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

 

AEP 2023 Reminder: Last Day for 2023 AEP Enrollments

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AEP Ends Wednesday, December 7, 2022

 

Important information about the last days of AEP and submitting enrollment applications

The following tips will help ensure your hard work this AEP pays off and your applications are processed correctly, including those submitted on Wednesday, December 7, 2022.

  • AEP application submission deadline: ALL applications must be submitted no later than 11:59 pm on December 7, 2022.
  • Date the application.  It is important to include a date on every enrollment application.  Applications without a date, received after December 7, 2022, are assigned the date the application was received by the carrier, which can invalidate apps received after AEP ends.  Apps that you received on December 7, 2022, must be submitted to the carrier, dated December 7, 2022.
  • Faxing Applications:  If faxing the application, remember to keep a copy of your successful fax transmittal as confirmation of submission.
App Submission Guide
2023 AEP Tips & Guidance

Cigna’s VBE Program – Pays more for digital applications

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It’s easy to make additional money with Cigna Medicare! Follow the steps below to earn up to $50 on every enrollment!

  1. Submit your new-to-Cigna application digitally and earn $20 per eligible approved application.
  2. Include a valid in-network PCP on the digital application and earn an additional $20.
  3. Include a valid customer email address on the digital application and earn an additional $10.

Eligible plans:

  • All Cigna MAPD plans are eligible for the additional VBE payments. 

Agent training qualifications:

  • Agents must complete all required training in order to be certified and ready to sell 2023 Cigna MAPD plans.
  • No additional VBE training modules are required.

Qualified digital applications:

  • Connecture (DRx)
  • Sunfire
  • eEnrollment
  • OEC files

Valid customer email addresses:

  • Agents must provide a unique and valid email address for the customer.
  • Generic email addresses or an agent’s personal/business email address will not be accepted.
  • Valid PCPs:
    • The provider must be in-network to qualify for the additional VBE payment. Out-of-network providers will not qualify for the additional VBE payment.
    • PCP information must be valid and correct. Incorrect information will not qualify for the additional VBE payment.

Application status:

  • Agents can view their application status in com.
  • Please note: The application status will not inform if the application qualifies for the VBE program payments.

Commissions statement:

  • “VBE – Digital Admin Fee” will be included in the Adjustment Notes column of the commissions statement.
  • The line item will indicate the name of the customer, so agents can verify that they have been paid for each successfully completed and eligible digital application.
Don’t forget about our health risk assessment (HRA) incentive!

 

·    Earn $125 when you enroll your Cigna Medicare Advantage customers in an eligible Medicare D-SNP or C-SNP plan and facilitate an HRA. (For 2023 effectives)

·    Earn $75 for each HRA that you facilitate with your other Cigna Medicare Advantage customers.

 

This means even more money in your pocket! Click here to learn more about Cigna’s HRA incentive.

Mutual of Omaha: Now Offering a Third PDP Plan for 2023

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Just in time for the Medicare Annual Enrollment Period, the Mutual of Omaha RxSM Essential (PDP) plan joins MOO’s lineup of two existing prescription drug plans to provide more options for senior-age customers. The new plan has low monthly premiums and is ideal for newly eligible Medicare-age individuals who typically don’t use a lot of medications or for people on low-cost medications.

 

Don’t forget — before producers can discuss the benefits of prescription drug plans with their clients, they must meet one of the following ready to sell requirements:

• Successfully complete AHIP’s 2023 Medicare and Fraud, Waste and Abuse Training AND the 2023 Mutual of Omaha Rx Product Training.
• Successfully complete the 2023 Mutual of Omaha Rx Compliance Training AND the 2023 Mutual of Omaha Rx Product Training.

 

LEARN MORE ABOUT THE PDP PLANS HERE

2023 Medicare Parts A & B Premiums and Deductibles 2023 Medicare Part D Income-Related Monthly Adjustment Amounts

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On September 27, 2022, the Centers for Medicare & Medicaid Services (CMS) released the 2023 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2023 Medicare Part D income-related monthly adjustment amounts.

Medicare Part B Premium and Deductible Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A. Each year the Medicare Part B premium, deductible, and coinsurance rates are determined according to the Social Security Act. The standard monthly premium for Medicare Part B enrollees will be $164.90 for 2023, a decrease of $5.20 from $170.10 in 2022. The annual deductible for all Medicare Part B beneficiaries is $226 in 2023, a decrease of $7 from the annual deductible of $233 in 2022.

