The provider contract between Regence Blue Shield and Harrison Memorial expired this past Thursday, having been extended past the July 31st expiration date. Here is a link to the full story from Insurance News Net.
Here is the full story from USA Today. The health system whose data was compromised was Community Health Systems based in Franklin, TN. The information stolen included names, addresses, dates of birth, phone numbers and social security numbers. The hackers were believed to be from China. The breach apparently occurred in April and June. The company confirmed that the hackers were able to successfully copy the patient data outside their system. Those affected are those that had received services from physicians affiliated with the system over the past 5 years.
Here is an interesting article on how Walmart is looking to move into the Primary Care space from the New York Times. They currently have 6 locations in South Carolina and Texas and plan on opening up 6 more locations in 2015. Walmart had opened some critical care clinics in the past, with limited success. Their new strategy is more focused on Primary care versus urgent or critical care and is using one managing partner versus several.
Here is a link to the memo: MMG Corrected 8 14 14.
Here is a summary of some of the important clarifications:
1. Section 70.6 Telephonic contact – I will probably need more clarification on this clarification. MMG currently reads, “Agents may contact their own clients and Plans/Part D Sponsors may contact current enrollees at any time to discuss plan business.” CMS clarifies that “Plan business” means their CURRENT PLAN and that “agent’s may not contact members, via the telephone, to discuss other plan options. This is considered an unsolicited contact.” Not sure if CMS is saying that agents cannot contact their own clients to discuss other options or that agents cannot contact plan members (not their clients) to discuss other options (like if a plan non-renews).
2. Referral fees (Page 2) – Limits referral fees on PDP to $25.
3. Payment of Compensation – Plans MUST wait until January 1st, 2015 to pay commissions on 1/1/15 effectives.
4. Renewal Compensation – Starting with January 2015 renewals, renewal commissions on ALL MA/PDP business must be paid according to the 2015 Fair market value (FMV), regardless of the renewal commission in place at the time the policy was written.
5. Admin Fees – Plans are allowed to pay admin fees to downstream entities such as FMO’s prior to January 1st, 2015. (This seems like it would be difficult to administer as the agent commission and override would be paid at two different times, if the plans choose to do this.)
6. Clarification on Initial payments – Clarifies that plans CAN pay either (1) the full initial commission for mid year entry OR (2) pro-rated compensation as long as there is no prior plan history, however, if the member disenrolls during the initial calendar plan year, the plan must charge back for ALL months the member was not enrolled (including months prior to enrollment). If a plan enrolls an initial member (cycle year 1) with prior history of MA enrollment, they may only pay for the remaining months in the year. Here is CMS’ example:
For example, a member ages into Medicare and elects an MA-PD plan (Plan A), effective April 1. The member moves and is eligible for a special enrollment period. The member elects a new MA-PD (Plan B), effective November 1. Plan A must recoup 5/12ths of the initial compensation (January through March and November through December) to account for the months the member was not enrolled in Plan A. Since the member had prior plan history when the member enrolled in Plan B, Plan B many only pay a pro-rated initial compensation equal to 2/12ths (November through December).
Must admit that this one was confusing for me! WellPoint is the parent company of Anthem. Consumers, for the most part, are more familiar with the Anthem brand. Pending shareholder approval, the company will be known as Anthem, Inc. to provide consumers with a single brand to recognize.
NAHU had been asking for this for many months and here is the inaugural issue of CMS newsletter for Agents and Brokers who participate in the Federally Facilitated Exchanges of the ACA.
Since HIV drugs are in a protected class, PDP companies can’t put any controls around them. Here is a link to a story from the Washington Post which talks about an inspector general report which identified $30 million in questionable HIV prescription fills.