Mandated Member Communications: The Most Important Parts of the Census to Health Plans

With the 2010 Census information released this week, it will be interesting to see the demographic shifts across the U.S. While to the general public, understanding how the population is shifting is a “nice to know," for health plans, this new information from the Census will directly impact how they operate their business. 

With the passing of the Centers for Medicare & Medicaid Services (CMS) 10% Translation Rule, health plans that sell products in either Medicare or Medicaid are required to provide all their materials in an alternative language if over 10% of their population in a specific area speaks that language as their primary. CMS and other regulatory bodies are not only requiring this, but also heavily enforcing it – with increased auditing and secret shopper activities ensuring the available and accurate translation of these materials.

While the Rule has been in effect for a few years now, a recent study by the National Senior Citizens Law Center (NSCLC) found that many Medicare Advantage plans and Medicare Part D plans are not publishing marketing materials in Spanish as required by CMS under their provider contracts.

This study shows just how widespread non-compliance of translated marketing materials is. To make matters worse, this study does not take into account the compliance requirements for pre enrollment, post enrollment and mandated communications – which means the likelihood of non-adherence or inaccuracies in these materials is most likely even greater than reported in this study. This should be alarming for any health plan, as any inaccurate or missing translated materials could have devastating effects on their ability to market themselves if CMS enforces penalties against them.

As the population of the United States continues to change, the number of areas with required translation needs and the number of languages that will be required will continue to grow. With these changing demographics, the need for accurately translated member communications - including marketing, pre enrollment, post enrollment and mandated communications - will continue to be a driving component to the viability of a health plan.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Mandated Member Communications: It’s the Most Wonderful Time of the Year?

“It’s the most wonderful time of the year

with the kids jingle belling and 

everyone telling 

you’ll be of good cheer

It’s the most wonderful time of the year.”

Let me be the first to say that it’s pretty clear Andy Williams did NOT work at a health plan!!

While he is singing about parties for toasting and marshmallows for roasting, the rest of us are neck deep in the enrollment season and the stress, long hours and craziness that go hand-in-hand with this supposed “most wonderful time of year”.

Health plans are in the middle of orchestrating a successful enrollment season. With three major communication initiatives occurring, plans must create, produce and distribute Agent/Broker Communications, Pre-Enrollment materials and Post-Enrollment materials accurately, on time and within compliance. Any mistake made along the way can have a devastating effect on the plan’s ability to attract or retain members. Because of this, plans have a laser focus on these activities ensuring they are executed flawlessly.

Often lost amongst all these activities is another major initiative that needs to be handled with kid gloves: Preparing and executing mandated post enrollment communications. While these communications often fly below the radar during this time of year, they can have a major impact on a business if they are not handled properly. With changing regulations, new exhibits and addendum, and increased monitoring by regulatory bodies, failure to adhere to the requirements can lead directly to penalties for non-compliance including monitoring, fines, and the risk of contract non-renewal.

While the other communications rightfully get most of the attention and resources, don’t let mandated member communications be the straw that breaks the camel’s back. Preparing, distributing, and reporting on mandated member communications is often a resource-draining and time-consuming process, and with the enactment of the Affordable Care Act and tightening regulatory guidelines, the process has only been compounded. Worse, failure to comply with strict service level agreements and deadlines can result in penalties, including monitoring, fines, and the risk of contract non-renewal. Taking the proper time will build positive momentum and will ensure that all your other enrollment activities were not for naught.

And you know what, if all of these communications are executed properly, this year’s enrollment season could very well end up being "the most wonderful time of year" for your plan.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Mandated Member Communications in Healthcare: An Introduction

Preparing, distributing, and reporting on mandated member communications is often a resource-draining and time-consuming process. The enactment of the Affordable Care Act and tightening regulatory guidelines have only compounded this already trying process. Worse, failure to comply with strict service level agreements and deadlines can result in penalties for non-compliance including monitoring, fines, and the risk of contract non-renewal.

Today, this blog is commencing a series on the topic of mandated member communications, including the different types that currently (and potentially) could exist, as well as new methods for companies to improve their process for staying compliant.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact her at Pamela.Argeris@merrillcorp.com.

Understanding the Digital Database Idea.

Last week, we presented a few ideas about the controversy surrounding a proposed digital database for insurance consumer information. The obvious faults that experts pointed out about the plan centered on the possibility that data-miners or corporate interests could easily access consumer information. Now we are going to take a look at the legislation that inspired the concept.

Back in July of this year, the Obama administration began announcing the features of the healthcare reform plan. Part of this plan was for every citizen to have an electronic medical record by 2014. This was motivated by the desire to make the process of healthcare easier, faster, and cheaper. A nationally-accessible database would prevent much of the pointless paperwork that takes up time and money in today’s system. It is around this point that things begin to get interesting.

The primary arguments today against this system are the potential for corporate interests to access private information. In actuality, privacy was one of the founding principles of the electronic database idea. In July, when the Health Information Technology for Economic and Clinical Health (HITECH) Act cam out, it required HHS to re-write HIPAA to strengthen privacy, security, and enforcement. The language used in HITECH is very similar to the language used to promote the electronic database:

• Expanding individuals' rights to access their information and to restrict certain kinds of disclosures of protected health information to health plans
• Requiring business associates of HIPAA-covered entities to follow most of the same rules as the covered entities
• Setting new limitations on the use and disclosure of protected health information for marketing and fund raising; and
• Prohibiting the sale of protected health information without patient authorization (From FierceHealthcare).