The 2022 premium included a contingency margin to cover projected Part B spending for a new drug, Aduhelm. Lower-than-projected spending on both Aduhelm and other Part B items and services resulted in much larger reserves in the Part B account of the Supplementary Medical Insurance (SMI) Trust Fund, which can be used to limit future Part B premium increases. The decrease in the 2023 Part B premium aligns with the CMS recommendation in a May 2022 report that excess SMI reserves be passed along to people with Medicare Part B coverage.

Beginning in 2023, certain Medicare enrollees who are 36 months post kidney transplant, and therefore are no longer eligible for full Medicare coverage, can elect to continue Part B coverage of immunosuppressive drugs by paying a premium. For 2023, the immunosuppressive drug premium is $97.10.

Medicare Open Enrollment and Medicare Savings Programs

Medicare Open Enrollment for 2023 will begin on October 15, 2022 and ends on December 7, 2022. During this time, people eligible for Medicare can compare 2023 coverage options between Original Medicare, and Medicare Advantage, and Part D prescription drug plans. In addition to the soon-to-be released premiums and cost sharing information for 2023 Medicare Advantage and Part D plans, the Fee-for-Service Medicare premiums and cost sharing information released today will enable people with Medicare to understand their Medicare coverage options for the year ahead. Medicare health and drug plan costs and covered benefits can change from year to year, so people with Medicare should look at their coverage choices annually and decide on the options that best meet their health needs.

To help with their Medicare costs, low-income seniors and adults with disabilities may qualify to receive financial assistance from the Medicare Savings Programs (MSPs). The MSPs help millions of Americans access high-quality health care at a reduced cost, yet only about half of eligible people are enrolled. The MSPs help pay Medicare premiums and may also pay Medicare deductibles, coinsurance, and copayments for those who meet the conditions of eligibility. Enrolling in an MSP offers relief from these Medicare costs, allowing people to spend that money on other vital needs, including food, housing, or transportation. People with Medicare interested in learning more can visit: https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/medicare-savings-programs.

Medicare Part B Income-Related Monthly Adjustment Amounts

Since 2007, a beneficiary’s Part B monthly premium is based on his or her income. These income-related monthly adjustment amounts affect roughly 7 percent of people with Medicare Part B. The 2023 Part B total premiums for high-income beneficiaries with full Part B coverage are shown in the following table:

Full Part B Coverage
Beneficiaries who file individual tax returns with modified adjusted gross income: Beneficiaries who file joint tax returns with modified adjusted gross income: Income-Related Monthly Adjustment Amount Total Monthly

 Premium Amount
Less than or equal to $97,000 Less than or equal to $194,000 $0.00 $164.90
Greater than $97,000 and less than or equal to $123,000 Greater than $194,000 and less than or equal to $246,000 $65.90 $230.80
Greater than $123,000 and less than or equal to $153,000 Greater than $246,000 and less than or equal to $306,000 $164.80 $329.70
Greater than $153,000 and less than or equal to $183,000 Greater than $306,000 and less than or equal to $366,000 $263.70 $428.60
Greater than $183,000 and less than $500,000 Greater than $366,000 and less than $750,000 $362.60 $527.50
Greater than or equal to $500,000 Greater than or equal to $750,000 $395.60 $560.50

The 2023 Part B total premiums for high-income beneficiaries with immunosuppressive drug only Part B coverage are shown in the following table:

Part B Immunosuppressive Drug Coverage Only
Beneficiaries who file individual tax returns with modified adjusted gross income: Beneficiaries who file joint tax returns with modified adjusted gross income: Income-Related Monthly Adjustment Amount Total Monthly

 Premium Amount
Less than or equal to $97,000 Less than or equal to $194,000 $0.00 $97.10
Greater than $97,000 and less than or equal to $123,000 Greater than $194,000 and less than or equal to $246,000 $64.70 $161.80
Greater than $123,000 and less than or equal to $153,000 Greater than $246,000 and less than or equal to $306,000 $161.80 $258.90
Greater than $153,000 and less than or equal to $183,000 Greater than $306,000 and less than or equal to $366,000 $258.90 $356.00
Greater than $183,000 and less than $500,000 Greater than $366,000 and less than $750,000 $356.00 $453.10
Greater than or equal to $500,000 Greater than or equal to $750,000 $388.40 $485.50

