“Announcement of Calendar Year (CY) 2012 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter” cited a research study by Dr. Junling Wang’s research team, under the title ―Disparity Implications of Medicare Eligibility Criteria for Medication Therapy Management Services. (Wang et al. 2010. ―Disparity Implications of Medicare Eligibility Criteria for Medication Therapy Management Services. Health Services Research 45 (4): 1061-1082.) The objective of the research study was to determine if there were racial and ethnic disparities in meeting eligibility criteria for MTM services provided for Medicare Part D beneficiaries. The report findings suggest that Hispanic and African American beneficiaries could have a lower likelihood of meeting the MTM eligibility criteria when compared to whites based on the original MTM eligibility thresholds in 2006 and the new thresholds beginning in 2010. The study also found that there was disparity among beneficiaries with severe health problems.
“Medicare Program; Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs. Proposed Rule” cited another research study by Dr. Junling Wang’s research team, under the title ―Historical trend of disparity implications of Medicare MTM eligibility criteria. (Wang, et al. 2012. ―Historical trend of disparity implications of Medicare MTM eligibility criteria. Research in Social and Administrative Pharmacy 2012: 1–12). In the proposed rule, it said:” They found that disparity patterns did not change from the first study. Their findings that racial and ethnic disparities in meeting the MTM eligibility criteria may not decrease over time unless the eligibility criteria are changed have led Centers for Medicare and Medicaid (CMS) to conclude that the current MTM eligibility criteria are overly restrictive.”