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.

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.

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.

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).

---------------------------------------------------------------------------------


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.

----------------------------------------------------------------------------------

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.

Medicare & Medicaid: Reduce Costs Through Quality of Information Part 1 of 4

CMS does a good job in many things, and keeping an eye on quality of information disseminated is one.

Their guidelines layout four buckets of review:

1. Utility
2. Objectivity
3. Integrity
4. Transparency and Reproducibility

There are key points to each guideline. Here's a glance at Part I.

Utility

Information is consistently tested with focus groups and should be developed in a collaborative process involving providers, consumers, academicians, and policy analysts

CMS stays active by developing special reports and topical studies that address emerging information needs (email, mobile, social, PDF documentation) that comes from proposed legislative changes and policy debates.

Having these guidelines helps Insurance providers in developing their communications. Moreover, having partners and suppliers throughout the communications chain that respect and understand their intent delivers results for the Medicare and Medicaid system. 

A knowledgeable communications chain from creation to production and dissemination, will ensure that information can be utilized across media and that costs can come out of the system at every step in the process.

-------------------------------------------------------------------------------------------

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.

Measuring Health Care

At-a-glance:

From The Common Wealth Fund, an interactive map/scorecard on quality of Health care across the US (click here).

-------------------------------------------------------------------------------------------

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 Audits Aim For “Real Time” Reviews

In years past, the norm for CMS has always been to conduct retrospective audits – essentially a review of data from prior months’ (EX. CMS would arrive at the plan in October to review data from January through June).

Audits were primarily focused their efforts on universe pulls and standard operating procedures along with any known escalated events that came through their jurisdiction such as CTMs.

Moving forward CMS will be conducting audits of plans on a more "real time" basis. They are conducting more "focused" audits and they are keeping a tight view of all plan CTMs and their occurrences.

Also, MA plans are now directed to report more in-depth information to CMS beginning with HEDIS and other metrics. With this increased scrutiny of plans and Medicare Improvements for Patients and Providers Act's arrival in 2008, the theme of tighter monitoring continues to resonate throughout regulation for 2010.

As such, better procedures and business processes are no longer discussion points, but key elements in maintaining quality and compliance (see: The 2010 Call Letter, Marketing Guidelines, and Enrollment and Dis-enrollment Guidance).

As with any guidance and changes from CMS, the first step is indentifying what’s new, then moving forward with an analysis of how it will change your business; what it could add, change or remove for your processes.

-------------------------------------------------------------------------------------------------
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.

2010 Marketing Guidelines Could Improve Communications

With the recently released 2010 CMS Marketing Guidelines, and the current AHIP conference, here’s one of guidelines that caught my eye: 

All plan sponsors that mail information to Medicare beneficiaries, prospective or enrolled, should include one of the three statements on any envelope or the mailing itself (if no envelope is being sent) that they are sending to Medicare beneficiaries regardless of the materials inside of the envelope. One of the three statements on the outside of the envelope or mailing itself should best fit the information being sent to the Medicare beneficiary which are:

1. Advertising pieces – "This is an advertisement;"

2. Plan information – "Important plan information about your enrollment; and

3. Health – "Health or wellness or prevention information."

On the surface, this sounds like an increase in cost. We’re confident that some planning can avoid that, and perhaps even create a way to reduce costs in the overall mailing piece, or improve the overall communication with prospects and enrollees.

I’m looking forward to continuing to discuss this and other CMS rulings throughout the week.

Note: The specific part of the guidelines referenced is section 50.6 - Plan Sponsor Mailing Statements on Envelopes/Mailing Itself.  ------------------------------------------------------------------------------------------------- 

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.