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The Challenges of Medicare Part D, Even Amid Decreased Complaints
By Richard Shank
The Government Accountability Office (GAO) conducted a study outlining the operational and oversight challenges of administering the Medicare Part D program—even though the number of complaints filed, and the time needed to resolve them, has diminished over the past year.
Medicare Part D coverage is provided through plan sponsors contracting with the Centers for Medicare and Medicaid Services (CMS). As of April 2008, about 26 million beneficiaries were enrolled in Part D. When beneficiaries encounter problems with Part D, they can either file a complaint with CMS or a grievance with their plan sponsors. CMS centrally tracks complaints data and plan sponsors must report summary data on grievances for each of their contracts.
In the past year, it was found that complaints have declined by 74%, and the average time needed to resolve a complaint decreased from its peak of 33 days to just 9 days.
However, trends in the complaints data suggest that ongoing issues remain in implementing the Medicare Part D program. For instance, CMS and plan sponsors did not effectively resolve a significant portion of complaints filed by beneficiaries at risk of depleting their medications. Furthermore, there were information processing issues related to requests for enrollment changes and premium withholding from Social Security payments.
Currently, CMS oversight efforts have not paid sufficient attention to the spotty grievance resolution process being practiced by many plan sponsors who believe they need more guidance on accurate reporting procedures.
GAO recommends that CMS undertake efforts to improve the consistency, reliability, and usefulness of grievances data. Such efforts include enhancing existing guidance, requiring plan sponsors to report additional information, and conducting systemic oversight of these data.
The report can be found at: http://www.gao.gov.
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