Revisions to the
Medicare Advantage and Prescription
Drug Benefit Programs
2008-11-14 2008-11-21 2008-11-21 2008-11-14 2008-11-14 2008-11-14 2008-11-14 2008-11-14 2008-11-14 2008-11-14
CMS-2008-0122-0059 CMS-2008-0122-0085 CMS-2008-0122-0088 CMS-2008-0122-0037 CMS-2008-0122-0045 CMS-2008-0122-0055 CMS-2008-0122-0061 CMS-2008-0122-0065 CMS-2008-0122-0030 CMS-2008-0122-0046
05:00:00 05:00:00 05:00:00 05:00:00 05:00:00 05:00:00 05:00:00 05:00:00 05:00:00 05:00:00
https://api.regulations.gov/v4/comments/CMS-2008-0122-0059 https://api.regulations.gov/v4/comments/CMS-2008-0122-0085 https://api.regulations.gov/v4/comments/CMS-2008-0122-0088 https://api.regulations.gov/v4/comments/CMS-2008-0122-0037 https://api.regulations.gov/v4/comments/CMS-2008-0122-0045 https://api.regulations.gov/v4/comments/CMS-2008-0122-0055 https://api.regulations.gov/v4/comments/CMS-2008-0122-0061 https://api.regulations.gov/v4/comments/CMS-2008-0122-0065 https://api.regulations.gov/v4/comments/CMS-2008-0122-0030 https://api.regulations.gov/v4/comments/CMS-2008-0122-0046
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I was placed into a Medicare Advantage program (Medicare Blue Plus PFFS)by my ex-employer on Jan1, 2008.  I am 70 years old and was on plain Medicare with BCBSM Medigap provided by my ex-employer (BCBS Michigan) upon my retirement.I had no choice in the matter. I see that permanent residence is required to be enrolled in a Medicare Advantage program.  I have not resided in the Michigan area for 10 years.  I am currently residing in St. Marys,GA and received most of my medical care in Jacksonville, Florida.I have read these regulations fairly thoroughly, and no where do I find that I could be forced into an MA program.  All that I read states that enrollment must be initiated or at least confirmed by the potential enrollee.There are very few providers in Jacksonville who accept MA.  Only 2 hospitals (one of which is the local emergency/charity hospital).  BCBSM cant provide me with a list of providers who will accept this MA insurance. I could spend days trying to find a provider of a specific speciality, if I have to call them all myself, explain the program and see if they will accept it.It seems that if permanent residence in the state (Michigan) is required to enroll in their program is required, how could I be forced into the program when my permanent residence is St. Marys, GA and has been for 10 years.I have had cancer 4 times, and have had cardiac problems. I was being treated by oncologists and cardiologists in Jacksonville.  All that changed on Jan. 1, 2008.  I had to find a new oncologist, a new hospital (Shands) and a surgeon for the CA related surgery I needed in April.  Now I am searching for a dermatologist, since the one I have had for 6 years will not accept the MA insurance.  BCBSM cannot tell me who will accept the insurance.I strongly suggest that you add something to the regulations which prohibits forcing enrollment into the program. It should be strictly voluntary and only for residents of the state where the program is initiated.  And that the opportunity to disenroll  will not depend on the threat of dropping the Medigap coverage by an ex-employer.  That would be blackmail and what was told would happen if I disenrolled in the MA program.You may contact me by replying to this e-mail, or a white pages search I am a long time agent in my mid forties, having worked in the insurance business for nearly 20 years.  I have ALWAYS had my clients best interest at heart, and it has ALWAYS been a struggle to do the right thing when you see unscrupulous agents making hundreds of thousands of dollars by doing the wrong thing.  But now with these new regulations, especially the fact that all 1st year commissions are going to be paid ONLY for new enrollees, and all others will be paid at renewal rates, it is going to run honest hard working agents like me out of the business.Lets take a specific example: I sell all of the leading companies (Humana, United HC, Aetna, AARP, BCBS, etc.) and a client who takes 12 different medicines that change often needs a prescription plan.  I spend more than 2 hours researching the literally 56 drug plans availabe in Texas for 2008 and he buys a Humana PDP.  I got paid a whopping $50 commission and continue to have to help my client whenever there is a prescription problem, so I have a service issue all the time, making my phone ring off of the wall.  Add to that, that when 2009 offerings come out, I need to re shop his list, and make the tweaks of the changes in his medicines, and reshop it with the literally 50 PDP plans available for 2009.  So if I were to sell him Humana again (or just leave him with them) I was making a whole $15. for the 2nd year renewal commission.  That $15 doesnt even pay the gas to drive round trip to many of these clients home, let alone pay me to be able to take the time it deserves to shop the case properly for the client.  