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ADDENDUM TO CONTRACTS WITH
MEDICARE PART D SPONSORS PURSUANT
TO SECTIONS 1860D-1 THROUGH 1860D-42 OF THE SOCIAL SECURITY ACT
FOR
THE OPERATION OF A VOLUNTARY MEDICARE PRESCRIPTION DRUG
PLAN
The Centers for
Medicare and Medicaid Services (hereinafter referred to as
“CMS”) and
, an organization operating a Voluntary Medicare Prescription Drug
Plan (hereinafter referred to as “the Sponsor”) agree,
pursuant to 42 C.F.R. § 423.508(a) to amend the contract
( )
governing the Sponsor’s Part D operations described in
Section 1860D-1 through 1860D-42(with the exception of
1860D-22(a) and 1860D-31) of the Social Security Act (hereinafter
referred to as “the Act”) to include the provisions
stated below.
This addendum
is made pursuant to Subpart L of 42 CFR Part 417, Subpart K of
42 CFR Part 422, and Subpart K of 42 CFR
Part 423.
NOTE: For the purposes of this addendum, “the
Sponsor” includes the following: standalone prescription drug
plan (PDP) sponsors, Medicare managed care organizations
offering Part D benefits (MA-PD), and employer
group/union-only organizations. For a PDP sponsor, this document
amends its contract with CMS. For MA-PD organizations and employer
group/union-only benefit sponsors, this document amends the
Part D addendum to their Medicare managed care contracts with
CMS.
Article I
Medicare Voluntary Prescription Drug Benefit
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A.
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This addendum is in no way intended
to supersede or modify 42 CFR, Parts 417,422 or 423, except as to
any requirements set forth in 42 CFR Part 423 that are
specifically waived or modified for Sponsors offering a
prescription drug benefit exclusively to Part D eligible
individuals enrolled in employment-based retiree prescription drug
coverage as provided in applicable employer/union-only group waiver
guidance and/or in this addendum. Failure to reference a regulatory
requirement in this addendum does not affect the applicability of
such requirements to the Sponsor and CMS.
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B.
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In
the event of a conflict between the employer/union-only group
waiver guidance issued prior to the execution of the contract and
this addendum, the provisions of this addendum shall control. In
the event of any conflict between the employer/union-only group
waiver guidance issued after the execution of the contract and this
addendum, the provisions of the employer/union-only group guidance
shall control.
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C.
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In
the event of any conflict between the provisions of this addendum
and any other pro
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