<nobr>Jun 24, 2005</nobr>

CMS Issues Service Area Waiver Guidance

Concerning Medicare Part D Prescription Drug Program, CMS has indicated that it would allow entities applying to sponsor employer/union-only group plans to request that CMS waive requirements beyond those already waived in CMS guidance, under the waiver authority outlined in section 1857(i) and 1860D-22(b) of the Social Security Act. This waiver authority states that CMS may waive or modify requirements that “hinder the design of, the offering of, or the enrollment in” an employer-sponsored group prescription drug plan. See also 42 CFR 422.106(d) and 42 CFR 423.458(c). Waivers apply to all similarly situated entities meeting the conditions of the waiver.

On June 23, 2005, CMS granted two additional employer/union group waivers. Both waivers deal with service area issues, one in the context of employer/union-only Private Fee-For-Service plans, and the other in the context of employer/union-only Regional PPO plans. Both waivers allow for coverage to be extended to retirees nationally, regardless of where in the country they may reside, provided certain conditions are met.

Edwina Rogers
Vice President, Health Policy
The ERISA Industry Committee
1400 L Street, N.W., Suite 350
Washington, DC 20005
(202) 789-1400
Cell (202) 674-7800
Fax (202) 789-1120
e-mail: erogers@eric.org
www.eric.org

Text Files:

Employer RPPO Guidance

Employer PFFS Guidance


Websites:

Guidance Documents

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