So now we have a system devised to protect privacy and security in response to a rule-change based in those same values. As long as the digital database functions as intended, it seems like a win-win scenario. Obviously, there is always the chance that an immoral healthcare worker could sell personal information to data-miners, but isn’t that just as possible today?

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

OPM Shows Little Concern for Privacy

OPM is making waves with their push toward a national database of health insurance customers. OPM’s argument is that such a database would provide "best value for both enrollees and taxpayers.” They also cite the potential efficiency such a system would offer. OPM also claims that the system would be “de-identified,” supposedly protecting individual customers from the healthcare data-mining that plagues the industry.

However, many are not satisfied with OPM’s vague claims. Harley Geiger, policy counsel for the Center for Democracy and Technology, tells Computerworld “[At this point,] there are far too many unknowns about the program for it to be acceptable.” Many questions are raised by the program: Are HIPAA and PHI going to be swirling around cyberspace? Exactly what measures are protecting consumers from data mining?

Most seem to agree that OPM’s notice is entirely too vague to garner any form of support for the new system. OPM’s plans to allow third-parties to access the material, including judicial and research groups, sends up further red-flags.

Until OPM is willing to release more specific information about the program, it is unlikely to be welcomed into the industry. Our concern should be for the protection and safety of consumers and average citizens, not for cost-cutting. If there is even a small potential for someone to profit from selling access of this database to commercial data-miners, then it is unacceptable as a system.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

HHS, IT Infrastructure and Health Insurance Exchanges

Last week, HHS announced a new initiative that will provide competitive funding opportunities for states to design and initiate IT infrastructures that will be necessary for the operation of Health Insurance Exchanges. Because these Exchanges will need to be designed to present a large number of individuals and small businesses with affordable health care options by 2014, new and advanced IT systems will be necessary well before then.

Exchanges, as we know, will provide a form of one-stop shopping for individuals and small businesses, with interested parties being able to examine, select, and enroll in one of many available plans offered at competitive, affordable prices. However, while many are focused and debating the policy aspect of this initiative, what gets lost is the IT infrastructure that will need to be constructed in order to make this (or any) end goal possible. The infrastructure will need to be well thought out and be based on several best practice examples (especially in the areas of simplicity and approachablity) in order to allow the Exchanges to operate like other similar consumer industry sites.

To assist with this aspect, states can apply, through HHS, for “Early Innovator Grants.” The grants will provide states with the capital to get a head start on building these necessary infrastructure models. States are to be chosen based on their current efforts toward consumer-friendly IT infrastructure, as well as their leadership in cost-effective solutions.

The first round of winners will be announced before February 15^th, 2011, and will be followed by additional award announcements which all states – including those that already received funding – will be eligible to receive.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

CMS Shares More Medicare Information.

This week, in our continue our assessment of CMS’s new health care regulations, we are examining some of the details of the ACA’s efforts to spread knowledge about Medicare.

The ACA has already launched the Medicare Plan Finder tool. This tool will allow beneficiaries and health plans to easily view information about their plans and benefits. The system already contains information about 2010 and 2011 data, with further updates to be conducted on October 28^th. Among these updates will be the ability to search for information by plan name or identification number, making it even easier for beneficiaries to find what they need to know.

A detailed pamphlet, Medicare and You, is currently being mailed out to all Medicare recipients. The handbook will describe the details of various plans and benefits, and is intended to be used as an aid for individuals to determine whether or not moving their coverage would be beneficial. CMS stresses that any decisions about changing one’s coverage should be researched through a trusted source, such as 1-800-Medicare, or the official government websites. Employer group and Union Medicare recipients can find information at these sources as well.

Finally, CMS has stated the importance of holding on to any Medicare information or documents that they receive through the mail for the rest of this year, as many changes are likely to affect current beneficiaries. This is all part of CMS's attempts to reduce Medicare fraud and abuse.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

New ACA Regulations Prompt Medicare Policy Changes.

Performed mostly in an effort to update the industry on new ACA regulations, CMS has released a large amount of information on new policies. These changes to regulations are primarily related to the benefits that Medicare will offer in 2011.

Beginning January 1^st, Medicare beneficiaries can expect to receive:

• One annual physical examination at no cost.
• Free Wellness visits.
• New free health screenings.
• A 50% discount on covered brand-name drugs and a 7% discount on covered generic drugs.
• Protection from excessive cost increase, through aggressive bids.
• Consolidation of low enrollment and duplicate plans.
• Set limits on out-of-pocket expenses.
• Coverage of preventative services with no cost sharing.
• Limits on cost sharing for skilled nursing care, chemotherapy, and renal dialysis.

CMS’s other major release this week described a renewed attention to inform seniors about the fraud, waste, and abuse that have been associated with Medicare in the past. The initiative has already launched, and is centered on two hotlines set up by the federal government. Interested parties can find information either of these hotlines, www.StopMedicareFraud.gov or 1-800-MEDICARE, for information on spotting fraud, waste, and abuse of Medicare. Merrill Corp will continue to post information about further ACA-related changes over the coming weeks.

Translating Healthcare

“CuidadoDeSalud.gov, like HealthCare.gov, is an unprecedented website which provides consumers with the power of information at their fingertips. Individuals, families, and small businesses will be able to easily compare both public and private health coverage options tailored specifically for their needs, said HHS Secretary Kathleen Sebelius. “CuidadoDeSalud.gov will give Latinos across the nation better information about the choices they have, how much they cost, and what they can expect from their doctor--specific to their life situation and local community.”

