CMS PROPOSES NEW PROTECTIONS FOR MEDICARE BENEFICIARIES IN MEDICARE ADVANTAGE AND PRESCRIPTION DRUG PROGRAMS
MEDICARE TIGHTENS MARKETING STANDARDS AND PROTECTS BENEFICIARIES FROM INAPPROPRIATE COST SHARING
The Centers for Medicare & Medicaid Services (CMS) today proposed enhanced protections for beneficiaries who are enrolled in Medicare Advantage (MA) health plans and Medicare prescription drug plans. CMS' actions today will strengthen marketing standards and extend additional protections to all beneficiaries including those receiving the low-income subsidy (LIS) and beneficiaries enrolled in special needs plans.
“These proposed changes will have a direct, positive impact on people with Medicare,” said Kerry Weems, Acting Administrator of CMS. “The Medicare Advantage program is a valuable source of enhanced benefits and coordinated care for beneficiaries, and it should not be undermined by the actions of a limited number of unscrupulous sales agents.”
This proposed regulation is a continuation of CMS’ efforts to enhance compliance and oversight of the Medicare Advantage program over the past ten months. Recent compliance and oversight actions include, posting the summaries of corrective actions taken against MA plans on the CMS Web site; establishing five-star ratings for plan performance; embarking on an extensive secret shopping program of plan marketing events that have led to compliance actions and more accurate sales presentations; and requiring private-fee-for-service plans to call new enrollees to verify their desire to join the plan.
The proposed rule would incorporate into regulation a number of requirements that CMS previously imposed through operational guidance. It also would introduce several new MA and prescription drug plan requirements. The new proposed prohibitions on door-to-door marketing and cold-calling as well as new proposed requirements pertaining to broker/agent commissions go beyond what the insurance industry recently endorsed as necessary regulatory changes to the program for improvement.
Specifically, the proposed plan marketing standards would:
Provisions to streamline eligibility determinations for extra help and limit beneficiary liability would:
The rule also would clarify one approach to calculating fines, or civil monetary penalties, against Medicare Advantage or Part D plans that violate Medicare rules in ways that adversely affect beneficiaries. Under the proposal, CMS would have greater flexibility in determining penalty amounts and would have clear authority to levy a penalty of up to $25,000 for each enrollee affected, or likely to be affected, by the violation.
The rule also proposes new protections for beneficiaries enrolled in special needs plans (SNPs). SNPs are a type of MA plan that provides coordinated care to individuals in certain institutions such as nursing homes, and those who are eligible for both the Medicare and Medicaid programs and/or have certain severe or disabling chronic conditions. Provisions in the proposed rule would:
The proposed regulation is available on the CMS website at: http://www.cms.hhs.gov/HealthPlansGenInfo/ . Comments must be submitted by 5:00 p.m. Eastern time on July 15, 2008.
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