Now Im told that if I take an existing client from one PDP to another, Ill get only renewal commissions, which are by far too small to make a living. Inocent clients will be suffering because you have taken away all of the good agents by cutting commissions to a level that makes it not a feasable what to make a living.  I feel betrayed by CMS and think that this whole business is messed up and that the regulators have little care about whats best for the whole lot of us.  I can NOT STAY IN BUSINESS with pay structures as horrible as these, and dont think that Im the only one.  This whole country will be suffering from no one being able to help them figure out the maze of options, because the CMS decided to over regulate.  FOR GODs SAKE, an agent working a booth at a Walmart cant even ask the prospect that comes up to them if anyone has helped them figure out their Medicare options for the following year, how messed up is that?  Seniors need proding, they often have no idea how to ask.  Thats another example of how ridiculous this mess is.  I only wish there were more I could say to bring through my feelings of disgust for the whole mess.  Ive no idea how you all can sleep at night dealing with matters such as this with such a dis incentive to agents.  Did you all not even get the a broad spectrum of agents from the real world involved in your research to figure better what to stay in the Medicare segment to help people who need help?  I pity the United States if this is where we are headed.  Response to Medicare Marketing GuidelinesWe are writing to express our concern about the recent Medicare Marketing Guidelines.  Our organization, DaVita VillageHealth, operates Medicare Advantage Chronic Special Needs Plans for beneficiaries with End Stage Renal Disease.  In addition, we operate a Medicare demonstration program for ESRD which also utilizes the Chronic Special Needs Plan business model.  When Medicare Advantage Special Needs Plans (SNPs) were authorized by the Congress, they were intended to provide specialized, tailored care to beneficiaries with severe and disabling chronic conditions.  CMS intent was to have these plans focus on specific high-needs populations and provide benefits and care management services not available through traditional Medicare.  In the case of Chronic Special Needs Plans, there was further hope that these targeted plans could facilitate greater integration between providers, filling the gaps in care that are commonly experienced by beneficiaries with one or more chronic illnesses.  The goal for SNPs was improved clinical outcomes and lower total costs through their highly targeted approaches.  The recent Medicare Marketing Guidelines reflect a desire to protect beneficiaries from inappropriate behavior by MA plans, which we appreciate and applaud.  However, these guidelines run directly counter to the founding principles for Chronic SNPs, which are fundamentally different from other MA plans.  Under the guidelines, Chronic SNPs face unique challenges to successfully expanding participation in their high-value programs. At DaVita VillageHealth, we specifically focus on beneficiaries with ESRD, who have even more unique and urgent needs.  ESRD patients need to receive life-saving dialysis treatments three times per week, and usually spend up to four hours in the dialysis facility during each treatment.  Their needs and experiences are different from those of other Medicare beneficiaries, and as a result, only Chronic Special Needs Plans with specifically approved waivers may enroll ESRD patients.  Our comment addresses the following aspects of the Medicare Marketing Guidelines: Marketing Through Unsolicited ContactsScope of AppointmentsSales/Marketing in Health Care SettingsMarketing through Unsolicited Contacts 42 CFR 422.2268(d) and 423.2268(d) -- CMS 4131-F The prohibition on marketing through unsolicited contacts is particularly challenging to the operations of our Chronic Special Needs Plans.  There are only 350,000 Medicare dialysis patients in the United States.  Our marketing efforts must therefore be highly targeted  it is not efficient for us to participate in mass advertising, given the low number of eligible patients in any one geography.  If we are unable to conduct targeted telemarketing activities, the only avenue available to let potential enrollees know about the plan is through direct mail. However, we desire to ensure patients fully understand the components of a Special Needs Plan, and do not feel that mail is the best forum for such a communication.  The demographics of dialysis patients also make targeted telemarketing especially critical for ESRD SNPs.  Many of our potential enrollees face literacy difficulties, and many others speak a primary language other than English.  In addition, many beneficiaries do not have permanent addresses, making it difficult for us to reach them by mail.  