Premiums for high-income beneficiaries with full Part B coverage who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows:

Full Part B Coverage
Beneficiaries who are married and lived with their spouses at any time during the year, but who file separate tax returns from their spouses, with modified adjusted gross income: Income-Related Monthly Adjustment Amount Total Monthly Premium Amount
Less than or equal to $97,000 $0.00 $164.90
Greater than $97,000 and less than $403,000 $362.60 $527.50
Greater than or equal to $403,000 $395.60 $560.50

Premiums for high-income beneficiaries with immunosuppressive drug only Part B coverage who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows:

Part B Immunosuppressive Drug Coverage Only
Beneficiaries who are married and lived with their spouses at any time during the year, but who file separate tax returns from their spouses, with modified adjusted gross income: Income-Related Monthly Adjustment Amount Total Monthly Premium Amount
Less than or equal to $97,000 $0.00 $97.10
Greater than $97,000 and less than $403,000 $356.00 $453.10
Greater than or equal to $403,000 $388.40 $485.50

Medicare Part A Premium and Deductible

Medicare Part A covers inpatient hospital, skilled nursing facility, hospice, inpatient rehabilitation, and some home health care services. About 99 percent of Medicare beneficiaries do not have a Part A premium since they have at least 40 quarters of Medicare-covered employment.

The Medicare Part A inpatient hospital deductible that beneficiaries pay if admitted to the hospital will be $1,600 in 2023, an increase of $44 from $1,556 in 2022. The Part A inpatient hospital deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. In 2023, beneficiaries must pay a coinsurance amount of $400 per day for the 61st through 90th day of a hospitalization ($389 in 2022) in a benefit period and $800 per day for lifetime reserve days ($778 in 2022). For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $200.00 in 2023 ($194.50 in 2022).

Part A Deductible and Coinsurance Amounts for Calendar Years 2022 and 2023
by Type of Cost Sharing
  2022 2023
Inpatient hospital deductible $1,556 $1,600
Daily coinsurance for 61st-90th Day $389 $400
Daily coinsurance for lifetime reserve days $778 $800
Skilled Nursing Facility coinsurance $194.50 $200.00

Enrollees age 65 and over who have fewer than 40 quarters of coverage and certain persons with disabilities pay a monthly premium in order to voluntarily enroll in Medicare Part A. Individuals who had at least 30 quarters of coverage or were married to someone with at least 30 quarters of coverage may buy into Part A at a reduced monthly premium rate, which will be $278 in 2023, a $4 increase from 2022. Certain uninsured aged individuals who have less than 30 quarters of coverage and certain individuals with disabilities who have exhausted other entitlement will pay the full premium, which will be $506 a month in 2023, a $7 increase from 2022.

For more information on the 2023 Medicare Parts A and B premiums and deductibles Notices (CMS-8080-N, CMS-8081-N, CMS-8082-N), please visit:

CMS-8080-N: https://www.federalregister.gov/public-inspection/2022-21180/medicare-program-calendar-year-2023-inpatient-hospital-deductible-and-hospital-and-extended-care

CMS-8081-N:https://www.federalregister.gov/public-inspection/2022-21176/medicare-program-cy-2023-part-a-premiums-for-the-uninsured-aged-and-for-certain-disabled-individuals

CMS-8082-N:https://www.federalregister.gov/public-inspection/2022-21090/medicare-program-medicare-part-b-monthly-actuarial-rates-premium-rates-and-annual-deductible

Medicare Part D Income-Related Monthly Adjustment Amounts

Since 2011, higher income beneficiaries’ Part D monthly premiums are based on income. These income-related monthly adjustment amounts affect roughly 8 percent of people with Medicare Part D. These individuals will pay the income-related monthly adjustment amount in addition to their Part D premium. Part D premiums vary from plan to plan and roughly two-thirds of beneficiaries pay premiums directly to the plan, while the remaining beneficiaries have their premiums deducted from their Social Security benefit checks. Regardless of how a beneficiary pays their Part D premium, the Part D income-related monthly adjustment amounts are deducted from Social Security benefit checks or paid directly to Medicare. The 2023 Part D income-related monthly adjustment amounts for high-income beneficiaries are shown in the following table:

