The Medicare Modernization Act
Medicare Prescription Drug, Improvement, and Modernization Act
The Medicare Prescription Drug, Improvement, and Modernization Act, also called the Medicare Modernization Act or MMA, is a federal law of the United States, enacted in 2003. It produced the largest overhaul of Medicare in the public health program's 38-year history.
What does the Medicare Prescription Drug Improvement and Modernization Act do?
Medicare Prescription Drug, Improvement, and Modernization Act. Long title. An act to amend title XVIII of the Social Security Act to provide for a voluntary prescription drug benefit under the medicare program and to strengthen and improve the medicare program, and for other purposes.
What is the Medicare Modernization Act of 2003?
The 2003 Medicare Modernization Act (MMA) is considered one of the biggest overhauls of the Medicare program. It established prescription drug coverage and the modern Medicare Advantage program, among other provisions. It also created premium adjustments for low-income and wealthy beneficiaries.
What is the Medicare Modernization Act (MMA)?
The 2003 Medicare Modernization Act (MMA) is considered one of the biggest overhauls of the Medicare program. It established prescription drug coverage and the modern Medicare Advantage program, among other provisions.
What is the legislative history of Medicare?
Legislative history. The Medicare Prescription Drug, Improvement, and Modernization Act, also called the Medicare Modernization Act or MMA, is a federal law of the United States, enacted in 2003.
What did the Medicare Prescription Drug Improvement and Modernization Act do?
Abstract. The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) provides universally available prescription drug benefits to elderly and disabled Medicare beneficiaries for the first time.
What was the biggest change to Medicare brought about by the 2003 Medicare Modernization Act?
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 was enacted in November 2003 and became effective on January 1, 2006. Two major changes occurred. A prescription drug benefit is now available for seniors and younger persons with disabilities who are covered by Medicare.
What was the impact of the Medicare Prescription Drug Improvement and Modernization Act quizlet?
What was the impact of the Medicare Prescription Drug Improvement and Modernization Act? The Act created Medicare Part D, the drug prescription program.
When was the Medicare Modernization Act passed?
December 8, 2003On December 8, 2003, the President signed into law Public Law 108-173, the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003.
How has Medicare changed over the years?
Medicare has expanded several times since it was first signed into law in 1965. Today Medicare offers prescription drug plans and private Medicare Advantage plans to suit your needs and budget. Medicare costs rose for the 2021 plan year, but some additional coverage was also added.
Who introduced the Medicare Modernization Act of 2003?
Speaker Dennis HastertThe bill was introduced in the House of Representatives early on June 25, 2003 as H.R. 1, sponsored by Speaker Dennis Hastert.
Which part of the Medicare program was created under the Medicare Modernization Act of 2003 MMA )? Quizlet?
The Medicare Modernization Act of 2003 (MMA) created an outpatient prescription drug benefit (Medicare Part D).
What is the most significant legislation resulting from public health policy since enactment of the Medicare and Medicaid programs in 1965 quizlet?
The answer is B. (C) Social Security Act amendments creating Medicaid and Medicare.
Does Medicare and Medicaid use DRGs to reduce costs quizlet?
The fixed fees paid by Medicare Part A are based on DRGs. In other words, Medicare uses DRGs to determine appropriate reimbursement for medical diagnoses and procedures, as do many private insurers. DRGs are assigned in the hospital when a patient is discharged.
Was the Medicare Modernization Act successful?
After the MMA rolled out, the portion of Medicare beneficiaries without drug coverage has declined. By 2016, an estimated 90% of Medicare beneficiaries had drug coverage, according to a report in Health Affairs.
What is the MMA law?
The Music Modernization Act (MMA) updates the copyright law to make statutory licensing more fair for creators and more efficient for digital music providers.
Which part of the Medicare program was created under the Medicare Modernization Act of 2003 MMA and represents the drug benefit?
Medicare Prescription Drug, Improvement, and Modernization Act of 2003 - Title I: Medicare Prescription Drug Benefit (Sec. 101) Amends title XVIII (Medicare) of the Social Security Act (SSA) to add a new part D (Voluntary Prescription Drug Benefit Program).
What Is the Medicare Modernization Act of 2003?
