Archive
I. Conference Call Information
Next Medicare Conference Call on May 17: “Reflect and Project”
II. In the News
Medicare Trustees Release 2006 Annual Report
GAO Report Calls for Improved Part D Communications
Kentucky and West Virginia are First to Implement DRA Reforms
III. Helpful Information
HAP Suggests Medicare & You Handbook Revisions
CMS Releases Contingency Plan Guidance for May 15 Deadline
CMS Releases Guidance to Address Facilitated Enrollment Problems
CMS Posts Additional Plan Enrollment Data
CMS Issues New Resources on Withholding Premiums from Social Security Payments
CMS Moves to Replace Carriers and FIs with MACs
I. Conference Call Information
Next Medicare Conference Call on May 17: “Reflect and Project”
The next Medicare Network Conference Call, Reflect and Project, is scheduled for Wednesday, May 17, at 3:00 p.m. EDT. The Part D coordinated Annual and Initial Enrollment Periods are ending. Now is the time to take a deep breath and think about what we have learned over the past months and how to apply that knowledge to our plans for the future. Join us for our next monthly call where we will discuss our past experiences and strategies for next steps.
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II. In the News
Medicare Trustees Release 2006 Annual Report
On May 1, the Department of Health & Human Services (HHS) announced the release of the 2006 Medicare Trustees Annual Report. Compared to the 2005 financial estimate, this year's fiscal projections for Medicare trust fund solvency declined somewhat, largely due to a predicted rise in spending. For more information, please see the full report. HAP is in the process of writing a review of the report. It will be available next week.
GAO Report Calls for Improved Part D Communications
The General Accountability Office (GAO) released a report on Wednesday, May 3, about the quality of CMS’s communications on the Part D drug benefit. The GAO studied CMS’s written communications, responses by customer service representatives at the 1-800-MEDICARE call centers, Part D sections on Medicare’s web site, and how CMS used SHIPs to respond to beneficiary needs concerning Part D.
Based on a review of six CMS documents, including section 6 of the Medicare & You handbook, the GAO found that the written materials were mostly complete and accurate but that they lacked clarity. It found that the reading levels for the documents ranged from the seventh grade to post-college. Meanwhile, forty percent of seniors read at or below the fifth-grade level. Additionally, the documents did not comply with about half of the common guidelines for good communication. The GAO observed that “the documents used too much technical jargon and often did not define difficult terms, such as formulary.”
The study also found that the customer service representatives (CSR) responded accurately to the 500 calls that GAO placed to 1-800-MEDICARE about two-thirds of the time. The CSR accuracy rate ranged from 41 percent for responses to calls about the drug plan that would cost the least, to 90 percent to calls about beneficiaries’ eligibility for the extra help program. The study found, too, that call waiting times varied considerably, from no wait time to over 55 minutes. The wait time was less than five minutes for 75 percent of the calls. The GAO made its 500 calls to 1-800-MEDICARE in January and February.
As to the SHIPs, the GAO reported that service levels increased dramatically due to Part D induced demand, and that the average number of calls referred from 1-800-MEDICARE “has increased significantly.” It found that the monthly average number of calls referred to SHIPs increased from 16,000 for the period between May and September 2005, to nearly 43,000 for October and November. The GAO looked especially at the five states with the largest beneficiary populations, and thus interviewed state SHIP staff in California, Florida, New York, Texas and Pennsylvania.
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Kentucky and West Virginia are First to Implement DRA Reforms
CMS announced on Wednesday, May 3, that two states--Kentucky and West Virginia--will be the first in the nation to implement programs under the Deficit Reduction Act of 2005 (DRA) for some of their Medicaid enrollees. According to a Department of Health & Human Services (HHS) press release, Kentucky will offer different “benefit packages” to meet the health care needs of three groups: children, the elderly and people with disabilities who need institutional care, and the general Medicaid population. CMS Administrator Mark McClellan said, “Kentucky is the first state to completely redesign their program to give people access to affordable care that better reflects their own health needs and preferences, such as living in the home and community.”
