Anthem: Talk Desk Discontinued as of March 20, 2023

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Talk Desk is being discontinued as a tool for recording telephonic scope of appointments and voice signatures. This change comes about due to the CMS implemented requirements of recording all pre-enrollment and post-enrollment calls to prospects and current members.

Additionally, Medicare Voice Signature Services is a new tool that is now available in Producer Toolbox. This tool is only available to use during a face-to-face appointment when the applicant is unable to physically or electronically sign the SOA or enrollment application and does not have a Power of Attorney representative present. The below Quick Reference Guide provides the steps for using the Medicare Voice Signature Service.

Medicare Voice Signature Services Quick Guide – PDF

  • As a reminder, all calls with prospects and current members must be recorded and stored in a HIPAA compliant manner according to the CMS requirements implemented in October 2022. This includes all pre-enrollment calls and post-enrollment calls.
  • By recording all calls, the requirements for recording telephonic scope of appointment and voice signature during enrollment are also fulfilled. It is not necessary to record a telephonic scope of appointment or voice signature separately.
  • Talk Desk, the tool used for recording a telephonic scope of appointment and voice signature, will be discontinued as of March 20, 2023.
  • Historical Talk Desk recordings will continue to be accessible in the Portal.

 

Questions?  Please contact your CSM rep

 

Devoted Health Ohio Network Update

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Premier Health is now in Devoted Health’s Network for Ohio!

Not contracted with Devoted? Contact CSM’s contracting department today and get started.

Update on Anthem’s MADP Addendum – Please Read!

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Communication below sent out to all CSM agents as of Thurs. 3/2/23:

Broker Update: Anthem MAPD Addendum Update

Delay as of 3/2/23: The process to review and acknowledge the updated Anthem MAPD Addendum, noted below, is not currently available.  All agents will receive an email communication from Anthem in 2-3 days that the notification is reflecting on their profile and they can complete the required review/acknowledgement per the guidance below.  Our apologies for any inconvenience caused.

__________________________________________________________________

Please note the following action item from Anthem:

In keeping with our requirement to ensure our Third-Party Marketing Organizations (TPMOs) adhere to all applicable laws, regulations, and CMS guidelines, we have updated the Medicare Advantage and Medicare Part D Producer Contract Addendum (MAPD Addendum) language per 2023 CMS Final Rule requirements. TPMO required verbiage has been updated in Section A, Number 4 as well as Section 16: Materials; TPMO Requirements.

Please take a few minutes to read and acknowledge the required document(s) by doing the following:

1. Log into the Producer Toolbox https://brokerportal.anthem.com/apps/ptb/login
2. You will be presented with a dialog box.
3. Click “Sign Forms”.
4. You will be directed to the document(s) that require your acknowledgement/signature.
5. Simply follow the prompts and you’re done.

If you choose to click “cancel” in the dialog box, you will receive the prompt the next time you log in to Producer Toolbox, or once logged in, you can select Account Details > Appointments, and the “Action Required” tab, where you can then sign the required form(s).

Reach out to your Cornerstone Senior Marketing Service Team if you have questions.

Aetna’s MA Compliance Connection: Feb. 2023 Edition

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In this issue, Aetna will discuss two topics including:

  • Caution to agents: Do not steer clients based on “scheduling fees”
  • Reminder: You can only require a zip code or county, and other location details from clients to review plans

READ FULL NEWSLETTER HERE 

Devoted Health In Ohio: 10 Benefits You Need to Know

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Not contracted with Devoted Health? Connect with CSM TODAY to get started! 

Social Security’s National Slam the Scam Day – 3/9/2023

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National Slam the Scam Day March 9, 2023

On National Slam the Scam Day and throughout the year, we give you the tools to recognize Social Security-related scams and stop scammers from stealing your money and personal information. Share scam information with your loved ones. Slam the Scam!

Recognize the four basic signs of a scam:

  1. Scammers pretend to be from a familiar organization or agency, like the Social Security Administration. They may email attachments with official-looking logos, seals, signatures, or pictures of employee credentials.
  2. Scammers mention a problem or a prize. They may say your Social Security number was involved in a crime or ask for personal information to process a benefit increase.
  3. Scammers pressure you to act immediately. They may threaten you with arrest or legal action.
  4. Scammers tell you to pay using a gift card, prepaid debit card, cryptocurrency, wire or money transfer, or by mailing cash. They may also tell you to transfer your money to a “safe” account.

Ignore scammers and report criminal behavior. Report Social Security-related scams to the SSA Office of the Inspector General (OIG).

Report a Scam

Visit www.ssa.gov/scam for more information and follow SSA OIG on Facebook, Twitter, and LinkedIn to stay up to date on the latest scam tactics. Repost #SlamtheScam information on social media to keep your friends and family safe.