The Medicare Prescription Drug, Improvement and Modernization Act of 2003 — also known simply as the Medicare Modernization Act (MMA) — is a sweeping piece of legislation that created a prescription drug benefit for millions of Medicare beneficiaries.
What Was the Impact of the Medicare Prescription Drug Improvement and Modernization Act?
The Medicare Modernization Act has impacted the program and its beneficiaries in significant ways. Perhaps the greatest impact is a massive enrollment shift to Medicare Advantage plans.
Medicare Modernization Act Pros and Cons
The Medicare Modernization Act expanded prescription drug coverage to millions of older and disabled Americans.
When did the 2005 Medicare prescription drug reforms end?
The Federal Trade Commission’s Bureau of Competition today issued a summary of agreements filed with the Commission in fiscal year 2005 (ending September 30, 2005 ) by generic and branded drug manufacturers. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 requires drug...
When did the 2007 drug agreement end?
The Federal Trade Commission’s Bureau of Competition today issued a summary of agreements filed with the agency in fiscal year 2007 (ending September 30, 2007 ) by generic and branded drug manufacturers.
When was Medicare Modernization Act enacted?
Signed into law by President George W. Bush on December 8, 2003. The Medicare Prescription Drug, Improvement, and Modernization Act, also called the Medicare Modernization Act or MMA, is a federal law of the United States, enacted in 2003. It produced the largest overhaul of Medicare in the public health program's 38-year history.
When did Medicare Advantage start?
Medicare Advantage plans. With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans, instead of through the Original Medicare plan (Parts A and B).
What is Medicare Part D?
Main article: Medicare Part D. The MMA's most touted feature is the introduction of an entitlement benefit for prescription drugs, through tax breaks and subsidies. In the years since Medicare's creation in 1965, the role of prescription drugs in patient care has significantly increased.
How many votes did the Senate have to override the conference report?
However, a budget point of order was raised by Tom Daschle, and voted on. As 60 votes were necessary to override it, the challenge was actually considered to have a credible chance of passing.
How many Americans were enrolled in HSAs in the first 10 years?
After the first 10 years over 12 million Americans were enrolled in HSAs (AHIP;EBRI).
When was the H.R. 1 bill introduced?
The bill was introduced in the House of Representatives early on June 25, 2003 as H.R. 1, sponsored by Speaker Dennis Hastert. All that day and the next the bill was debated, and it was apparent that the bill would be very divisive. In the early morning of June 27, a floor vote was taken. After the initial electronic vote, the count stood at 214 yeas, 218 nays.
Can formularies be used to restrict prescription drug choices?
formularies can be used to restrict prescription drug choices. prescription coverage can be deferred to the patient or a Medicare Part D prescription plan. care other than emergency care can be restricted to a particular region. federal reimbursement can be adjusted according to the health risk of the enrollees.
What is Medicare Modernization?
Medicare modernization: the new prescription drug benefit and redesigned Part B and Part C
When was Medicare created?
When Medicare was created in 1965 , its purpose was to protect seniors from the catastrophic costs of long hospital stays and expensive medical procedures (1–3). Since then, Medicare has expanded the scope of its benefits, the populations it covers, and, consequently, its costs.
What is CMS in healthcare?
The Centers for Medicare and Medicaid Services (CMS) administers all aspects of the Medicare program, including making decisions about covered services, determining payment rates and policies, administering claims, educating beneficiaries and health care providers, and conducting research on alternative health care delivery systems.
How much does Medicare pay for a drug?
For drug costs exceeding $5100, Medicare will pay 80%, the plan will pay 15%, and the beneficiary will pay 5%.
Why do Medicare Advantage plans have to bid?
The competitive bidding system is intended to encourage plans to compete to offer the best benefits at the lowest prices for beneficiaries.
How many parts are there in Medicare?
There are four distinct parts to the Medicare program: Parts A, B, C, and D. CMS organizes, funds, and administers each part separately.
How many therapeutic categories are there in the CMS?
The Model Guidelines, released on January 3, 2005, consist of 41 broad therapeutic categories based on similar groups of diagnosis codes; 137 pharmacologic classes generally based on similar mechanisms of action or chemical structure; and 146 unique therapeutic categories and pharmacologic classes. A plan's formulary must include at least two drugs in each therapeutic category or class. CMS may require more than two drugs per class when additional drugs offer unique and important efficacy and safety advantages.
