Ritter Insurance Marketing, Craig Ritter

CMS releases final version of “Call Letter” for Medicare Advantage providers

CQ HealthBeat (3/31, Reichard) reports, CMS has released its final version of itsCall Letter ” advising private Medicare Advantage (MA) plans “how to prepare bids for 2010.” The letter instructs insurers to “prune their offerings next year so beneficiaries can clearly see the differences in plans.” In a press release announcing the final version yesterday, CMS emphasized “that it will sharpen its scrutiny of out-of-pocket charges to seniors and the disabled to prevent discrimination against sicker beneficiaries.” In addition to bids by regarding MA plans, the letter “offers guidance for insurers bidding to offer” the Medicare Part D “prescription drug plans.” Missing from the final Call Letter is a “requirement that MA plans publicize ‘medical loss ratios,'” which House Ways and Means Health Subcommittee Chair Pete Stark (D-CA) covered in the Feb. 25 briefing.

        According to the Wall Street Journal (3/31, Zhang), “administration officials said the changes are intended to weed out certain out-of-pocket costs charged” by providers offering MA plans. They said such plans “will face more government scrutiny if they don’t cap a patient’s annual out-of-pocket costs at $3,400 or less, or if they charge patients more than traditional Medicare does for dialysis, home healthcare and other services. If the government deems the charges too high, insurers will be asked to scale them back.” In addition, insurers “won’t be allowed to charge sick, low-income patients more than what they would pay under traditional Medicare.” President Obama has criticized MA plans for “spending too much while doing too little to care for the nation’s elderly and disabled. He has proposed cutting payments to those plans to help pay for a healthcare overhaul.” Modern Healthcare (3/31, DoBias), however, points out that according to the CMS, “27 percent of all MA plans have fewer than 10 enrollees, and removing them from the market would affect only about one percent of the more than 10-million seniors who are enrolled in such programs.”

        The AP (3/31, Alonso-Zaldivar) adds, “Medicare officials said the changes include winnowing the number of versions of a plan that insurers can offer, protecting patients with chronic diseases from excessive copayments and banning a practice by some plans that can add even more to the costs of brand name drugs.” The new policies “reflect an administration effort to put its stamp on private plans in Medicare, which flourished under Republicans but are seen by some Democrats as undermining the traditional program.” The final Call Letter requires that insurers “submit their bids by June 1.”

        Similarly, the Minneapolis Star Tribune (3/31) notes, MA providers “include Humana Inc., UnitedHealth Group Inc. and Aetna Inc., as well as BlueCross and BlueShield companies. The private plans — favored more by Republicans than Democrats — emerged as a target of President Barack Obama in the 2008 presidential campaign.”

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