductibles but will include limitations on out-of-pocket expenses.
Effective date for new regional PPOs, should private insurance companies choose to offer them, under the Medicare Advantage program.
Individuals with incomes over $80,000 per year and couples with incomes over $160,000 per year will have to pay a greater share of the Part B premium.
Start of the premium support Acomparative cost adjustment@ demonstration project, in which traditional Medicare will have to compete with managed care plans in 6 different parts of the country.
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