What items were reduced in the 2005 Medicare payment?
Provides that for 2005 the payment amount for certain items, oxygen and oxygen equipment, standard wheelchairs, nebulizers, diabetic lancets and testing strips, hospital beds and air mattresses, will be reduced.
What is SSA Title 3?
Title III: Combatting Waste, Fraud, and Abuse - (Sec. 301) Amends SSA title XVIII to allow the Secretary to make a conditional Medicare payment if a primary plan has not made or cannot reasonably be expected to make prompt payment. Requires the payment to be contingent on reimbursement by the primary plan to the appropriate Medicare trust fund. Requires a primary plan as well as an entity that receives payment from a primary plan to reimburse the Medicare Trust Funds for any payment made by the Secretary if the primary plan was obligated to make payment. Makes other changes with regard to Medicare as a secondary payer to address the Secretary's authority to recover payment from any and all responsible entities and to bring action, including the collection of double damages, to recover payment under the Medicare secondary payer provisions.
Which title directs the Secretary to request the Institute of Medicine of the National Academy of Sciences to conduct an evaluation of the?
Directs the Secretary to request the Institute of Medicine of the National Academy of Sciences to conduct an evaluation of the peer review program under SSA title XI.
When did the CCA program begin?
241) Directs the Secretary to establish a program for the application of comparative cost adjustment in CCA areas, to begin January 1, 2010, and last six years, and to test whether direct competition between private plans and the original Medicare fee-for-service program will enhance competition in Medicare.
Who conducts a study for a report to the Congress on the extent to which drug utilization and access to covered?
Requires the Comptroller General to conduct a study for a report to the Congress on the extent to which drug utilization and access to covered part D drugs by subsidy eligible individuals differs from such utilization and access for individuals who would qualify as such subsidy eligible individuals except for application of the assets test.
What is MEDPAC report?
Requires a Medicare Payment Advisory Commission (MEDPAC) study and report to Congress with respect to authority regarding disapproval of unreasonable beneficiary cost-sharing.
Home Health Services, Economics of
After the passage of the Medicare Modernization Act, Medicare Advantage enrollment has increased rapidly. As of February 2010, 25.2% of Medicare beneficiaries were enrolled in Medicare Advantage.
Decision Making and Health Literacy among Older Adults
After patients construct a representation of health-related problems, they must develop a plan for action, which often involves evaluating and choosing options. Patients are continually faced with choices in order to manage their health, and considering options is challenging.
Organizations On Aging
In the current policy climate of entitlement cutbacks and continued devolution to the states that got underway in the 1990s, organizations on aging will find it more difficult to promote major new programs, such as national social insurance for long-term care.
Medicare
The US Medicare program began in 1965 to address issues of access to care for three groups of Americans: the aged, the disabled, and people with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease).
Fiscal Implications of Population Aging
Our current dismal fiscal picture is a sharp turnabout from a decade ago. At the beginning of this century, the US federal budget outlook was rosy in the short term with some important but manageable demographic challenges in the long term.
Politics of Aging
C. Kelly, V.W. Marshall, in Encyclopedia of Gerontology (Second Edition), 2007
What is the MMA in Medicare?
The addition of a prescription drug benefit to Medicare as a result of the MMA represents a landmark change to the Medicare program, a change that will significantly improve the healthcare coverage available to millions of Medicare beneficiaries. In the final regulation, we have included policies, such as formulary requirements and exceptions and appeals processes, to assure that beneficiaries have access to covered drugs that are medically necessary for their condition while enabling plans to design and manage their formularies to provide the most affordable benefit possible. We are also adjusting the payments to drug plans based on the expected costs of their enrollees, as well as implementing many other steps to limit the financial risk facing drug plans. Together, our goal is to provide a foundation for fair competition to offer high-quality coverage at the lowest cost to all types of Medicare beneficiaries, and to reward plans that focus on this critical policy goal.
Does CMS review drug lists?
Regardless of the classification system chosen, CMS will review and approve drug lists that are consistent with best practice formularies currently in widespread use today. The following paragraphs describe the multiple checks that will be utilized as part of the drug list review.
