The HAP staff extends to you and yours our best wishes for a happy holiday season!
I. Conference Call Information
II. In the News
CMS Awards Exclusive $440 Million Call Center Contract to Pearson
Kaiser Report: Few Seniors Intend to Switch Drug Plans This Year
Retiree Drug Coverage Expected to be Stable but More Costly
III. Helpful Information
CMS to Part D Plans: Monitor Inappropriate Marketing Activities
Hospital Discharge Notice and Patient Liability Procedures to Change
Drug Plans Take Steps to Respond to SHIP Concerns
CMS Postings
IV. HAP News and Resources
Three States Embrace Technology to Better Meet Their Needs
HAP Releases Guide to 2007 Medicare Advantage Open Enrollment Period
Conference Call Information
HAP’s next conference call for SHIP staff and their partners will take place on Wednesday, January 17, at 3:00 p.m. EST. Look for details about the conference call in an email alert that we will send a few days before the call.
In the News
CMS Awards Exclusive $440 Million Call Center Contract to Pearson
Pearson Government Solutions announced on November 16 that CMS awarded it a $440 million contract to manage the Beneficiary Contact Center program over a two and a half year period. The contract provides that the company will manage all the calls coming into the 1-800-MEDICARE Help Line, including Medicare claims calls and written correspondence. In handling calls about Medicare claims, Pearson’s Carol Miller clarified that the company’s customer service representatives are instructed to refer callers to the Carriers, Fiscal Intermediaries, Medicare Administrative Contractors (MAC), or providers, as appropriate.
Mary Agnes Laureno, Director of CMS’s Beneficiary Information Resources Group, stated, “We are confident [Pearson] will continue to deliver world class customer assistance to Medicare beneficiaries.” Pearson operates Medicare call centers in the Lawrence, Kansas and Cedar Rapids, Iowa areas.
Kaiser Report: Few Seniors Intend to Switch Drug Plans This Year
The Kaiser Family Foundation (KFF) on December 19 released the results of a survey suggesting that few seniors intend to switch Medicare drug plans during the Annual Enrollment Period which ends on December 31. Only five percent of the survey respondents who belong to Part D plans said that they expected to switch plans for 2007, and only 29 percent said that they are uncertain about switching. The KFF survey results may provide some explanation for the reports from various SHIPs that the number of Part D counseling requests since November 15 has been relatively low.
KFF also found that three in four seniors enrolled in a Part D plan described their experience as positive. At that same time, however, 73 percent of the respondents said that the Medicare drug benefit is “too complicated,” with four in ten saying that there are too many plans available. KFF conducted the survey between November 9 and 19, with a nationally representative sample of seniors.
Retiree Drug Coverage Expected to be Stable but More Costly
Another KFF report created in conjunction with Hewitt Associates, found that 78 percent of large employers surveyed said that they expect to take federal subsidies under Part D to continue providing drug coverage for their retirees in 2007. KFF observed that this “is only a slightly smaller share than the 82 percent of firms that say they accepted the subsidy in 2006, suggesting the subsidies so far are working as an incentive for businesses to maintain retiree drug coverage for Medicare-eligible retirees.”
While the relatively stability of retiree drug coverage perhaps comes as good news for SHIPs and their clients, it is tempered somewhat by KFF’s finding that retirees will most likely pay more for health insurance. As they look ahead to 2007, 64 percent of the large firms surveyed said that they are very likely to raise premiums and 26 percent said they will likely raise cost-sharing amounts.
As their employer-sponsored coverage becomes more expensive, some retirees may seek help from SHIPs to evaluate their coverage in light of other options, including Medicare Advantage plans, stand-alone drug plans, and Medigap insurance. Significantly, KFF reported that 36 percent of the firms accepting the Part D subsidy for 2007 said that retirees would lose all their retiree medical coverage if they enroll in a Medicare drug plan. 82 percent of the firms said that the spouses of retirees could not keep their employer-sponsored health coverage if the retiree opts for a Medicare drug plan. In addition, 57 percent of the firms surveyed would not allow retirees to rejoin the company health plan once they have enrolled in a Medicare drug plan. These findings underscore the need for SHIP counselors to make sure that retirees have all the facts about their group plans before deciding to drop the coverage.
