Complaints over Medicares Part D program are declining, but oversight and operational challenges remain, the Government Accountability Office reported.
Following up on a request from leaders of the House Ways and Means and Energy and Commerce committees and Sen. Sherrod Brown (D-Ohio), the GAO did an analysis of the number and type of grievances and complaints filed by Part D enrollees and also reviewed the CMS oversight of the complaint and grievance process.
The GAO found that 630,000 complaints were filed with the CMS against drug plans from May 2006 through October 2007. During that period, the monthly complaint rate declined by 74% and the average time needed to resolve complaints decreased from a peak of 33 days to nine days.
However, a substantial proportion of complaints filed when beneficiaries were at risk of exhausting their medications were not resolved within the CMS desired time frames, according to a written statement from the Energy and Commerce Committee. Specifically, the GAO found that 53% of immediate need complaints and 27% of urgent need complaints were not resolved in a timely fashion, raising concerns that beneficiaries could deplete their medications before their complaints are resolved. Seniors and people with disabilities deserve better, and CMS needs to strengthen oversight of Part D plans immediately, said Energy and Commerce Chairman Rep. John Dingell (D-Mich.) in a written statement.
The CMS could not explain many of the problems the GAO identified in the grievances data, although it promised to make improvements in the quality of the data. -- by Jennifer Lubell
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