Immediate Action Casework Resolution Deadline Extension

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Immediate Action Casework Resolution Deadline Extension

This notice is in reference to the June 30, 2006 and August 31, 2006 memorandums on the Resolution of Medicare Beneficiary Complaints Monitoring. Specifically, CMS is holding all Part D sponsors accountable for the prompt resolution of CMS recorded complaints. The original deadline outlined in both memos required Sponsors to reduce the number of outstanding cases designated as "immediate action" and more than 2 days old by at least 95% by September 7, 2006. CMS is extending this deadline to September 10, 2006 at 11:59 PM ET.

CMS expects that by September 10, 2006, cases designated as "immediate action" and are more than 2 days old will be reduced by 95%. Your organization's number of open immediate action complaints older than 2 days, as well as the thresholds your organization is expected to achieve, can be viewed on HPMS.

Should your organization fail to meet the September 10, 2006 target, we will consider your organization to be out of compliance with one or more Part D program requirements. In that instance, CMS could conduct a targeted audit of your organization's Part D program operations. Where audit findings indicate that your organization is not meeting Part D requirements, CMS may request that you develop and complete a formal corrective action plan (CAP) to cure the deficiencies indicated by the audit. Where the findings indicate significant non-compliance, CMS may move to impose intermediate sanctions (i.e., suspend marketing and enrollment activities or withhold CMS payments). Where the non-compliance presents potential harm to beneficiaries, CMS may also consider pursuing civil monetary penalties against your organization.

Thank you for your attention to this important matter. If you have any questions or concerns, please contact your Part D Account Manager.