US · guidance
CMS Pub. 100-11, ch. 14, § 30
Medicare Part D COB
On December 8, 2003, Congress enacted the MMA of 2003 (PL 108– 173). Several
sections of the MMA impact PACE organizations. Most notably, Section 101 of the
MMA affected the way in which PACE organizations are paid for providing certain
outpatient prescription drugs to any Part D eligible participant. As specified in Sections
1894 and 1934 of the Act, PACE organizations shall provide all medically necessary
services, including prescription drugs, without any limitation or condition as to amount,
duration, or scope and without application of deductibles, copayments, coinsurance, or
other cost sharing that would otherwise apply under Medicare or Medicaid.
Prescription drugs provided under Medicare Part D will be covered in the Medicare
capitation rates paid to PACE organizations and payment for non-Medicare covered
outpatient prescription drugs and prescribed over-the-counter medications covered in the
Medicaid capitation rate.
History
(Rev. 2, Issued: 06-09-11; Effective: 06-03-11; Implementation: 06-03-11)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
3efa4e36a7af5a338a4fa2215abc945b1f9a5b05dcecc462e6860cf160f0f7b4
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