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Cms conditions for coverage Form: What You Should Know

Regulations and Guidance — CMS Dec 14, 2024 — Final Rules for End-Stage Renal Disease (ESD): Requirements for ESD Medicare beneficiaries, Medicare Advantage members, and Preexisting Condition Exclusions  Notices and Forms — Medicare & Medicaid Dec 14, 2024 — Notice and Form. Medicare may require plans to file notices if the plan is in effect under a federal health risk, health status, risk rating, or health care plan requirement, and has missed a compliance date, or is in violation of a federal health risk, health status, risk rating, or health care plan requirement. The final rule changes the notice and form requirements to require plans to  notify each qualified beneficiary that he or she is eligible for Medicare benefits. This notice is also required for Medicare Advantage/IBM members. Note: The final rule also provides for the extension of the reporting requirements to all Medicare beneficiaries that are entitled to receive a  Medicare benefit for end-stage renal disease and/or are aged 65 or over and reside in a participating community pharmacy, rural health clinic (RHC), or community health center (CHC) service area; Regulations & Guidance — Medicare & Medicaid Dec 8, 2024 — Final Rule for ESD Beneficiaries, Medicare Advantage Members, and Preexisting Condition Exclusions: The Medicare Advantage Prescription Drug Plan (PAP) and Medicare Savings Plans must notify beneficiaries that they are eligible for Medicare benefits, as defined in section 1860D- 1(g) or for the prescription drug benefit under section 1862(f) of the Social Security Act, on the effective date of the notice. Regulations and Guidance — Medicare & Medicaid Dec 10, 2024 — Final Rule for End-Stage Renal Disease (ESD): Medicare Advantage physicians, hospital, and clinical laboratory organizations (Close) will be required to provide information to beneficiaries who are enrolled in the Medicare Advantage prescription drug program (PHP) on the end-stage renal disease (ESD) benefit described in paragraph (a) and (b) of CMS- 1635. In addition, CMS expects certain Close to provide this information on a quarterly basis. The Notice & Final Rule will require Close to report quarterly to CMS the number of beneficiaries who were enrolled in their Medicare Advantage PHP plan during each of the 3 months ending November 3 and September 3.

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