6/26/09 EDITOR’S NOTE: SEE BREAKING NEWS!!
Here is what I sent to CMS earlier this afternoon. . .
6/22/09 EDITOR’S NOTE: CMS’ Reply to my Letter
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Since last night, I’ve gotten a better understanding of the fundamental issue in question and have had the opportunity to see where CMS is coming from on this issue. With this knowledge, perhaps I can give a more precise argument.
It is my understanding that in 2010, CMS is interpreting that the replacement of Original FFS Medicare and a Stand Alone Medicare Prescription Drug Plan (PDP) with a Medicare Advantage Plan (MA or MAPD) would be considered a “Not Like Plan” replacement and, therefore, entitling the broker to an “Initial” commission.
It is also my understanding that in 2009, CMS is interpreting the identical situation as “Renewal”. This is, of course, the opposite conclusion.
From what I have been about to gather, the reason we are coming to OPPOSITE conclusions originated from November 10th Interim Final Guidance (http://www.cms.hhs.gov/ManagedCareMarketing/Downloads/CMS-4138-IFC2_11-10-08_1119am.pdf) and was a result of the fact that CMS didn’t have the administrative capabilities at the time to communicate to the plans and, therefore, would be sending the list of members who were to be paid at initial commission rates “from time to time” during 2009.
Quoting directly from the Interim Final Guidance (page 4, I believe), “Several times in 2009, we will run a report identifying those beneficiaries enrolled in an MA plan or PDP who were enrolled in an MA plan or PDP who were newly entitled or enrolled from Original Medicare.” (emphasis added)
From this statement, CMS developed the “initial commission” report and it seems that there is some disagreement about what it means to be “enrolled from Original Medicare.”
If I am correct, you believe that someone who has Original Medicare is not being enrolled from Original Medicare if there is a PDP. Rather, you are arguing that they are not being “enrolled from Original Medicare”, but rather, they are being enrolled from the PDP. In fact, they are being enrolled from BOTH. I don’t think it’s a situation where it is solely one or the other, but both. So, they ARE being “enrolled from Original Medicare” and they ARE being enrolled from the PDP at the same time. I think it’s logical to say that both are true.
Assuming you agree that both are true, someone enrolling from Original Medicare would be enrolling from Original Medicare without regard to their prescription drug choice, or lack thereof.
However, assuming we MUST pick either one or the other and it CANNOT be both, it seems to me that it would make sense to choose the approach which is consistent with CMS’ 2010 interpretation and consistent with a fresh reading of the Federal Code of Regulations 422.2744(a)(3).
It seems that as each new interpretation came out, the interpretation of 422.2744(a)(3) got morphed into a conclusion that someone with Original Medicare is NOT being “enrolled from Original Medicare” if they have a drug plan. This conclusion, I believe, is totally inconsistent with 422.2744(a)(3) and this is the reason why you are arriving at two different answers (2009 versus 2010) to the same identical question.
Thank you again for the opportunity to express my thoughts as this definition of “enrolled from Original Medicare” will have an enormous impact on many people’s lives!
Craig
How quaint Mike. You actually think they’ll respond??
In all due respect, we agents have no effective organization or entity that represents us…..none at all. Maybe we need a union!
How quaint. You expect CMS to respond.
Robert,
At least someone like Craig took the time to craft such a well thought out email to go to bat for us. What do you suggest? Please don’t tell me a class action lawsuit.
Yes…that is exactly what we need …A CLASS ACTION LAW SUIT.
We have to pay taxes, but the CMS (government) does not have to honor their contracts?
The insurance companies get their money BUT the agents get screwed (to put it bluntly). CMS makes up the rules as they go along (the way it seems). I do have something to hang in my office now “The Certificate of Appreciation” from the insurance company for doing such a fine job. I show this to my creditors to let them know what a good job I’m doing without getting paid for it!! At least it proves that I’m working, ain’t!?
I renewed my “Commercial Drivers License” which I thought I was done with BUT sure am glad I renewed it. CMS makes it imposable to get clients and now they’re making it impossable to get paid. Anyone have any suggestions? I’m open for anything (within reason) now!
Craig,
At least you emailing CMS you have a job, I called CMS and talked to rep and got the info I needed and then I was terminated from my job. CMS called my company,WHP to correct them on the info they were telling the agents was wrong and of coarse they didn’t like it. So now I have no job selling MAPD plans or my money.
How could a company do that to you. All companies told agents the same thing. What company pulled your contract for asking CMS a question?
Craig,
Your work is very much appreciated. If I could I would transfer all my contracts o your company. Not one FMO I work for has given any response to this issue. You are one of the few people that even have the wherewithal to craft such a detailed well written response. Whether your efforts produce extra commissions or not, I personally want to thank you for your efforts and skill and knowledge you provide to us independents. Hopefully you are making lots of money in the insurance business. You certainly deserve it.
Well done Craig.
Great post and letter however I have a feeling that talking to CMS is no different than talking to me son. He looks like he’s listening but ….
The real villian in this are the carriers for throwing independent agents under the bus once again. They have now saved millions by this rule interpretation and have little to gain to fight for us.
I wish Obama and the rest of the socialists would just end all this with a single payer system. I’m tired of the slow death. And to those who ask how we can afford this, remember, as long as their are checks left, we have the money.
Rick
ummmmmmmmmmm
Can you release the email address? Perhaps a name? We would all like to write a letter…
Awesome point, Craig. Extremely well-crafted post. Hope you post the response as well.