While the six month anniversary of the Affordable Care Act was celebrated on September 23rd with a conclave of changes, ranging from a ban on insurance companies discriminating against kids with pre-existing conditions to young adults being able to stay on their parent’s health plan, for many, October 1st was the day they had been looking forward to the most.
 

The U.S. Department of Health and Human Services, to further their goal of improving the overall member experience, created a Spanish language version of the Healthcare.gov website, which can be found at www.CuidadodeSalud.gov (the page officially launched on September 8th, but October 1st was the date that essential cost data was uploaded). CuidadodeSalud.gov is the first website of its kind. Developed entirely in Spanish primarily, its mission is to help even more consumers take control of their healthcare by connecting them to new information and resources that will help them access quality, affordable health care coverage.

This is a necessary step in the goal of creating a healthier country because, according to HHS:

• One in three Hispanics lacks healthcare coverage.
• Half of all Hispanics do not have a regular doctor.
• Hispanics suffer disproportionately from chronic health diseases such as diabetes and cardiovascular disease.
• Hispanic women contract cervical cancer at twice the rate of white women.

Thinking beyond the politics of the healthcare issue, as a technology-enabled services provider for a wide range of industries, we commend the seriousness and accuracy HHS, as well as CMS and the DOIs have shown with translated pieces. The website is just one example, and comes on the heels the new requirement that all communications need to be available to prospects and members in areas in which 10% of the population have the same first language. We believe that these changes and enhancements will aid all the agencies in their goal of improving education and decreasing confusion for more people.

The Patient and Protection Affordable Care Act…..6 months later

While The Patient and Protection Affordable Care Act (ACA) was enacted on March 23, 2010, it didn’t officially go into effect until last week on September 23. However, despite being enacted, there are still many debates and discussions raging on about the bill.

The goal of the ACA was to reduce the cost of healthcare, improve the quality of care and improve the overall member experience. Thus ACA included the following items:

• No lifetime or restricted annual limits on benefits
• Eliminated pre-existing conditions and rescissions
• Young adults covered to age 26 on their parent's policy
• Drug discounts for seniors (starting June 15, 2010)
• Tax break for small businesses

However, there are also additional changes taking place behind the scenes that many consumers are unaware of, but could greatly alter the healthcare landscape. Most notably, changes to Medicare Enrollment Period’s and Medical Loss Ratio calculations.

With reduced enrollment periods, plans will have to alter how and when they market to their members. This constricting timeline is going to make an already trying process, an even greater strain on resources. Additionally, the 80-85% Medical Loss Ratio that plans will be mandated to operate at will force some plans to change their plan type, or worse may force them to drop certain coverage in order to comply.

On top of all of this, with November elections looming, funding may be reduced or cut and each new member of Congress will push for what they think will be the best circumstance for their delegates. Like always, Merrill Corporation will be monitoring all these changes and more from HHS, CMS and all other regulatory bodies to ensure that health plans can successfully navigate and comply with Health Reform.

Comments on Director Blum's Message at the CMS Fall Conference

As noted in our previous blog post, Merrill Corp attended the Center for Medicare and Medicaid Services (CMS) 2010 Fall Conference earlier this month. On Day 2, before sessions on Customer Service Monitoring, QIP/CCIP Expectations and a panel on 2010 audits by the CMS Central Office Representatives, Deputy Administrator and Center for Medicare Director Jonathan Blum gave a presentation to the health plans in attendance.

Blum, who we have posted about in the past, made several key points, with the most interesting being his comments on marketing materials (CMS will be closely monitoring them to ensure accuracy and honesty) and on the change in way CMS interacts with health plans (in reaction to comments from some plans on feeling that CMS has greatly changed the way it interacts and partners with them, he confirmed that yes, there has been a change and that it is intentional). Additionally, he covered a wide-range of topics, including:

• Enrollment
• Surveillance Activities
• 2011 Selling Season
• Health Reform and the Affordable Care Act (ACA)
• Plan Sponsor's Responsibilities
• Plan Risk and protection of beneficiaries
• CMS Communication to beneficiaries 

From Merrill Corp's perspective, we commend the director's statements and feel that is in parallel with Merrill's philosophy on compliance-driven communications. In the coming weeks, we will dive deeper into these discussion points and provide insight on how Merrill Corp can assist with the upcoming changes.

Notes from the CMS Fall 2010 Conference

Whew!

The Merrill Healthcare Team just wrapped up attending the CMS Fall 2010 Conference in sunny Baltimore and in addition to an excellent crab cake (ok...crab cakes 'cause who can eat just one!) what great information about all things healthcare! While all the speakers were great, the highlight of the conference was the opportunity to listen to newly appointed Director of CMS, Jonathan Blum.

Among the many topics covered at this conference were:

~ Enrollment Policy / Operations and Part D IRMAA

~ End of year transitions and MARx Activity & Enhancements with MARx Redesign & Modernization Overview

~ Customer Service Monitoring

~ Mandatory Compliance Programs

~ 2010 Marketing Guidelines & AEP Surveillance

A common theme that emerged across these presentations underscored the continual state of change we as Healthcare communicators will be dealing with well beyond 2014. Additionally, compliance-driven communications and CMS oversights will continue to challenge us in our member communications. Increased marketing surveillance and auditing are here to stay!

As we continue to grasp and operationalize the information gained, the Merrill platform for member and prospect communications will continue to set our customers apart; both to CMS and to their members.

More detailed information to come once I get a chance to digest everything I learned this week!