UHC: Ohio Network Update

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Sourced from Broker Annoucement from 2/16/23:

UnitedHealthcare’s Network is Growing in Ohio

We are excited to announce that several new providers within Agilon Health will be in-network for all UnitedHealthcare® Medicare Advantage (MA) and Dual Special Needs Plan (DSNP) members of Jan. 1, 2023.

For more information on Agilon Health providers visit:

Central Ohio Primary Care

Pioneer Physicians Network

Community Health Care

Primed Physicians

The Toledo Clinic

Wood County Hospital/Bowling Green Hospital

*This does not apply to Medicare Supplement plans which do not require the use of a network.

CMS Press Release: HHS Secretary Responds to the President’s Executive Order on Drug Prices

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FOR IMMEDIATE RELEASE
February 14, 2023 

Action announces new models and supports access to $2 generic drugs

Today, the Centers for Medicare & Medicaid Services (CMS) announced that the Secretary of the Department of Health and Human Services (HHS) has selected three new models for testing by the CMS Innovation Center to help lower the high cost of drugs, promote accessibility to life-changing drug therapies, and improve quality of care. The Secretary released a report describing these three models to respond to President Biden’s Executive Order 14087, “Lowering Prescription Drug Costs for Americans,” which complements the historic provisions in the Inflation Reduction Act of 2022 (IRA) that will lower prescription drug costs.

“HHS is using every tool available to us to lower health care costs and increase access to high-quality, affordable health care,” said HHS Secretary Xavier Becerra. “We are full steam ahead in delivering the cost savings from the President’s Inflation Reduction Act of 2022, and people on Medicare are already feeling the benefits. But as President Biden has made clear, we must build on the new prescription drug law with further action, which is why HHS is implementing these new projects to bring down prescription drug costs.”

“Prescription drug prices in the United States are the highest in the developed world, resulting in affordability and access challenges,” said CMS Administrator Chiquita Brooks-LaSure. “The prescription drug law is making lifesaving prescription drugs more affordable for millions of people who have Medicare, and through the selected models, the Innovation Center will lower prescription drug costs and improve access for people with Medicare and Medicaid, ranging from $2 access to certain generic drugs to better deals for expensive new therapies.”

Tackling the high costs of prescription drugs and increasing access to novel therapies continue to be priorities of the Biden-Harris Administration. As part of the Inflation Reduction Act of 2022, for the first time in history, Medicare will be able to negotiate lower prescription drug prices for beneficiaries, and starting this year, drug companies that raise their prices faster than inflation will have to pay Medicare a rebate. But the Administration recognizes there is more work to do to lower prescription drug costs for more American families. That’s why on October 14, 2022, President Biden issued an executive order directing Secretary Becerra to consider additional actions to further drive down prescription drug costs. In particular, the executive order directs the Secretary to consider whether to select for testing, by the CMS Innovation Center, new health care payment and delivery models that would lower drug costs and promote access to innovative drug therapies for beneficiaries enrolled in the Medicare and Medicaid programs, including models that may lead to lower cost-sharing for commonly used drugs and support value-based payment that promotes high-quality care.

“These selected models will test strategies to make it easier for Medicare patients to afford and access needed prescriptions at $2 or less, help expand access to cutting-edge cell and gene therapies for people with Medicaid, and help ensure drugs already on the market are safe and effective,” said CMS Deputy Administrator and Director of the CMS Innovation Center Liz Fowler, PhD, JD. “We look forward to working on these models and helping to lower drug costs for Americans with Medicare and Medicaid.”

The three models selected by the Secretary for testing by the CMS Innovation Center and described in the report address the themes outlined in the executive order and meet the selection criteria thresholds of affordability, accessibility, and feasibility of implementation. The models are:

  • The Medicare $2 Drug List: For chronic conditions like high blood pressure and high cholesterol, there are many relatively inexpensive generic medications that have significant clinical benefits, but cost-sharing can vary widely across insurance plans based on the specific formulation a doctor prescribes. This means patients may experience unexpected changes in their cost-sharing and may pay more than they have to. Under this model (the Medicare High-Value Drug List Model), Part D plans would be encouraged to offer a low, fixed co-payment across all cost-sharing phases of the Part D drug benefit for a standardized Medicare list of generic drugs that treat chronic conditions. Patients picking plans that participate in the Model will have more certainty that their out-of-pocket costs for these generic drugs will be capped at a maximum of $2 per month per drug.
  • The Cell and Gene Therapy Access Model: Cell and Gene Therapies are an emerging area of new drug development that holds significant potential, but these therapies can cost upwards of $1 million. Under this model, state Medicaid agencies would assign CMS to coordinate and administer multi-state, outcomes-based agreements with manufacturers for certain cell and gene therapies. As new therapies come to market, this will help Medicaid beneficiaries gain access to potentially life-changing, high-cost specialty drugs for illnesses like sickle cell disease and cancer.
  • The Accelerating Clinical Evidence Model: Some drugs are approved before they have established evidence of improvement in a clinical endpoint, which is called accelerated approval. CMS would develop payment methods for drugs approved under accelerated approval, in consultation with the Food and Drug Administration, to encourage timely confirmatory trial completion and improve access to post-market safety and efficacy data. This would reduce Medicare spending on drugs that have no confirmed clinical benefit.

