Proposed Medicare rules would tighten CMS oversight of nursing home prescriptions

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Proposed Medicare rules would tighten CMS oversight of nursing home prescriptions
Proposed Medicare rules would tighten CMS oversight of nursing home prescriptions

In light of reports that Medicare Part D prescribing practices are endangering seniors — many of them in long-term care facilities — the Centers for Medicare & Medicaid Services has issued a proposed rule that would give the agency more power to oversee and control the prescription drug program.

To date, CMS has taken a limited role in overseeing Part D, saying that this is the responsibility of the private health plans that administer it. This has led to some problematic prescribers doling out potentially harmful medications to seniors for years, according to investigative journalism organization ProPublica.

Some of the seniors most at risk reside in skilled nursing facilities and other long-term care settings, according to a high-profile report published last year by ProPublica and The Washington Post. The article focused on some of the most prolific Part D prescribers in the nation, such as Adolphus Ray Lewis. Even after admitting responsibility for the death of a nursing home resident given excessive doses of painkillers, Lewis went on to account for the fifth-highest number of Medicare prescription claims in the country in 2010.

Miami psychiatrist Enrique Casuso was another doctor investigated. He prescribed more antipsychotic medications to Medicare beneficiaries than any other physician in the nation in 2010, and many of those seniors had dementia and were living in facilities, according to ProPublica.

Under the newly proposed CMS rule, prescribers would have to be enrolled in Medicare for their prescriptions to be covered by Part D. The Medicare certification process would allow CMS to more effectively ensure that only “qualified individuals” are prescribing Part D drugs, the agency stated. CMS also would be empowered to revoke prescribers' enrollment if abusive practices are discovered.

By allowing CMS to obtain invoices, prescription records and other documents directly from pharmacies rather than through Part D plan sponsors, the rule also would improve efforts to combat fraud and abuse, the agency argues.

The 678-page proposed rule contains a variety of other regulatory changes for Medicare Advantage and Part D. It is scheduled to be published Friday in the Federal Register.

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