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

CMS's Recent Rulings

On June 4 of this year, the Center for Medicare and Medicaid Services (CMS) issued the third and final chapter of the Medicare Marketing Guidelines. Over the next couple weeks, we will be telling you more about these changes, who they affect and how those people are affected.

Some of the more interesting and notable changes include requirements for plan sponsors with non-English speaking populations and populations with special needs. For example, a new ruling states that ID cards for Medicare Beneficiaries are excluded from translation requirements and only need to be produced in English. Additionally, the new guidelines state:

“Plan sponsors must make their marketing materials available in any language that is the primary language of more than ten percent of a plan sponsor’s service area. Additionally, plan sponsors must place translated versions of these materials on the plan’s website. Also, all plan sponsors’ call centers must be able to accommodate non-English speaking/reading beneficiaries. Plan sponsors must have appropriate interpreter services available to call center personnel to answer questions from non-English speaking beneficiaries.”

The role of social networking has been in constant debate regarding healthcare and pharma companies recently with regards to how companies can use sites like Facebook, LinkedIn and Twitter to market their products. Now, CMS will allow plan sponsors to market their products via social networking websites, but CMS will carefully monitor use of social networking sites to inform potential future revisions to this policy.

Good News About a Bad Virus

Everybody loves good news, so it should bring a smile to your face when you find out that the World Health Organization has downgraded the H1N1 virus from a pandemic. The H1N1 virus is a new strain of the seasonal flu that grew into a pandemic last year. People rushed to get vaccinated and fears of vaccinations running out frequently made news headlines, but although it is no longer a pandemic, it is still present.

More good news is that most people are now immune to H1N1 which is the reason for the downgrade from pandemic. This year, the H1N1 virus and flu season are fast approaching again and many lessons have been learned from last year’s H1N1 pandemic. They include: receiving vaccinations, staying home when sick, appropriate washing of hands and covering your cough. With these four simple principles applied, last year’s big news story appears for all intensive purposes to be in control for this flu season.

The media and those associated with the dissemination of information regarding H1N1 should be commended. Because of the attention given to this topic as to its causes, symptoms and treatments, a large portion of the population were able to make the proper adjustments and take the appropriate precautions, which has led to a less anxious-driven flu season for this year. The next phase is keeping the topic in people's minds without using scare tactics because despite its demotion from a pandemic, it has not been banished from existence.

Healthcare Facts vs. Healthcare Opinions: Which is winning?

Knowledge is power, right? How much do you know about the new healthcare law? Have you heard that it will cut Medicare benefits for seniors, decrease payments to doctors and ration healthcare?

You may have, but it’s not true. In a recent poll, high percentages of Americans expressed that they believe the above three actions to be true. Even half of those surveyed believed in the death panel myth, the idea that these panels could make end-of-life decisions.

While some would say that these poll results bring to light the influence some members of the media have in presenting opinions as facts, the larger point is that this current method of information dissemination could lead to people not being able to take full advantage of benefits that exist and could help them.

As marketing communications experts, and in an attempt to aid both the general public and those healthcare organizations that want to provide a true list, we would like to do our part in making clear what new benefits exist. More information on these facts can be found on the Department of Health and Human Services website.

• Young adults who lack coverage can remain on their parents’ plan until they turn 26.
• Approximately four million small businesses are eligible for tax credits of up to 35 percent off their health insurance costs.
• People can get tests such as mammograms or colonoscopies without having to pay a share of the cost.
• People who have pre-existing conditions or are uninsured for at least six months can get high-risk coverage through a state or federal high-risk pool.

We know that an issue this big will never be apolitical (especially in an election year), nor should it necessarily be in a free society. However, as the September triggers approach, it will be to the benefit of healthcare organizations that have knowledge in this arena to lead (not sway) the public through the complexity of this issue.

HHS Strengthens Health Information Privacy and Security through New Rules

“To improve the health of individuals and communities, health information must be available to those making critical decisions, including individuals and their caregivers. While health information technology will help America move its health care system forward, the privacy and security of personal health data is at the core of all our work.”

--U.S. Health and Human Services Secretary Kathleen Sebelius

On July 8, Secretary Sebelius announced important new rules to strengthen the Health Insurance Portability and Accountability Act of 1996 (HIPAA), improve the privacy of health information and help all Americans understand their rights and the resources available to safeguard their personal health data.

In short, the proposed rule would strengthen and expand enforcement by:

• Expanding individuals’ rights to access their information and to restrict certain types of disclosures of protected health information to health plans;
• Requiring business associates of HIPAA-covered entities to be under most of the same rules as the covered entities;
• Setting new limitations on the use and disclosure of protected health information for marketing and fundraising; and
• Prohibiting the sale of protected health information without patient authorization.
  

“The benefits of health IT can only be fully realized if patients and providers are confident that electronic health information is kept private and secure at all times,” said Georgina Verdugo, Office for Civil Rights director at HHS. “This proposed rule strengthens the privacy and security of health information, and is an integral piece of the administration’s efforts to broaden the use of health information technology in health care today.”

In addition, HHS also launched a privacy website to help visitors easily access information about existing HHS privacy efforts and the policies supporting them. The site emphasizes the deep commitment to privacy in the collection, use and exchange of personally identifiable information. This new resource provides Americans with confidence that their personal information is secure and underscores HHS’ goal of greater openness and transparency in government.

For more information about the new rule, click HERE.

For other HHS Recovery Act programs, click HERE.

Dr. Berwick: New Admin of CMS

At Merrill Corp., we like change. We like it because we see it as an opportunity to grow, to expand and to better provide our services for our clients in newer and more efficient ways because as the winds of change blow, we embrace the new direction of travel.

