CMS OPEN PAYMENTS COVID-19 ANNOUNCMENT

Wednesday, March 25, 2020

Open Payments COVID-19 Announcement

Open Payments COVID-19 Announcement

CMS is aware that the COVID-19 pandemic may impact some reporting entities and may affect their ability to submit records to the Open Payments Program on or before March 31st 2020.

CMS does not have the authority to waive the statutorily mandated requirement that Open Payments reporting be completed by the 90th day of the calendar year (see 42 U.S.C. § 1320a–7h(a)(1)(A) and 42 U.S.C § 1320a–7h(a)(2)) or to postpone the publication deadline of June 30 (42 U.S.C § 1320a–7h(c)(1)(C)). As such, CMS is unable to extend the submission window past the March 31st deadline.

However, CMS is sensitive to the challenges caused by the pandemic and will consider the impact that these circumstances have on reporting entities’ ability to report in a timely, accurate, and complete manner.

CMS will exercise enforcement discretion with respect to submissions completed after the statutory deadline due to circumstances beyond the reporting entity’s control associated with the pandemic. In an assumptions statement, you may explain your organization’s reporting methodologies or reasons for unusual or partial submissions.

If the pandemic has impacted your reporting processes, please include the phrase “COVID-19 Impact” in your assumptions statement alongside the explanation of the circumstances and, if applicable, include reference to any related help desk ticket numbers.

Questions—Contact Live Help Desk

Need help or have more questions? Contact the Open Payments Help Desk at openpayments@cms.hhs.gov or call 1-855-326-8366 (TTY Line: 1-844-649-2766).The Help Desk is available Monday through Friday, from 8:30 a.m. to 7:30 p.m. (ET), excluding Federal holidays.

The Help Desk refers media inquiries to CMS’ Press Office for response.

CSM Service Team Introduces a VALUE-ADDED process!

NEW!  One email for all service issues!

Effective March 2, 2020, brokers can begin sending all service related questions or action items to one specific email address:  service@cornerstoneseniormarketing.com

Incoming emails are delivered to a shared folder managed by the entire Cornerstone Senior Marketing service team. The goal is to reduce delays in responses, share management of all issues, and help cover team members when they are out of the office.

Important.  Brokers retain their personal service rep, assigned based on our long-standing alpha-split system, and may continue to contact their rep by phone for situations that do not extend to service issues best communicated and managed by email.

Senior Service Team Alpha Split – BY BROKERS LAST NAME

Jim Meyer, Service Specialist (A-F) | Call: 513-629-2395 | Email:  service@cornerstoneseniormarketing.com

Lila Sohnly, Service Specialist (G-K) | Call:  614-763-2263 | Email:  service@cornerstoneseniormarketing.com

Patrick Wiley, Service Specialist (L-Q) | Call:  614-763-2264 | Email:  service@cornerstoneseniormarketing.com

Lisa VanSuch, Lead Service Specialist (R-Z) | Call:  614-763-2258 | Email:  service@cornerstoneseniormarketing.com 

UnitedHealthcare Plan Faces Medicare Sanction

UPDATE FROM UHC REGARDING THE SANCTIONS IN OHIO:

In Ohio, this effects only Dual Plan H5322-028 (Light Blue banded kit), which is now Closed to New Enrollment for 2020.  Members on this plan can remain for as long as they like.  Agents will continue their AOR status and be paid their renewal commissions.

The reason for this sanction is: the aggregate medical loss ratios of  the 9 states included in this plan number,  were less than the CMS required 85%.   So in essence UHC didn’t lose enough money on that plan.

To note: Ohio was not a contributor to the low losses ratio, UHC had plenty. 

UHC has replaced H5322 with H8125-002 for those 75 counties, so they can continue to serve Dual beneficiaries in the State of Ohio.

This does not affect the other Dual Plan H5253-059 (Purple banded kit) which serves Metropolitan 13 counties in Ohio.

All UHC Ohio Plans starting with: H5253 are all 4.5 stars plans and not effected!

 

By

UnitedHealthcare is facing enrollment restrictions next year in one of its Medicare Advantage health plan contracts, regulators say, because the insurer hasn’t been spending a large enough share of revenue on the health care needs of enrollees.

The sanction from the Centers for Medicare and Medicaid Services (CMS) applies to just one of United’s many contracts with the federal government to sell Medicare Advantage health plans and doesn’t apply to coverage sold in Minnesota.

Minnetonka-based UnitedHealthcare, the nation’s largest health insurer, says it fell out of compliance due to federal legislation that reduced the insurer’s tax liability last year. The sanction applies to a health plan contract for coverage sold in nine states to less than 1% of the company’s roughly 6 million Medicare Advantage members. The states include Florida, Georgia, Kansas, New Hampshire, New Jersey, Ohio, Oklahoma, Texas and Virginia.

“CMS imposed enrollment sanctions on a subsidiary of UnitedHealthcare … because the organization did not meet a Medical Loss Ratio (MLR) of at least 85% for a third consecutive year,” CMS said in a response to Star Tribune questions.