Helpful Information
CMS to Part D Plans: Monitor Inappropriate Marketing Activities
Cynthia Tudor, Director of CMS’s Medicare Drug Benefit Group, and David Lewis, Acting Director of the agency’s Medicare Advantage Group sent a joint memo to Part D and Medicare Advantage plans to call their attention to a number of complaints that CMS has received “concerning inappropriate marketing activities performed by sales agents.” According to CMS, the improper activities include providing incomplete or inaccurate information about plans, failing to ensure that beneficiaries understand plan rules, and requiring face-to-face appointments to obtain plan information.
CMS advised the plans that it is “closely monitoring and tracking complaints related to the activities of sales agents and has begun taking corrective actions as necessary.” The agency did not, however, describe or detail those corrective actions. Neither did it describe the extent of the problem, other than to say that “the number of complaints” warrants that all plans review their guidance to sales agents. CMS reminded the plans that they must conduct monitoring activities to comply with the law and expressed “hope that your proactive measures will reduce the need for CMS to take action against organizations and sponsors for the inappropriate activities of their sales agents.”
The CMS memo comes in the wake of reports from the field that brokers in some parts of the country are churning their client base, for example, by marketing a new company’s MA-PD plans to replace the PDPs they sold last year under another company’s banner.
Hospital Discharge Notice and Patient Liability Procedures to Change
CMS published a final rule on November 27 in which the agency backed off an earlier proposal to align its hospital discharge notice procedures with those in other health care settings by requiring hospitals to issue a generic discharge notice to all patients and a more detailed notice to those who disagree with a discharge decision. Instead, the new rule sets forth a notice procedure that relies on hospitals to provide, explain, and obtain a beneficiary’s signature on an updated Important Message (IM) from Medicare within two days of admission. Subsequently, the hospital is to present a copy of the signed IM to the beneficiary or her representative no more than two days before discharge, except in the case of short inpatient stays.
The new rule does away with Hospital Initiated Notices of Non-coverage (HINN) and Notice of Discharge and Medicare Appeal Rights (NODMAR) used in the Original Medicare and Medicare Advantage programs as a first step in requesting a Quality Improvement Organization’s (QIO) to review the discharge decision. To avoid financial liability for a continued hospital stay, the new rule will require beneficiaries to request a QIO review no later than the day of discharge instead of by noon of the day following delivery of a HINN or NODMAR. Under the new rule, in the event of an unfavorable QIO determination, a beneficiary faces financial liability for ongoing inpatient hospital services starting at noon of the day following receipt of the QIO review decision.
CMS’s new hospital discharge notice rule takes effect on July 1, 2007. Between now and then, HAP will more fully analyze the new procedures and their impact on SHIP counseling and education activities. We will alert you to new resources on this topic in future issues of our E-Newsletter.
Drug Plans Take Steps to Respond to SHIP Concerns
Representatives of several Part D drug plan sponsors reported that they have taken steps to respond to SHIP concerns, including the need for dedicated contact persons at the plans’ call centers. The meeting on December 18, sponsored by the Association of Health Insurance Plans (AHIP) at its Washington, DC offices, provided an opportunity for Medicare advocates and plan representatives to discuss communication and customer service issues.
According to Ellen Leitzer, HAP’s Executive Director and a participant at the meeting, representatives of Humana, Wellcare, Aetna, HealthNet and United Health Care, described some of the steps their companies have taken to meet with or contact state SHIP staff. Humana reported that its representatives have met in person with SHIP staff in 33 states and have initiated conference calls with eleven other state SHIP offices. Others said that they have met with, called, or mailed, the SHIPs. All five companies reported that they have designated customer service staff as SHIP contact persons and provided SHIPs with names and phone numbers. Wellcare noted that it has assigned managers to monitor the quality of service on its dedicated SHIP phone lines. Contact your state SHIP office for more information about the dedicated numbers for these plans.