The latest winds have brought Dr. Donald Berwick to serve as the Administrator of the Centers for Medicare & Medicaid Services (CMS) through a recess appointment. A “recess appointment” means that the president is putting Berwick in place while Congress is not in session, therefore bypassing the Senate confirmation process (an act that is both legal and surrounded in precedent).

While the recess appointment has generated much debate, the current administration feels there is no time for delays in Dr. Berwick’s appointment, especially with health reform in full on-boarding mode. Dr. Berwick’s appointment is supported by AARP, three prior directors of the CMS, and American Association of Family Physicians, the American Medical Association, and the American Hospital Association.

The hiring of Dr. Berwick shows the importance the administration is placing on health reform. “With the agency facing new responsibilities to protect seniors’ care under the Affordable Care Act, there’s no time to waste with Washington game-playing,” stated a White House Spokesperson.

While the administration is placing great importance on health reform, we are making sure to embrace the change and use it to better provide for our clients. As organizations look for ways to strengthen and improve communications to their membership, they will turn to vendors who remain informed and stand out as progressive thought leaders. We welcome Dr. Berwick and are excited to see what changes come about from his new position.

Will Healthcare Reform Lead to Improved Marketing Communications?

As expected, the Healthcare Reform package has triggered the tightening of CMS regulations and disclaimer notations in the 2011 Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) documents for Medicare Part C and Part D plan sponsors. Plans must adhere to these changes and not modify these standardized documents except as noted in the instructions and allowed by CMS.

These changes to the ANOC/EOC are just the tip of the iceberg, as mandated communications are predicted to become more prevalent and standardized with the passing of Healthcare Reform. Plans will need to evaluate how they’re positioned to manage these required communications. Does your data to produce the communications come from disparate sources? Do you have adequate staffing to handle the increased workload? Does your organization have access to the approved templates? What happens if your membership dramatically increases?

With regulatory bodies vowing to closely monitor the accuracy of these communications, Merrill Corporation sees this as an opportunity for organizations to reconsider their marketing communications strategies. Identifying a partner who can help streamline the execution of these mandated communications, ensuring accuracy, timeliness and adherence is a necessity for success. Merrill is equipped with the latest ANOC/EOC templates, and our unique knowledge of the evolving regulations will provide your organization with 100% compliant communications.

2011 Marketing Regulations from the Center for Medicare & Medicaid Services

Whether you are in the military or business world, to be a leader, you must know how to adapt to change.

Many marketing communications firms will be tested on this trait with the recently published 2011 marketing regulations from the Center for Medicare & Medicaid Services (CMS). In the document, it lists a number of important changes, many of which will directly affect how organizations develop their documents. Some of the notable differences include:

1. The Summary of Benefits will be part of the required materials for the enrollment kit starting in OEP 2010.
2. There will be clarification of current plan mailing statements and the addition of a new mailing statement for non-health, non-plan information. Also, there is a new requirement for the inclusion of the plan name or logo on every mailing to beneficiaries.
3. There will be clarification of requirements for plan sponsors with non-English speaking or special needs populations.
4. You can expect significantly restructured and consolidated disclaimer requirements.
5. Clarification of requirements for provider and pharmacy directory mailings, specifically regarding multiple people living at the same address.
   

Knowing what the changes are is only one part. How those changes are addressed is what sets marketing communications firms apart. For example:

1. Because healthcare organizations will need to address these new realities effective immediately, organizations need a partner organization that has proven that they can address changes seamlessly.
2. The Summary of Benefits change affects 2010 Enrollment Kits that we produce today. We understand this and are fully prepared to accommodate the recent changes.
3. Creating a translation service from scratch is timely. However, certain firms already offer a translation service for the non-English speaking population and can be serviced in the same quality, professional manner as our English speaking clients.
4. Restructured and consolidated disclaimers along with new mailing requirements for provider and pharmacy directories are dramatic changes for the 2011 enrollment period. Some communications firms know this, while others need to be told. This is an important difference.
   

For more information, you can read the final CY 2011 Medicare Marketing Guidelines that are posted at: www.cms.hhs.gov/ManagedCareMarketing

The CMS / CGI Partnership

The contract that most sports enthusiasts are pondering this summer is that of Lebron James. However, if you are interested in the healthcare / web development equivalent of this question you need not wait any longer.

This week, the Centers for Medicare and Medicaid Services (CMS) announced that it has awarded CGI Federal, Inc. a five-year, $73.2 million contract to redevelop three of their websites that enable Medicare beneficiaries to find information about their healthcare programs.

The three sites - www.medicare.gov, www.cms.hhs.gov and www.Mymedicare.gov - provides information for 44 million beneficiaries and receives a total of 500 million views a year. The sites are primarily focused on allowing consumers to view health claims information, compare health and drug plans based on quality measures and estimated costs, and create a report listing information that they can share with their healthcare providers. As an example of the importance HHS puts on the ability to navigate the site, the following video was released involving Secretary Sebelius walking viewers through the Medicare.gov:



The execution of this contract will be an extremely interesting task. It has been well documented that a large chunk of the healthcare reform package will be enacted and implemented over this period of time, and as new regulations are developed on items such as the role of social media, these three websites will have to be well managed.

CGI and CMS have had a long standing and successful collaboration, including projects like the Hospital Compare and Nursing Home Compare tools, which combine geographical data from Google Maps with healthcare provider quality-of-care information to help users locate and assess nearby healthcare facilities. Additionally, CGI was awarded the Enterprise System Development (ESD) contract, which covers systems development and integration, system and application engineering and technical support to improve the automated systems and agency-wide applications of the Health and Human Services Department.