Beneficiaries who file individual tax returns with modified adjusted gross income: Beneficiaries who file joint tax returns with modified adjusted gross income: Income-related monthly adjustment amount
Less than or equal to $97,000 Less than or equal to $194,000 $0.00
Greater than $97,000 and less than or equal to $123,000 Greater than $194,000 and less than or equal to $246,000 12.20
Greater than $123,000 and less than or equal to $153,000 Greater than $246,000 and less than or equal to $306,000 31.50
Greater than $153,000 and less than or equal to $183,000 Greater than $306,000 and less than or equal to $366,000 50.70
Greater than $183,000 and less than $500,000 Greater than $366,000 and less than $750,000 70.00
Greater than or equal to $500,000 Greater than or equal to $750,000 76.40

Premiums for high-income beneficiaries who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows:

Beneficiaries who are married and lived with their spouses at any time during the year, but file separate tax returns from their spouses, with modified adjusted gross income: Income-related monthly adjustment amount
Less than or equal to $97,000 $0.00
Greater than $97,000 and less than $403,000 70.00
Greater than or equal to $403,000 76.40

CMS Marketing Changes

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The marketing guidelines for Medicare Advantage and Prescription Drug Plans were updated on May 9, 2022. Among the provisions that apply directly to agents, the two most critical, which are to be in use by October 1, 2022, for Plan Year 2023, are a new required disclaimer and a requirement to record all sales calls with beneficiaries. While not comprehensive, the FAQ’s below will provide details. 

Required Disclaimer 

Disclaimer Language To Use:

“We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.” 

Who must use this disclaimer?

Any third-party marketing organization (which includes agents and brokers) must include this disclaimer. 

When and where do I have to have the disclaimer?

  • On all marketing materials: print (if possible, use a 12pt font), electronically, television, and radio
  • Within the first minute of all sales calls
  • Prominently displayed on TPMO websites
  • Verbally, electronically, or in writing, during any sales meeting with a beneficiary

What if I DO offer all plans in my area? 

While the regulation does provide a carve-out for TPMO’s that truly offer all plans in their area, it is exceedingly rare for an agent to truly be able to do this. In most areas, there are one or more plans that are offered only through captive agents, direct to consumer, or certain types of plans that agents and brokers cannot sell. Even if you do offer all plans in one county or service area, it is possible your marketing or referrals may extend to an area where that is not true, so the disclaimer would still be required. 

Requirement to Record Sales Calls

Under these new guidelines, all sales calls with beneficiaries and TPMO’s MUST be recorded and retained for 10 years, including enrollment calls. 

What constitutes a sales call? 

Any call that is related to what CMS calls the “chain of enrollment,” which has been defined as the events from a beneficiary becoming aware of an MA/PDP plan to the end of the enrollment process. This means that calling leads, scheduling appointments, collecting scopes of appointment (telephonically), presenting plans, collecting drug and doctor lists, and phone enrollments would all fall under this guidance. This list is not exhaustive, and other calls that contain marketing content will also need to be recorded and retained. 

How can I record and store calls? 

We recommend reaching out to your current phone provider to see if they offer call recording. If they do not, or it seems cost prohibitive, consider a VOIP phone system that can be used in the office or the field. Some common options are Ring Central, 8×8, and Vonage. For storage, you will need to develop a process for sorting and storing the calls either on a local drive or cloud-based storage. Since these calls contain sensitive data, most free storage accounts will not be HIPAA compliant. We are currently researching the best options for agents to compliantly store this data. 

What about in person appointments? 

In-person marketing and sales appointments do not need to be recorded, however, calls to set appointments or follow-up calls to answer benefit questions would require recording. Servicing questions about current plan business, such as claims, billing, and requesting in force plan documents, are not sales calls and would not require recording. 

I use my cell phone. How can I handle this? 

Most VOIP services have a mobile app version that would allow calls to be recorded from your mobile device. There are also recording apps that would allow for recording calls without VOIP. Be cautioned, however, as a stand-alone recording app will not include any disclaimers that may be required by your jurisdiction before recording, whereas most VOIP systems offer/include these options.

Please reach out with any questions to your team at Cornerstone Senior Marketing.  (614) 763-2255 |  compliance@cornerstoneseniormarketing.comquirement to Record Sales Calls

AultCare 5-Star Rated MA for 2022

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Excellent!

PrimeTime Health Plan is rated a 5-Star Medicare Advantage Plan for 2022 by the Centers of Medicaid and Medicare Services (CMS).This rating is considered excellent by CMS.

