CMS - Special Open Door Forum: Part D Appeals Process

Centers for Medicare & Medicaid Services

Special Open Door Forum:

Part D Appeals Process

Tuesday, December 20, 2016

2:00pm – 3:30pm Eastern Time

Conference Call Only

The Centers for Medicare & Medicaid Services (CMS) will host a Special Open Door Forum on Tuesday, December 20 from 2 – 3:30 p.m., EST to allow stakeholders to give feedback on the current Part D appeals process.  Consistent with section 704(f)(1) of the Comprehensive Addiction and Recovery Act (CARA), CMS is seeking input on key aspects of the current Part D appeals process from major stakeholders such as beneficiaries, beneficiary advocates, Part D sponsors, pharmacy benefit managers, pharmacists, providers, independent review entities, and pharmaceutical manufacturers. 

In an effort to continue exploring avenues to make the Part D coverage determination, appeal, and grievance processes more understandable and accessible for Medicare beneficiaries, CMS will consider feedback for potential improvements and future policy changes.  CMS encourages feedback on all areas of the Part D appeals process including, but not limited to:

• The grievance process;
• Initiating a coverage determination, including exception requests, redeterminations, and timeframes for issuing a decision;
• Reopening and notice requirements;
• Overall responsibilities of the beneficiaries and the Part D sponsors; 
• The additional levels of appeal; and
• Features of the Part C appeals process that work well and could potentially be applied to the Part D appeals process to enhance beneficiary access.

More information about the Part D appeals process can be found at: https://www.cms.gov/Medicare/Appeals-and-Grievances/MedPrescriptDrugApplGriev/index.html

Because this is a listening session where participants will provide comments only, CMS will not be answering questions related to the Part D appeals process.  Stakeholders that cannot participate at the scheduled time may submit comments on the current Part D Appeals Process to PartD_Appeals@cms.hhs.gov until December 27, 2016.  Please include “Open Door Forum” in the subject line.

Special Open Door Participation Instructions: 

Participant Dial-In Number: 1-800-837-1935

Confernce ID #: 34524170

Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.  

A transcript and audio recording of this Special ODF will be posted to the Special Open Door Forum website at http://www.cms.gov/OpenDoorForums/05_ODF_SpecialODF.asp         

For automatic emails of Open Door Forum schedule updates (E-Mailing list subscriptions) and to view Frequently Asked Questions please visit our website at http://www.cms.gov/OpenDoorForums/.