• • About the Part D Benefit
  • Education and Counseling
  • Medicare Advantage
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  • General Medicare

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Legal Authorities

• Medicare Modernization Act

  The pertinent provisions about the drug coverage (18Kb PDF file) are on pages 6 through 66.

• Medicare Law

  The complete compilation of Medicare law contains legal provisions that govern Medicare coverage (Parts A and B), Medicare Advantage (Part C) and Medicare drug coverage (Part D).
  
  
• Regulations

  Regulations are the legal interpretation of the statute by the governmental agency in charge of administering a statute.

  The Centers for Medicare & Medicaid Services (CMS) administers the statute, and the regulations are contained in Part 423 of Volume 42 the Code of Federal Regulations. The legal citation for these regulations is 42 CFR Part 423.

• CMS - Part D Manual – Rules
  • Chapter 2 - Part C and D Marketing Guidelines (35Kb PDF file)
  • Chapter 3 - PDP Enrollment and Disenrollment Guidance (July 16, 2008)
  • Chapter 4 - Creditable Coverage Period Determinations/Late Enrollment Penalty (18Kb PDF file)
• Chapter 5 - Part D Benefits and Beneficiary Protections (July 3, 2008)
• Chapter 6 - Part D Drug and Formulary Requirements (July 18, 2008)
• Chapter 7 - Quality Improvement and Medication Therapy Management (18Kb PDF file)
• Chapter 9 - Fraud, Waste and Abuse (542Kb PDF file)
• Chapter 14 - Coordination of Benefits Guidelines (287Kb PDF file)
• Chapter 18 of the Prescription Drug Benefit Manual - Part D Enrollee Grievances (January 1, 2008) (1Mb PDF file)