Members have a one-time Special Enrollment Period (SEP) to enroll in a Medicare Advantage 5-Star plan and brokers are able to market the 5-Star PrimeTime Health Plan year-round (between December 8, 2021 through November 30, 2022), as opposed to waiting for the Annual Enrollment Period, starting October 15 each year.

An exclusive opportunity…

Cornerstone Senior Marketing is the only FMO that offers broker contracting with AultCare. Get appointed now and add the 5-Star rated MA PrimeTime Health Plan to your product portfolio.

PrimeTime Health Plan in NE Ohio

Medicare Advantage Plans are available in select NE Ohio counties:

Carroll | Columbiana | Harrison | Holmes | Mahoning | Medina | Portage | Stark | Summit | Trumbull | Tuscarawas | Wayne

Contact your Sales or Service Rep to discuss additional benefits of adding AULTCARE to your product portfolio.

Jaime Lebron NE Ohio | 216-503-4509

AultCare PrimeTime Choices Med Supp GI

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Med Supp Guaranteed Issue Advantage.

Through the end of May, 2022, AultCare offers clients to move from Plan F to Plan G from any carrier or within the PrimeTime network and anyone coming from an existing/active Plan C supplement plan will receive the Guaranteed Issue to downgrade to Plan G, M or N. 

Enrollment app enhancements….

A new PrimeTime Choices Enrollment Application is available with upgraded features that mirror the current Medicare Advantage submission process.  The enhancements include:

  • Single submission for both member and broker information, eliminating the need for brokers to submit a separate form.
  • Attachments can be included with your submission
  • A progress gauge 
  • Ability to print the completed application before submission
  • A confirmation message when the submission process is complete

For 35 years, AultCare has provided quality healthcare at an affordable cost to the Ohio communities it serves, state-wide for the PrimeTime Choices Medicare Supplement Plan.

Cornerstone Senior Marketing offers our broker partners the exclusive opportunity to contract with AultCare and offer their plans as a significant part of a well-rounded product portfolio.

Insurance Companies and Group Health Plans to Cover the Cost of At-Home COVID-19 Tests

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Posted by CMS Jan 10, 2022:
As part of its ongoing efforts across many channels to expand Americans’ access to free testing, the Biden-Harris Administration is requiring insurance companies and group health plans to cover the cost of over-the-counter, at-home COVID-19 tests, so people with private health coverage can get them for free starting January 15th.  The new coverage requirement means that most consumers with private health coverage can go online or to a pharmacy or store, buy a test, and either get it paid for up front by their health plan, or get reimbursed for the cost by submitting a claim to their plan. This requirement incentivizes insurers to cover these costs up front and ensures individuals do not need an order from their health care provider to access these tests for free.

Beginning January 15, 2022, individuals with private health insurance coverage or covered by a group health plan who purchase an over-the-counter COVID-19 diagnostic test authorized, cleared, or approved by the U.S. Food and Drug Administration (FDA) will be able to have those test costs covered by their plan or insurance. Insurance companies and health plans are required to cover 8 free over-the-counter at-home tests per covered individual per month. That means a family of four, all on the same plan, would be able to get up to 32 of these tests covered by their health plan per month. There is no limit on the number of tests, including at-home tests, that are covered if ordered or administered by a health care provider following an individualized clinical assessment, including for those who may need them due to underlying medical conditions.

“Under President Biden’s leadership, we are requiring insurers and group health plans to make tests free for millions of Americans. This is all part of our overall strategy to ramp-up access to easy-to-use, at-home tests at no cost,” said HHS Secretary Xavier Becerra. “Since we took office, we have more than tripled the number of sites where people can get COVID-19 tests for free, and we’re also purchasing half a billion at-home, rapid tests to send for free to Americans who need them. By requiring private health plans to cover people’s at-home tests, we are further expanding Americans’ ability to get tests for free when they need them.”

Over-the-counter test purchases will be covered in the commercial market without the need for a health care provider’s order or individualized clinical assessment, and without any cost-sharing requirements such as deductibles, co-payments or coinsurance, prior authorization, or other medical management requirements.

As part of the requirement, the Administration is incentivizing insurers and group health plans to set up programs that allow people to get the over-the-counter tests directly through preferred pharmacies, retailers or other entities with no out-of-pocket costs.  Insurers and plans would cover the costs upfront, eliminating the need for consumers to submit a claim for reimbursement.  When plans and insurers make tests available for upfront coverage through preferred pharmacies or retailers, they are still required to reimburse tests purchased by consumers outside of that network, at a rate of up to $12 per individual test (or the cost of the test, if less than $12). For example, if an individual has a plan that offers direct coverage through their preferred pharmacy but that individual instead purchases tests through an online retailer, the plan is still required to reimburse them up to $12 per individual test. Consumers can find out more information from their plan about how their plan or insurer will cover over-the-counter tests.