Because HAP staff raised concerns about these issues at a June 2006 meeting with AHIP and the drug plans, we would like to hear about your experiences related to the plans’ recent efforts to reach out to and engage the SHIPs. Please contact Ellen Leitzer at eleitzer@hapnetwork.org, or Kelly Brantley at kbrantley@hapnetwork.org.
CMS Postings
Reminder: Transition Fill Guidance for 2007
According to CMS guidance issued in April, beneficiaries who are having trouble accessing their drugs and whose plan or formulary coverage has changed in some way, are entitled to a thirty day one-time prescription refill. This applies to beneficiaries whose medication has been removed or whose access to the drug has been altered due to new cost utilization management requirements.
CMS Releases Resource Guide for Partners
CMS made available on December 1 a Resource Guide for SHIPs and other partnering organizations that provide outreach and counseling services to Medicare beneficiaries. The comprehensive guide contains fact sheets, model forms, beneficiary communications, training materials, and web links covering a wide array of topics.
CMS Releases Fall 2006 Mailings Chart
The 2006 Mailings Chart outlines important beneficiary notices and steps that should be taken when the beneficiary receives the document. The chart also provide links to each notice.
CMS Releases 2007 Annual Enrollment Period (AEP) Enrollment Processing Information
On November 22, Anthony Culotta, Director of the Medicare Enrollment and Appeals Group, sent a memo to Part D Plans and Medicare Advantage (MA) Organizations detailing key enrollment processing information. The plans must provide beneficiaries with their plan membership information, including all ID numbers and 4-Rx data, before the effective date of enrollment. Even if a beneficiary submits an enrollment request at the end of the AEP, the plan must send the membership information within seven business days. Enrollment forms will only be accepted if received by January 6, 2007, regardless of postmark date.
Draft of Chapter 7 of Part D Manual Available for Comment
On December 1, CMS released a Draft version of the Chapter 7 of the Medicare Part D Manual. Chapter 7 includes information about previous guidance, question and answers, and HPMS memos related to quality assurance requirements, medication therapy management, E-prescribing, and drug utilization management. Comments were due to CMS by December 15, 2006.
Clarification of LTE DESI Drugs and Oral Anti-Cancer Agents Available
CMS has distributed Q&As about DESI Drugs and Oral Anti-Cancer Drugs covered under Part B.
HAP News and Resouces
Three States Embrace Technology to Better Meet Their Needs
HAP is excited to be helping three state SHIP programs—Iowa, Maine and Ohio—to better meet their needs through customized technology tools. The Iowa Senior Health Insurance Information Program (SHIIP) will be implementing HAP’s eNPR (electronic National Performance Reporting) Service in January 2007. The eNPR is a web-based tool that captures the data required by CMS to satisfy national performance reporting including the Client Contact Form (CCF), the Public and Media Activity (PAM) form, and the Volunteer Resource Report (VRR). Under a CMS Competitive Grant, the IA SHIIP was also able to create an Online Recertification System (ORS) with HAP’s assistance. The ORS is a web-based tool that provides information to counselors in one place via an online manual, and then “tests” their knowledge of the information through online reviews. The ORS also is now being piloted in Maine as part of a Collaborative State Project with HAP. In addition to using HAP’s eNPR Service, the Ohio SHIIP developed its Collaborative Tools under a CMS Competitive Grant. The Collaborative Tools allows SHIPs to better communicate with Medicare beneficiaries about SHIP activities and facilitates a more efficient exchange of information among SHIP personnel. For more information about these technology tools, please visits HAP’s website at: http://www.hapnetwork.org/ship-building/technology-tools/ or contact us at tools@hapnetwork.org.
HAP Releases Guide to 2007 Medicare Advantage Open Enrollment Period HAP has created a new tool concerning the 2007 Medicare Advantage (MA) Open Enrollment Period (OEP). This illustrative guide shows the important rules and limitations of the MA OEP in an easy to understand and colorful format.
Past E-Newsletters as well as HAP Weekly Emails are available through the Archive.
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