To help identify model options, the CMS Innovation Center solicited input from a variety of sources, including beneficiary advocates, health care providers, prescription drug manufacturers, and more. The CMS Innovation Center looks forward to additional input as these models are further developed.

In addition to the three selected models, the Secretary has identified additional areas for research with the potential to lower prescription drug costs. The CMS Innovation Center looks forward to feedback on these ideas and will continue research into the design and feasibility of these ideas.

For more information on the selected models and the additional areas of research that address the executive order, a Fact Sheet is available at https://innovation.cms.gov/data-and-reports/2023/eo-rx-drug-cost-response-report-summary.

Frequently Asked Questions are available at https://innovation.cms.gov/data-and-reports/2023/eo-rx-drug-cost-response-report-faqs.

View the report at https://innovation.cms.gov/data-and-reports/2023/eo-rx-drug-cost-response-report.

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Anthem Ohio Network Alert: Christ Hospital Health

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Sourced from Anthem’s Producer Newsletter on 2/9/2023:

February 9, 2023

We’ve worked closely with The Christ Hospital Health Network for several months, but we haven’t reached an agreement to keep them in your clients’ plans.

This means that starting April 1, 2023, your clients may pay more for care they receive from Christ Hospital’s facilities, and May 1, 2023 for care they receive from Christ Hospital’s doctors. This includes care your clients received at the following Christ Hospital facilities:

  • The Christ Hospital
  • The Christ Hospital Medical Center – Liberty Township
  • The Christ Hospital Outpatient Centers
  • The Christ Hospital Urgent Cares
  • The Christ Hospital Surgery Centers
  • The Christ Hospital Outpatient Imaging Centers
  • The Christ Hospital Lab Draw and Pre-Surgical Testing Centers
  • The Christ Hospital Cardiovascular Testing Centers
  • The Christ Hospital Health Network Physical and Occupational Therapy Centers
  • The Christ Hospital Sleep Centers
  • The Christ Hospital Outpatient Clinics
  • The Christ Hospital Wound & Ostomy Care Centers
  • The Christ Hospital Medical Associates (physician practices)

We will be sending a notice to your clients letting them know. Unless we reach an agreement, Christ Hospital won’t be in your plan’s network starting April 1, 2023 for Christ Hospital facilities, and May 1, 2023 for Christ Hospital doctors.

Clients may pay more if they decide to keep seeing a Christ Hospital doctor or receiving care at these facilities
If the client decides to keep seeing this doctor or receiving care at these facilities after April 1, 2023 or seeing this doctor after May 1, 2023, they may pay more or all of the costs for the care. Some plans only cover care from doctors and care facilities in the plan’s network, except in emergencies. Employees can check their plan documents to learn more.

There may be exceptions
A client may be able to stay with Christ Hospital’s doctors and facilities for a limited time if they are in treatment for a serious and complex condition, in the hospital, scheduled for nonelective surgery, pregnant, or terminally ill. Their plan documents include more information about continuity of care.

We will continue to negotiate with Christ Hospital and hope to reach an agreement that keeps them in our plan’s networks.

 

Ohio Department of Insurance: Consumer Alert: “New Medicare Card” Telephone Scammers Posing as Government Employees to Steal Personal Information

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For Immediate Release
February 2, 2023

COLUMBUS – Ohio Department of Insurance director Judith L. French is urging Ohioans on Medicare to be alert for telephone scammers posing as representatives of the government to steal their personal information.

Called the “New Medicare Card” scam, the scammers are posing as employees of the Social Security Administration, Medicare, and even the Ohio Department of Insurance. They call their intended victims and say the person needs a new Medicare card or they need to turn in their paper card for a plastic card. The scammers then request the person’s personal information.

Government agencies, such as the Social Security Administration, Medicare, and the Ohio Department of Insurance do not cold call Ohioans on Medicare.

How Ohioans on Medicare can protect themselves:

  • Never give personal information, including Medicare, Social Security, bank account, and credit card numbers, to anyone who contacts you unsolicited by telephone, email, text, or in person, such as door-to-door sales.
  • Know that Medicare will never call you to sell anything, visit your home, or enroll you over the phone unless you called first.
  • Keep in mind that Medicare or Medicare health plans will only call and request personal information if you are a plan member or you called and left a message.

Ohioans who suspect or have been victimized by a Medicare scam should contact the Ohio Senior Medicare Patrol at 800-488-6070 or proseniors.org.

Ohioans with Medicare questions can contact the Ohio Department of Insurance’s Ohio Senior Health Insurance Information Program (OSHIIP) at 800-686-1578, oshiipmail@insurance.ohio.gov, and insurance.ohio.gov. OSHIIP is the state’s official Medicare educational and counseling program.

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