“Testing is critically important to help reduce the spread of COVID-19, as well as to quickly diagnose COVID-19 so that it can be effectively treated. Today’s action further removes financial barriers and expands access to COVID-19 tests for millions of people,” said CMS Administrator Chiquita Brooks-LaSure.

State Medicaid and Children’s Health Insurance Program (CHIP) programs are currently required to cover FDA-authorized at-home COVID-19 tests without cost-sharing. In 2021, the Biden-Harris Administration issued guidance explaining that State Medicaid and Children’s Health Insurance Program (CHIP) programs must cover all types of FDA-authorized COVID-19 tests without cost sharing under CMS’s interpretation of the American Rescue Plan Act of 2019 (ARP). Medicare pays for COVID-19 diagnostic tests performed by a laboratory, such as PCR and antigen tests, with no beneficiary cost sharing when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional. People enrolled in a Medicare Advantage plan should check with their plan to see if their plan offers coverage and payment for at-home over-the-counter COVID-19 tests.

This effort is in addition to a number of actions the Biden Administration is taking to expand access to testing for all Americans. The U.S. Department of Health and Human Services (HHS) is providing up to 50 million free, at-home tests to community health centers and Medicare-certified rural health clinics for distribution at no cost to patients and community members. The program is intended to ensure COVID-19 tests are made available to populations and settings in need of testing. HHS also has established more than 10,000 free community-based pharmacy testing sites around the country.  To respond to the Omicron surge, HHS and FEMA are creating surge testing sites in states across the nation.

Aetna Medicare Network Update: Mount Carmel Health System & Negotiations with Trinity

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Sourced from Aetna broker communication from 11/10/21:

Network Update | November 10, 2021

Update on negotiations with Trinity – Mount Carmel Health System – OH

 

Highlights

As promised, we are keeping you informed on the progress made during Aetna’s negotiations with Trinity – Mount Carmel Health System – OH. This update, and the ones that follow, will supplement the original network communication you received on 10/26/2021. We will keep you informed of updates until negotiations are complete and/or concluded.

Update # Date of Update Update Description
1 11/09/2021 Trinity Health has provided Aetna with a contract extension to 1/31/22 – for the Commercial and Medicare products.

The parties agree to continue to work through the local market negotiations and memorialize the terms and conditions of a new National LOA over the next several weeks.   This National LOA will memorialize the new national template contract language, the respective rate increases for the respective markets and a commitment to utilize a Trinity-specific national contract template for all of their Trinity Ministries by January 1, 2023 or sooner.

Aetna and Trinity Health have signed a contract extension, assuring continued in-network access for its members in NY, OH, MI, and IL.  We’re pleased that our members will be able to continue receiving in-network care from their hospitals and doctors with the intent to limit further disruption during open enrollment.

Trinity Health extended the termination date of the following NY, Ohio, Illinois and Michigan hospitals to 1/31/22:

  • Samaritan (Troy)
  • Samaritan / Albany Memorial (Albany)
  • St. Josephs (Syracuse)
  • Mt. Carmel East Hospital (Columbus)
  • Mt. Carmel New Albany Surgical Hospital (New Albany)
  • Mt. Carmel St. Ann’s Hospital (Westerville)
  • Mt. Carmel Health System Grove City (Grove City)
  • Diley Ridge Medical Center (Canal Winchester)
  • Loyola University Medical Center (Chicago)
  • MacNeal Hospital (Chicago)
  • Gottlieb Hospital (Chicago)
  • Mercy St. Mary (Grand Rapid)
  • MHP Mercy Campus (Muskegon)
  • MHP Hackley
  • Lakeshore (Shelby)
  • St. Joseph Mercy (Chelsea)
  • St. Joseph Mercy (Ann Arbor)
  • St. Joseph Mercy (Oakland)
  • St. Mary Mercy (Livonia)
  • St. Joseph Mercy (Livingston)

 

 

We appreciate your support in this matter, as we continue to try to address the rising cost of health care services for Central Ohio area employers and residents.  We will continue to keep you informed of any changes in our local network.