“This enrollment suspension will be in effect for contract year 2020,” the federal agency said. The federal MLR rule “requires that a percentage of revenue should be used for patient care, rather than for other items [such] as administrative costs or profit.”

UnitedHealthcare is one of the nation’s largest sellers of Medicare Advantage plans, a newer form of Medicare coverage in which enrollees opt to receive federal health insurance benefits through a private managed care company. In 2019, roughly one-third of Medicare beneficiaries are opting for Medicare Advantage coverage, according to the Kaiser Family Foundation, as opposed to receiving benefits through the original Medicare program.

The federal government monitors the share of revenue that Medicare Advantage plans spend on patient care needs, vs. the amount spent on administration and kept as profit. This measure is called the “medical loss ratio,” and it’s a standard way for regulators and consumers to assess the profitability of health plans.

When a Medicare Advantage plan’s MLR drops below 85% for three consecutive years, the government can suspend new enrollment in the plan while letting current enrollees maintain the coverage. In a Sept. 11 letter to UnitedHealthcare, CMS said the medical loss ratio (MLR) was 71.3% in 2016, 83.9% in 2017 and 84.1% in 2018 for health plans within the contract that’s being sanctioned.

In a response to Star Tribune questions, UnitedHealthcare said the MLR last year fell below the mark — despite added benefits — because the company saw a financial benefit from the federal Tax Cut and Jobs Act, which became law in late 2017. The company says it subsequently factored the change into its calculations and anticipates achieving an MLR above 85% in 2019.

“While we won’t be enrolling new members in [this contract] for 2020, existing members will continue to receive the same level of care and support, including an increase in their coverage and benefits,” the insurer said in a statement. “UnitedHealthcare also has additional Medicare Advantage plans available in many of these markets.”

“We anticipate that we will achieve the MLR threshold in 2019 for [this contract], which will allow us to resume enrollment in these plans in 2021,” UnitedHealthcare said.

The health plan contract that’s being sanctioned primarily provides coverage for people who quality for benefits from both Medicare and the state-federal Medicaid program. UnitedHealthcare officials have said these products for “dually eligible” enrollees are an important growth area for the company.

If the MLR for a Medicare Advantage plan falls below the 85% mark for five years, the government can terminate its contract with the health plan. CMS says the regulatory action against UnitedHealthcare is the first time the agency has suspended enrollment in a Medicare Advantage plan due to noncompliance with the MLR rule.

CMS Released 2020 MA/PDP Commission Rates

The Centers for Medicare & Medicaid Services (CMS) has released the broker commission rates, training, and testing requirements for the 2020 plan year.

Medicare Advantage commissions will increase 6% in 2020! 

2019 is currently at $482

In 2020 it will be $510

Please see chart below for reference

 

You can download the original CMS document with this information here.

 

If you have any questions please reach out to your Cornerstone Senior Marketing representative. 

Why is CMS Rejecting MA Applications?

To Our Valued Brokers,

We have been informed that CMS is rejecting a high number of Medicare Advantage applications this year due to the HICN# or the new MBI# NOT being included on the application.

To list only the social security number on any Medicare Advantage application is guaranteeing a rejected application from CMS.

If you are switching an existing Medicare client, the application will need to have either the HICN# or the new MBI#.

If your client is new to Medicare, the application will have to have the new MBI# listed.

Please take the time to check the various carrier enrollment portals to make sure the applications you are submitting are being accepted and processed by the carriers.

If you have any questions or concerns, please contact your Cornerstone Senior Marketing representative.

CMS’s New Registration Tracker is Now Available

Last month, the Centers for Medicare & Medicaid Services (CMS) launched a new tool that enables you to look up your Marketplace registration status using your National Producer Number (NPN) and ZIP Code.

The tool shows you a summary of your Marketplace registration status.

In addition, the tool displays details of the Marketplace training and registration steps you have completed.

It also shows the status of CMS’ validation of the NPN you provided in your Marketplace Learning Management System (MLMS) profile.

CMS Mailing New Medicare Cards to Wave 4 States

The Centers for Medicare and Medicaid Services started mailing new Medicare cards to people with Medicare who live in Wave 4 states: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, and Vermont. CMS will continue to mail new cards to people who live in Wave 3 states, as well as nationwide to people who are new to Medicare.

CMS finished mailing cards to people with Medicare who live in Wave 1 and Wave 2 states and territories (Alaska, American Samoa, California, Delaware, District of Columbia, Guam, Hawaii, Maryland, Northern Mariana Islands, Pennsylvania, Oregon, Virginia, and West Virginia). If someone with Medicare says they did not get a card, print and give them the “Still Waiting for Your New Card?” handout (in English or Spanish) or instruct them to:

  • Sign into MyMedicare.gov to see if we mailed their card. If so, they can print an official card. They need to create an account if they do not already have one
  • Call 1-800-MEDICARE (1-800-633-4227). There might be something that needs to be corrected, such as updating their mailing address.

via Medicare Learning Network