The Comprehensive Addiction and Recovery Act of 2016 (CARA) included provisions that give Medicare Prescription Drug Plans and Medicare Advantage plans (including Medicare-Medicaid Plans (MMPs)) tools to address opioid overutilization. To implement this law, the Centers for Medicare & Medicaid Services (CMS) adopted a regulation that allows Medicare plans that provide prescription drug coverage (including MMPs) to implement drug management programs that limit access to certain controlled substances determined to be “frequently abused drugs” for members who are considered to be at-risk for prescription drug abuse. These programs are currently optional for 2020 and 2021 but will be mandatory beginning in 2022 as a result of the SUPPORT Act of 2018.1 MMP members in such drug management programs must meet criteria for a Medicare Enrollment Period or Medicare Special Election Period (SEP) to enroll in, disenroll from, or change plans.
The following technical assistance tools are scripts for Medicare-Medicaid Plan (MMP) enrollment brokers to follow while assisting individuals with CARA lock-in indicators looking to disenroll, enroll, or change their plan.
VIEW MMP DISENROLLMENT SCRIPT» https://www.integratedcareresourcecenter.com/sites/default/files/MMP_Disenrollment_Script_CARA.pdf
VIEW MMP ENROLLMENT SCRIPT» https://www.integratedcareresourcecenter.com/sites/default/files/MMP_Enrollment_Script_CARA.pdf
VIEW CHANGE MMP SCRIPT» https://www.integratedcareresourcecenter.com/sites/default/files/MMP_Switch_Script_CARA.pdf
Technical Assistance Tool: Medicare-Medicaid Plan (MMP) Enrollment Restrictions Resulting from the Comprehensive Addiction and Recovery Act of 2016 (CARA): https://www.integratedcareresourcecenter.com/resource/medicare-medicaid-plan-mmp-enrollment-restrictions-resulting-comprehensive-addiction-and
Medicare Enrollment Periods and Special Election Periods for Dually Eligible Individuals: Reference Tables: https://www.integratedcareresourcecenter.com/resource/medicare-enrollment-periods-and-special-election-periods-dually-eligible-individuals