However, this project will involve developing tools for the public at large, not a subset of experts in the industry. It is a different mode of thinking, but the potential is there for a new evolution of internet communication.

The 411 on Form 990

February is the perfect time to make predictions for the year, but trying to make predictions on the healthcare industry, even month-to-month, for 2010 is best defined as difficult. However, that didn’t stop people from trying.

McDermott Will & Emery’s Stephen Bernstein was one of many that took a stab with his “Top 10 health law issues for 2010” article, outlining his thoughts on what the buzz-topics of the year would be. Among many of the obvious subjects, he mentioned a very specific administrative function, which is Schedule H for Form 990 and how it relates to hospitals. He explained it this way:

Tax-exempt hospitals must, for the first time, fully complete Schedule H to Form 990 when filing their 2009 tax returns. Schedule H requests disclosure of each hospital’s community building activities, bad debt expenses, Medicare-shortfall and debt-collection practices, arrangements with management companies, participation in joint ventures, and level of charity care and other community benefits. In addition to these data, Schedule H also requests supplemental information in narrative form, including descriptions of how the hospital assesses the needs of its community, informs patients of their eligibility for charity care, and uses community building activities to promote the health of its service area. While many hospitals used last year’s filings as “practice” for Schedule H’s data portions, few prepared sample responses to its narrative portions.

In addition to learning about the ins-and-outs of Schedule H, tax-exempt hospitals must also fully complete Form 990's Schedule K. Schedule K, which requests additional information on tax-exempt bonds, including disclosure of private business use.

All of this information compiled by Schedule H and Schedule K, because of the way it is being filed, will eventually be subject to public disclosure and the media. While there will be a lag of about a year in being made public, hospitals should be consulting now with outside organizations on how to properly compile this information for the federal government.

While this issue isn’t as heart-pounding as others in healthcare, what can’t be denied is that an economy that is in the midst of recovery, combined with a large-scale healthcare reform, creates a scenario in which every ounce of efficiency has to be identified, and while we are still in the beginning stages of this new process, there is potential to learn a great deal from the information that will now be shared via these new mechanisms. The immediate reaction is to assume that this will be used as source material for negative investigations, but through this process, we may also be able to create an upgraded business model and examples of best practices for hospital administration.

The Breach Notification Rule

On September 23, 2009, Section 164.408 of the breach notification interim final rule became effective, which implements section 13402(e)(3) of the HITECH Act.

If you are reading this blog, chances are you know what this means. However, if you don't necessarily know the ins and outs of the regulations, this section requires covered entities to provide notification of breaches of unsecured protected health information directly to the Secretary of HHS.

More importantly, breaches that affect 500 or more individuals must be reported to HHS within sixty days and covered entities must provide this notification via the online form on the Office for Civil Rights (OCR) website. (Note - A covered entity is any health plan or company who transmits health information, this includes Merrill Corp.) By posting this information on the HHS website, OCR has met its HITECH Act obligation of making this information public. The list of the covered entities that have reported such breaches, along with other relevant information about each breach, is consistently updated and available here.

This new rule is just another example of the tightening regulations affecting the healthcare industry as HHS, CMS and other regulatory bodies continue to focus on data management. Because of this increasing regulation, health plans are going to need and experienced partner- like Merrill- now, more than ever before.

Merrill is uniquely positioned to help health plans remain compliant in the execution of their member communications. While our compliance-driven message is new to the industry, it is one that has been resonating.

For more information on this regulation, visit the OCR website, and also, continue to visit this blog as I continue my ongoing research to offer new insight into the inner workings of the Health Reform and the future of the healthcare industry.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

News from the World Healthcare Congress

Among the many announcements made at the 7th Annual World Healthcare Congress, acting director of the Center for Drug and Health Plan Choice Jonathan Blum was introduced as the new Policy Director for the Centers for Medicare and Medicaid, reporting directly to HHS Secretary Kathleen Sebillius.

In his presentation, Jonathan made several key statements:

• On the Medicare side, CMS will take the lead in payment reform and quality improvement measures, stressing a desire to partner with State Medicaid and Private Payers to reduce cost, improve quality outcomes, and maximize available dollars.
  
• His first priorities are dealing with Part D, where the "donut hole" will be closed in a ten year period.
• CMS is also looking to contract for discounts. Changes to payments for Medicare Advantage (MA) plans will occur and have basis of payment on quality and outcomes in 2012. When plans have an increase in their quality rating and elevate outcomes, they will receive a reward of higher payments.
• The CMS Center for Innovations has been established to open in January 2011 with funding of $10 million. They are planning on creating an Accountable Care Organization (ACO) policy for Medicare Programs, Pay for Performance Systems (PPS) for hospitals. However, bundled payment will take more time. With the Center for Innovations, CMS now has the authority to take successful demonstration projects from inception to reality without having to return to Congress for approval. For unsuccessful projects, there will still be valuable information learned.
• Next steps for MA include streamlining the process for beneficiaries, developing best-care models (with an emphasis on coordination of care for members), and creating better quality and more competitive plans.
• There has not been a substantial change in the number of PFFS plans leaving the market place, however, there is an all-time high of beneficiary satisfaction in their MA plans and are increasing their request of geographical areas.
• Fraud and abuse continue to be a huge area for CMS and will continue to be addressed.
  

