Healthcare Financial News

CMS on May 8 proposed enhanced protections for beneficiaries who are enrolled in Medicare Advantage (MA) health plans and Medicare prescription drug plans. CMS’s actions are intended to strengthen marketing standards and extend additional protections to all beneficiaries, including those receiving the low-income subsidy (LIS) and beneficiaries enrolled in special needs plans. It also would introduce several new MA and prescription drug plan requirements.

Among other provisions, the proposed plan marketing standards would prohibit cold-calling and expand the current prohibition on door-to-door solicitation, prohibit sales activities at educational events such as health information fairs, and require MA organizations to use state-licensed agents to market MA and Part D plans.

The rule also would grant CMS greater flexibility in determining penalty amounts against Medicare Advantage or Part D plans that violate Medicare rules in ways that adversely affect beneficiaries.

Comments are due by July 15, 2008. Read the proposed rule.

CMS announced on May 7 that National Heritage Insurance Corporation (NHIC) has been awarded a contract of up to five years for the combined administration of Part A and Part B Medicare claims payment in Alaska, Idaho, Oregon, and Washington. NHIC will take claims payment work now performed by two fiscal intermediaries and one carrier in the four states. The Part A/Part B Medicare Administrative Contractor (A/B MAC) contract has an approximate value of $148 million over five years.

As the A/B MAC contractor, NHIC will immediately begin implementation activities and will assume full responsibility for the claims processing work in its four-state jurisdiction by Dec. 31, 2008. NHIC, headquartered in Hingham, Mass., is the seventh new Part A/Part B MAC to be named by CMS. By 2011, 15 new Part A/Part B Medicare contractors will cover every state and the District of Columbia. Read the press release.