The Centers for Medicare and Medicaid Services (CMS) announced Sept. 24 that, after being found compliant with Medicare requirements through a comprehensive marketing review, seven health plan sponsors may resume marketing their private fee-for-service (PFFS) plans. The approvals allow the sponsors, as well as all other Medicare Advantage organizations, to market to newly eligible Medicare beneficiaries through Oct. 1, 2007. The plans may also market to those beneficiaries with special enrollment periods.
The United Health Group, Blue Cross Blue Shield of Tennessee, Humana Inc., Sterling Life Insurance Co., Coventry Health Care Inc., Universal American Financial Corp., and WellCare Health Plans Inc. are the seven sponsors that voluntarily suspended marketing PFFS plans earlier this year. The suspensions of the plan sponsors’ PFFS market activities were lifted after CMS verified that each organization had the systems and management controls in place to meet all the conditions specified by CMS. When marketing begins for the 2008 benefit year on Oct. 1, 2007, all PFFS plans will be subject to the same standards.
Any plan that is found to be in violation of CMS requirements can be subject to a full range of available penalties, which can include suspension of marketing and/or enrollment, suspension of payment for new enrollees, civil monetary penalties, and termination from the Medicare program. Read the press release.
