Centers for Medicare & Medicaid Services officials are finalizing details for three Medicare pilot programs set to begin this year, agency officials announced.
Nursing homes should be able to test new approaches and analyze results by participating in any of the three pilots, but the overall audit score won’t negatively impact their survey process, CMS said.
Adequacy audits, which will start in the fall, will be run through the pilot to see if sponsor organizations are inappropriately denying services to beneficiaries.
A medication therapy management pilot audit, which will start in early fall, will analyze how programs are implementing enrollment and targeted and comprehensive medication reviews, CMS said. The results of this audit process will be used to improve sponsors’ performance in the program.
The third pilot involves drugstore counter prescription rejections under Part D. Sponsors will be tested on problem solving strategies for when a prescription cannot be filled as written. The point-of-sale pilot will help weigh options for resolving rejections without an enrollee requesting a coverage determination from a plan, CMS said.