West Virginia’s redesigned Medicaid program will target healthy children and adults, offering enrollees a choice of two benefit packages. These include a “basic” plan based on the state’s current Medicaid services, and an “enhanced” plan that includes new benefits such as tobacco cessation and nutritional education. To qualify for the enhanced plan, the state will ask enrollees to agree in writing to “comply with all recommended medical treatment and wellness behaviors.”
III. Helpful Information
HAP Suggests Medicare & You Handbook Revisions
In response to a request for suggestions to improve the Medicare & You 2007 handbook, HAP submitted comments on May 2 to CMS from the view point of a counselor and educator. HAP urged CMS to more prominently and frequently refer to how SHIPs can help Medicare beneficiaries, along with the suggestion to add references to the SHIPs and their contact information in each section of the handbook. HAP also recommended that CMS change its definition of SHIPs to more accurately reflect SHIP’s mission as set forth in the law that created the program. For more information on HAP’s comments, please contact Hilary Dalin at hdalin@healthassistancepartnership.org.
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CMS Postings
CMS Releases Contingency Plan Guidance for May 15 Deadline
On May 2, Gary Bailey, Center for Beneficiary Choices Deputy Director, sent a memo to Part D plans detailing how the May 15, 2006 Initial Enrollment Period deadline will work and the preparations plans should make to accommodate beneficiaries who enroll as the deadline approaches. As part of two temporary policy changes, CMS will expect plans to 1) accept all mailed applications postmarked on or before May 15, and 2) consider incomplete applications received by May 15 to be complete. Also, plans will be required to accept all beneficiary enrollment requests through midnight on May 15. As such, plans will need to make sure that their call centers are sufficiently staffed and their website capacity is adequate to meet the expected increase in call volume and website traffic.
CMS Releases Guidance to Address Facilitated Enrollment Problems
On May 2, Anthony J. Culotta, Director of Medicare’s enrollment and appeals group, dispatched a memo to Part D plans explaining how to resolve cases where facilitated enrollments have "trumped" a beneficiary’s drug plan election. In most of these cases, CMS says the cause relates to a processing error on the part of the plan and/or CMS. CMS recommends that plans submit enrollment transactions on a "flow basis." Also, in cases where a processing error has occurred, plans must work quickly and efficiently to re-submit the enrollment for the beneficiary. CMS has claimed that MARx processing errors were corrected by March 28, for facilitated enrollment effective May 1.
CMS Posts Additional Plan Enrollment Data
CMS posted additional Part D plan enrollment level information on its Medicare Drug Coverage Enrollment Data web page on May 1. Some of the new data should be helpful to SHIPs and their partners as they assess local outreach and enrollment efforts, as well as each plan’s market share. CMS’s local enrollment data includes enrollment by state for each PDP, and enrollment by county for each MA-PD.
CMS Issues New Resources on Withholding Premiums from Social Security Payments
In response to questions about the options that beneficiaries have for paying their Part D plan premiums and to address recent reports about three-month delays in withholding premiums from Social Security checks, CMS released a question and answer fact sheet last Friday, April 28. The fact sheet first describes the three main options that beneficiaries have for paying their plan premiums. It goes on to answer questions about the normal time frame for Social Security’s automatic deductions to start and what to do when mistakes or other factors further delay the withholding. CMS also posted a model letter that it will use to contact beneficiaries’ whose Social Security payments are too small to cover a two or three month aggregated premium payment.
CMS Moves to Replace Carriers and FIs with MACs
CMS posted on May 3 a Request for Information and the draft Scope of Work (SOW) that it plans to use in its first contract cycle for the new Medicare Administrative Contractors (MAC). MACs will eventually replace the current Part A Fiscal Intermediaries and Part B Carriers, and will process both Part A and Part B claims. CMS seek “reactions and concerns” about the SOW from providers, contractors and other partners. At the same time, CMS reported that it will soon announce the award of the first MAC contract for Jurisdiction 3, an area that comprises Arizona, Montana, North Dakota, South Dakota, Utah and Wyoming. The Medicare Modernization Act requires CMS to replace the FIs and Carriers with new MACs.
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