For the majority of ESRD beneficiaries, brief contact by phone enables us to provide clearer, more comprehensive information and more effectively reach those who could benefit from the program.    Therefore, we request that Chronic Special Needs Plans be able to contact potential enrollees by phone.  In order to ensure beneficiary protection, we will submit a script to CMS for approval and use this script for all outgoing calls.  Scope of Appointments 42 CFR 422.2268(g) and (h); 423.2268(g) and (h) -- CMS 4138-IFC The Medicare marketing guidelines also require that plans document the potential enrollees agreement to the scope of any marketing appointment.  The guidelines emphasize that no lines of business other than that agreed to by the beneficiary may be discussed at the appointment.  However, our offer ESRD patients only our Chronic Special Needs Plans; there is no risk of cross-selling.  This guideline will therefore only result in unneeded administrative activities given how few beneficiaries we typically seek to enroll, the relative impact of this guidelines associated administrative costs (particularly the installation of recording software) is significant.Therefore, we request that Chronic Special Needs Plans that offer only one product or line of business be exempted from the requirement to document the scope of marketing appointments.  We believe that such a change would not decrease the level of beneficiary protection that CMS has intended to provide, but would eliminate unnecessary administrative burden upon single-product organizations. Sales/Marketing in Health Care Settings 42 CFR 422.2268 (k) and 423.2268(k) -- CMS 4131-F Dialysis patients are unique even among those with severe chronic conditions.  In order to sustain life, they must undergo dialysis treatments three times per week, and typically spend up to four hours in a dialysis facility at each treatment.  The dialysis facility is a source of information to patients about their treatment, lifestyle and nutritional behaviors, and insurance.  Therefore, the dialysis facility, where ESRD patients spend the vast majority of their time, is where they seek critical, reliable information.In addition, dialysis facilities themselves are unlike many other health care settings.  In order to be accessible to beneficiaries, they are frequently located in low-income areas and are generally modest stand-alone facilities that do not have lobbies or common cafeterias.  Dialysis clinics usually consist of treatment floors, waiting rooms, offices, and a break room for staff.  Most do not contain patient-accessible conference rooms or other common areas.  According to Section 42 CFR 422.2268 (k) and 423.2268(k) of CMS 4131-F, Chronic Special Needs Plans are unable to market to potential beneficiaries in the waiting rooms of dialysis facilities.  Since dialysis facilities are unlike other health care settings and often do not have patient-accessible common areas, this would greatly restrict beneficiaries ability to learn about or participate in the new special needs programs now available to them.   We thank CMS for understanding the special nature of dialysis facilities and for thus providing flexibility to our ESRD Chronic Special Needs Plans with respect to conducting marketing activities at dialysis facilities. *********ESRD is severe and debilitating, has high mortality and risk of hospitalization, and is usually accompanied by multiple co-morbidities.  Because of the tremendous needs of ESRD patients and their potential to benefit from care management, this is exactly the kind of condition for which Special Needs Plans were intended.   We appreciate the support CMS has consistently provides to our ESRD Chronic Special Needs Plans, and hope that CMS will again take our comments above into consideration before finalizing its regulations.Sincerely, Jess ParksGeneral Manager, VillageHealth  This note goes to CMS. I can see by the Catagory above that as a health insurance agent you dont consider my opinion worthy enough to give us a seperate catagory. Maybe if you did, you wouldnt have the mess you have created involving the Medicare Advantage plans that you do. I applaud the attempt to levelize commissions to stop the churning. But just once, have you stopped to consider what is written in the Medicare and You handbook? You know, the part that tells the medicare recipients that they should review their plans each and every year? Well, as an agent who is true blue to his clients thats my job! If I find a better plan for my client then its my job to change them or churn them as you want to label it. I do understand there have been many agents doing this but Im not one of them. The mess you have created trying to solve another mess is not getting the job done. Maybe you should get the insurance companies to stop changing the plans every time you turn around and we wouldnt have to jump through hoops each and every year