Jonathan clearly has both the credentials and contacts to be successful in his new role, and his remarks indicate that he has a firm grasp on the process to develop and implement many of the new regulations that will be addressed in the upcoming months and years.

CMS Releases 2011 Draft Medicare Marketing Guidelines

As a follow-up to our blog on the CMS 2011 Call Letter draft, a draft of the 2011 Medicare Marketing Guidelines has also been released. The summary of significant changes included within are as follows:

Summary of Significant Changes

• Clarified guidance related to requirements for plan sponsors with non-English speaking or special needs populations (section 30.7).
• Added guidance related to material status and date stamp for file & use materials (section 40.1).
• Clarified guidance related to customer service hours of operation requirements and added a new section on agent/broker customer service number requirements (sections 40.11 and 40.11.1).
• Significantly restructured and consolidated disclaimer requirements (section 50).
• Clarified and restructured guidance related to advertising/explanatory marketing requirements (sections 50.1 and 50.1.1).
• Clarified plan mailing statements (section 50.2; formerly section 50.6).
• Clarified the responsibility for the summary of benefits review on the comprehensive statement in section 4 regarding accuracy of SNP benefits (section 60.1).
• Clarified guidance related to provider and pharmacy directory mailing requirements (sections 60.4.1 and 60.4.2).
• Clarified that door hangings are considered unsolicited contacts (section 70.4).
• Revised our policy with regard to outbound enrollment verification (OEV) requirements, including applicability of OEV requirements to enrollment changes within organizations and to agents when acting as customer service representatives only, operational timeframes, and guidance on recording and retaining verification calls. We also added Medicare Medical Savings Account OEV requirements to this section (sections 70.6 & 70.6.1).
• Restructured and revised guidance regarding educational events and sales/marketing events to encompass relevant topics or examples from current Guidelines sections 70.7.1-70.8.3 (sections 70.7 and 70.8; formerly 70.8 and 70.9).
• Added guidance on resubmitting previously disapproved marketing pieces (section 90.4).
• Revised the submission of template materials (section 90.10).
• Extended website requirements to Part C organizations and to social networking sites (section 100.1).
• Added requirements regarding the prohibition of charging additional marketing fees (section 120.5.4.1).
• Added and clarified requirements with respect to the charge back for agents and brokers (section 120.5.6).
• Clarified that the Medicare Mark will be incorporated in the contract management module in HPMS and that further guidance will be forthcoming as part of the annual contracting process (section 150).
• Added previously released policy guidance on the use of Federal funds and the use of Medicare beneficiary information obtained from CMS requirements (sections 160 and 170).
  

If you would like more information on the guidelines, click HERE (as a note, at the time of this blog, the CMS website was being updated).

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Communicating the Healthcare Reform Bill

As a continuation on the brief synopsis we supplied on last week’s blog on the Healthcare Reform Bill, we wanted to share some additional components of the law, but also share ideas on how to convey the information to the public.

There have literally been thousands of articles written over the past week on different aspects of the legislation. I've been reading many of them for both personal and professional reasons to learn about the law, review the different opinions, and most importantly, research the best ways to communicate it. I found that this one which discusses the most well-known changes that will take effect either immediately or eventually, as well as a brief description on some of the lesser known components of the bill, including:

Transparency in Insurance Companies

• Insurers must now reveal how much money is spent on overhead

New Insurance Plans must include Preventative Care

• New plans must cover checkups and other preventative care without co-pays. All plans will be affected by 2018

Deductions for non-profit organizations

• Non-profit organizations will be required to maintain a medical loss ratio -- money spent on procedures over money incoming -- of 85 percent or higher to take advantage of IRS tax benefits

Encouraging Investment in New Therapies

• A two year temporary credit (up to a maximum of $1 billion) is in the bill to encourage investment in new therapies for the prevention and treatment of diseases

Strengthened Fraud and Abuse Checks

• New screening procedures will be implemented to help eliminate health insurance fraud and waste

Medicare Expansion to Rural Areas

• Medicare payment protections will be extended to small rural hospitals and other health care facilities that have a small number of Medicare patients

Customer Appeals Process

• Any new plan must now implement an appeals process for coverage determinations and claims

Of the many articles I’ve read, this is an example of one that not only presents the key information that different segments of the population need to know (with the potential to expand on it in the future), but as a communications professional, an example of method that organizations should consider when developing their own collateral on behalf of their clients.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

An Unbiased Look at Healthcare Reform

No matter which side of the issue you are on, there is no denying that March 23rd, 2010 will go down as a notable day in the annals of the United States with the signing into law of the Healthcare Reform bill. Numerous presidents and legislators throughout history had made attempts at addressing this issue, and while many may still be wondering “what just happened?” it is clear that much change is on the horizon.

A number of people have a number of questions on how this bill will affect them, and while different changes will happen at different times, we have broken down the changes into two categories:

Changes forthcoming for 2010:

No annual caps or limits
No rejections based on pre-existing conditions
Young adults covered to age 26 on parent’s policy
Drug discounts for seniors
Tax breaks for small businesses

Changes that will occur by 2014:

Health Insurance Exchange
No discrimination allowed
Tax breaks for consumers
Medicaid expansion to include childless adults

There will be much debate to ponder over in the upcoming weeks, months and years. Time will advise us of the pro's and con's established within this piece of legislation. Let's always remember change is not easy but with change there is opportunity.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

CMS Releases 2011 Draft Call Letter

The CMS 2011 Call Letter has a completely different look and feel this year. It is much shorter in both length and scope in how to direct plans and organizations to details with the Medicare Manuals for regulatory guidance and compliance factors.