What is the Medicare Modernization Act?
This article also probes whether or not the bill has been successful in meeting the needs of the elderly population to gain secure access to affordable prescription medicine as well as helping the federal government lower its spending. Based on available literature, the Modernization Act has a limited advantage to the people it seeks to serve, while giving private companies more money and business. The Medicare Modernization Act fails to answer the needs of the elderly population to have better access to prescription drug because. While it offers more services and benefits, the MMA does not answer the problem on cost related to medication.
Does Medicare cover disabled people?
The program also covers people under 65 years old who are disabled and are not capable of holding employment. Traditionally, the Medicare provides hospitalization and medical insurance to the elderly [1]. Later amendments allowed an individual to enhance the services by integrating a private health plan into Medicare for an additional cost.
Is Medicare Modernization Act a failure?
Those who believe that the Medicare Modernization Act is a failure have based their arguments on some points. For one, Medicare users can’t avail of the drug prescription benefit without getting involved with private health insurers and paying for monthly premiums. While this is not an issue for some, there are elderly people whose monthly stipends are meager. They could not afford the premiums. Although the MMA provides that this type of people can be accommodated and given prescription drugs for free, the question would lie on what type of drugs would they get, given that they are not paying for them? This would also imply that the MMA becomes discriminatory based on income. Those who can afford to pay get more, while those who cannot get less. This beats the very essence of Medicare being a social program.
Overview
The Medicare Prescription Drug, Improvement, and Modernization Act, also called the Medicare Modernization Act or MMA, is a federal law of the United States, enacted in 2003. It produced the largest overhaul of Medicare in the public health program's 38-year history.
The MMA was signed by President George W. Bush on December 8, 2003, after …
Prescription drug benefits
The MMA's most touted feature is the introduction of an entitlement benefit for prescription drugs, through tax breaks and subsidies.
In the years since Medicare's creation in 1965, the role of prescription drugs in patient care has significantly increased. As new and expensive drugs have come into use, patients, particularly senior citizens at whom Medicare was targeted, have found prescriptions harder to afford. The …
Medicare Advantage plans
With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans, instead of through the Original Medicare plan (Parts A and B). These programs were known as "Medicare+Choice" or "Part C" plans. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, the compensation and business practices for insurers that offer these plans changed, a…
Health savings accounts
The MMA created a new Health Savings Account statute that replaced and expanded the previous Medical Savings Account law by expanding allowable contributions and employer participation. After the first 10 years over 12 million Americans were enrolled in HSAs (AHIP;EBRI).
Other provisions
While nearly all agreed that some form of prescription drug benefit would be included, other provisions were the subject of prolonged debate in Congress. The complex legislation also changed Medicare in the following ways:
• it mandated a six-city trial of a partly privatized Medicare system (by 2010)
• it gave an extra $25 billion to rural hospitals (at the request of congressional representatives in the rural West)
Legislative history
According to the New York Times December 17, 2004 editorial W.J."Billy" Tauzin, the Louisiana Republican who chaired the Energy and Commerce Committee from 2001 until February 4, 2004 was one of the chief architects of the new Medicare law. In 2004 Tauzin was appointed as chief lobbyist for the Pharmaceutical Research and Manufacturers of America (PhRMA), the trade association and lobby group for the drug industry with a "rumored salary of $2 million a year," dr…
Costs
Initially, the net cost of the program was projected at $400 billion for the ten-year period between 2004 and 2013. Administration official Thomas Scully instructed analyst Richard Foster not to tell Congress of Foster's finding that the cost would actually be over $500 billion. One month after passage, the administration estimated that the net cost of the program over the period between 2006 (the first year the program started paying benefits) and 2015 would be $534 billion. As of F…
Bar to negotiation of prescription drug prices
Since the enactment of Medicare Prescription Drug, Improvement, and Modernization Act in 2003, only insurance companies administering Medicare prescription drug program, not Medicare, have the legal right to negotiate drug prices directly from drug manufacturers. The Medicare Prescription Drug Act expressly prohibited Medicare from negotiating bulk prescription drug prices. The "donut hole" provision of the Patient Protection and Affordable Care Act was an attem…