trying to help them. Standardize the plans just like the Medicare Supplements are if you want to stop this mess. And now, Representative Stark wants to limit my commissions? Get real! I wish someone from CMS would come down and work in the trenches with us then you might begin to understand what you put us through with no consideration that we are the ones that have to help these seniors in the way they need it! We are the ones that have to figure out from all of the possibilities what plans suit thier needs. And on top of that you give us just a very few days to figure it out! Not only that, but you do it near to the biggest holiday time of the year! Does this not seem a little ignorant to you? Please, Im begging, stop the insanity! I am very glad to see that CMS is getting stricter with us, the producers of PDP and MAPD Plans.  However, there might still be an element out there that is disregarding all of the rules imposed by both the Federal as well as the State Government Regulatory entities.  There are still agents who are bringing in people from across the border from El Paso, Texas and getting them to market these plans by phone.  These people are unlicensed.  I believe that more secret shoppers are needed all over the country to be able to catch the law breakers.Thank You for getting stricter.I believe that eventually all of these plans will have to be standardize just like the medicare supplements were standardize several years ago.Who knows, if Obama gets in office we might just have the comrades from the kremlin take care of us.  What do you think? This new Scope of Appointment form is not being well received by Medicare recipients.  Mostly I am hearing this is the most ridiculous thing Ive ever heard.  Dont they have something better to worry about than this.  I can understand filling one out for people that are not current clients but the ones that are clients already are counting on us to help them with all their options.  You really need to reevaluate this before 11/15 and quite worrying about commissions.  Believe it or not Insurance Agents also have families, utilities, gas bills, etc. just like everyone else.  We have 6 weeks to help anywhere from 300-700 clients, we sure dont need more paperwork.  You are only hurting the Medicare recipients because Agents do not have time for all these additional requirements and alot of them are going to be left without help.   As a life and health  insurance agent for 28 plus years, and a member of the National Association of Health Underwriters and also the National Association of Insurance and Financial Advisors, I feel that the most recent regulations imposed on health insurance agents marketing Medicare Part D and Medicare Advantange products are heavy handed at best and oppressive at worst.Members of the two professional insurance agent associations have very specific codes of ethics that all members thereof are expected to fulfill very seriously and conscientiously.  It appears to me that CMS is trying to make it so difficult to market the Medicare senior products of Medicare Part C and D that many agents will just chose to not go through the hastle involving time, money and long hours to jump through the hoops being imposed.  This will eventually lead to a bureacratic takeover of a national health insurance system that fails to provide qualified professional agents to advise their clients.  Telling an agent that he/she must wait 48 hours before a clients question can be answered or discussed because it hasnt been previously submitted as a subject to be discussed in the interview is pure foolishness.  This whole thing is a case of using a sledge hammer to kill a fly instead of a fly swatter!Walter J. Sexton,  LUTCF; Agent  OwnerSexton Insurance AgencyP. O. Box 445Franklin, KY 42135(270) 586-7746 Your Scope of Agreement Form is another brick wall for Seniors seeking help with their Medicare Options and gaining information about Medicare from agents that specialize in Medicare. You people make harder and harder for seniors to get help. Why do you keep making things harder for our Seniors? WHY? Isnt life complicated enough for them. STOP with your rules!!!! Get off the insusrance agents back.  We are intitled to make a living.  We are not all crooks.  The same cannot be said about the congress. If you are going to cap agents commission, then are you going to cap the profits of the insurance companies?  How much did the BIG companies contribute to your campaigns?I know that AARP wields a lot of weight because of their contributions. THE  SCOPE  OF  APPOINTMENT  FORM  IS  UNNECESSARY  BECAUSE  WE  ARE  COVERED  BY  THE  FREE  LOOK  PERIOD  ACCORDING  TO  WHAT  I  SEE..  YOU  ARE  MAKING  THINGS  TOO  DIFFICULT  FOR  THE  AVERAGE  CITIZEN  ...  YOU  MUST  BE  LISTENING  TO  THE  COMPLAINTS  OF  MAYBE  1%  AND  PUTTING  THE  REST  OF  US  THROUGH  MORE  TIME  SPENT  JUST  TRYING  TO  APPLY  FOR  THE  COVERAGE ...