Highlights of provisions in the Call Letter include:

• Announcements of a combined calendar listing with side-by-side key dates and timelines applicable to MA, MA-PD, Part D and cost-based plans. The calendar contains important operational dates for plans, such as the date that CMS will begin accepting bids, dates for non-renewing plans, and dates for beneficiary mailings.

• A provision encouraging sponsor practices to curb waste of unused drugs dispensed in the retail setting, information about reassignment, information about the release of data, information on the Medicare Enrollment Assistance Demonstration, and information on potential new B versus D coverage determination for beneficiaries with ESRD.

Jonathan Blum, Acting Director, Center for Drug and Health Plan Choice, writes this as a synopsis of the draft:

Attachment VI provides the draft CY 2011 Call Letter for Medicare Advantage (MA) organizations (MAOs); section 1876 cost-based contractors; prescription drug plan (PDP) sponsors; demonstrations; Programs of All-Inclusive Care for the Elderly (PACE) organizations; and employer and union-sponsored group plans, including employer/union-only group waiver plans (EGWPs). The Call Letter contains information these plan sponsor organizations will find useful as they prepare their bids for the new contract year.

The Advance Notice/Call Letter has been drafted assuming current law. If new legislation is enacted after this Notice is released and before the April Rate Announcement is published, CMS will incorporate changes in the Rate Announcement.

This is not the only CMS draft that has changes. Next week, we will review the 2011 Medicare Marketing Guidelines.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Will Rearranging CMS Spell Anything New?

With healthcare legislation news taking prominence over the past several weeks, buried in the news has been s the very important announcement of the reorganization of the Center for Medicare & Medicaid Services in the upcoming months.

The headline has been the naming of former Virginia Secretary of HHS Marilyn Tavenner as the first principal deputy administrator for CMS, a position that has been defined as the second highest position within the agency. Members of the medical community, such as the American Health Care Association have commended the selection of Ms. Tavenner, not only because of her experience within former Governor Kaine’s cabinet, but also for her 25 years working for the Hospital Corporation of America (HCA), as well as working her way up from staff nurse to CEO of Johnston-Willis Hospital.

In addition to the creation of this new post, the decision has been made to merge several of the CMS offices:

• The Center for Medicaid and State Operations will be renamed the Center for Medicaid, CHIP and Survey & Certification, and it will be led by CMS Deputy Administrator Cindy Mann.
• The Center for Strategic Planning will realign the Office of Research, Development and Information with the Office of Policy.
  
• The Office of External Affairs and Beneficiary Services will realign the Office of Beneficiary Information Services with the Office of External Affairs.

To comment on these changes before they have had the opportunity to be integrated would be irresponsible, but history tells us that a streamlining of this caliber has the opportunity to be either significantly efficient or potentially dangerous. Approximately 98 million people rely on CMS’s 4,400 employees for assistance with their Medicare, Medicaid or the Children’s Health Insurance Program (CHIP), so above all else, this reorganization must be done with a communications strategy in place which will allow all customers to know how the process will affect them and all staff members to know what their new responsibilities will be.

The Real Debate in D.C. (Part 2)

Last week, we discussed the difference between the Bipartisan Summit and other, less publicized but more comprehensive events, such as the Managed Healthcare Business Forum.

As a follow-up, let's talk about some of the outcomes. There has been a great deal of coverage on the event with elected officials, but none on the other. So, here is first-hand account on some of the key topics discussed:

Health Reform: The discussions were much like what was happening across town. What are the next steps? Where do we go from here? What should we expect from our regulatory bodies and the current administration? The truth is that much is known and yet unknown at this point. It is expected by most that some type of health reform will be developed this year. However, the size, scale and price tag remain a mystery.

Streamlining Cost and Quality of Care: Cost reductions and the management of costs are at the forefront of all discussions. Being creative is essential, thus newer ways to incent (i.e. work with) providers are emerging, such as payment programs and quality metrics to determine performance within their patient base and to their peers. Most would see this as the old standard capitation methodology with a twist. However, when you delve deeper, you can see the potential cost savings and the new horizon for quality metrics reporting, monitoring and performance.

Health and Wellness of the Membership Base / Moving Health and Wellness to the Next Level: Health and wellness of our membership continues to be a key to any solution worth implementing, and therefore new ways to carve out components of our membership and incent them to actively participate in wellness campaigns is on the horizon more so now than ever before. There are two basic reasons:

1. To enhance/improve a members overall quality of life.
2. To streamline/enhance cost savings.
   

Examples of ways to accomplish this were discussed, including how to develop customized, well-rounded plans that would allow individuals to potentially lower their premium costs if utilized. So, if a member had diabetes, they would be in a plan specifically designed for them with tailored programs to facilitate education, wellness, and healthy lifestyle habits that would not only benefit them, but in a small way, help the industry become more efficient.

Service: This concept continues to be a major separator in the playing field. While price and benefits continue to be the top components, service is a close second. With a competitive price in the market place, service will be the key component that separates plans. Members are looking for "first call resolution" (as opposed to be being transferred multiple times) and a one-stop shop for answers. Those that can perfect (or come closest to) a model in which a single phone number can result in a live body that can handle all their needs will have a leg-up on competitors.

The event provided all that attended with an abundance of information, with the added benefit of zero television cameras, so ideas could be shared without 'post-event wrap-up commentary.' The next step is the hardest, though. We need to take these ideas and philosophies back to our respective corners of the world and turn them into solutions.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.