CMA Alert – December 6, 2018

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  1. Amidst Medicare Open Enrollment, CMS Reports High Rates of Inaccuracy in Medicare Advantage Provider Directories
  2. In Her Own Words: A Beneficiary’s Take On Medicare Advantage Steering
  3. Health Care Sabotage: Administration Doubles Down on States’ Ability to Undermine ACA

Amidst Medicare Open Enrollment, CMS Reports High Rates of Inaccuracy in Medicare Advantage Provider Directories

The Medicare Annual Coordinated Election Period (ACEP) is the most crucial time of year for Medicare beneficiaries to make decisions about how they wish to receive their Medicare coverage.  This year the Administration seems to be actively promoting Medicare Advantage plans. However, at the same time that this steering toward private plans is occurring, the Centers for Medicare & Medicaid Services (CMS) reported that Medicare Advantage  provider directories contain extremely inaccurate information, which could lead beneficiaries to sign up for plans that might not actually include their doctors.

This is CMS’ third round of provider directory review since initially being alerted by a beneficiary complaint. CMS Examined 5602 providers and their listed locations from 52 different Medicare Advantage organizations between November 2017 and July 2018.  Reviewers in the study called provider offices to verify the accuracy of the information in the provider directory. Information to be verified included names, address and phone numbers; whether the provider accepted the MA-PD in question at that location, and whether they accepted new patients with the MA-PD in question. CMS assigned each error a score, with incorrect locations, numbers and statements regarding accepting patients weighted highest.[1]

The CMS review found that:

  • Almost half (48.74%) had at least one inaccuracy.
  • Percentage of inaccuracies by MA organization ranged from 4.63% for the best network listing to 93.02% for the worst.
  • The majority of MA organizations had between 30% and 60% inaccuracies.
  • “Providers should not have been listed at 33.14% (3,481) of the locations…either because the provider did not work at the location or because the provider did not accept the plan at the location.”[2]
  • “85.64% of locations with deficiencies…had deficiencies of the highest weighted, most egregious errors.”[3]
  • 41.75% of all locations listed had inaccuracies “with the highest likelihood of preventing access to care.”[4]

Beneficiaries and caregivers rely on provider directories to make important choices about their care. In this era of overt steering toward Medicare Advantage by the Administration[5], accurate information has never been more crucial. Errors in provider listings “create a barrier to care and raise questions regarding the adequacy and validity of the MAO’s network as a whole.”[6] 

Despite these inaccuracies, according to the Washington Post, “[t]he Trump administration is holding off on punishing Medicare Advantage plans for error-ridden doctor directories — further evidence” that CMS “is showing special favor to the alternative program over traditional Medicare offerings.”[7]  The Post continues: “Last year, the agency threatened to impose fines on the plans if they didn’t clean up their act. While this year’s report shows no substantial improvement over last year (or the year before that), CMS isn’t following through on the threat [emphasis in original].”


[1] Online Provider Directory Review Report (Centers for Medicare & Medicaid Services) (November 2018), available at: https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/Downloads/Provider_Directory_Review_Industry_Report_Round_3_11-28-2018.pdf, p. 5, table 3.
[2] Id, p. 6
[3] Id, p. 8
[4] Id, p. 1
[5] In addition to previous Center Alerts, see, e.g. “Trump Administration Peppers Inboxes With Plugs for Private Medicare Plans” by Robert Pear, New York Times, (Dec. 1, 2018), available at: https://www.nytimes.com/2018/12/01/us/politics/trump-medicare-advantage-plans.html, and “The Health 202: Trump administration lets Medicare plans off the hook” by Paige Cunningham, (Dec. 4, 2018), Washington Post, available at:  https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2018/12/04/the-health-202-trump-administration-lets-medicare-plans-off-the-hook/5c058e4b1b326b60d12800f1/?utm_term=.072d2e85242c.
[6]Online Provider Directory Review Report , p. 1
[7] “The Health 202: Trump administration lets Medicare plans off the hook” by Paige Cunningham, (Dec. 4, 2018), Washington Post, available at:  https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2018/12/04/the-health-202-trump-administration-lets-medicare-plans-off-the-hook/5c058e4b1b326b60d12800f1/?utm_term=.072d2e85242c.

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In Her Own Words: A Beneficiary’s Take On Medicare Advantage Steering

Dear CMA,

I am a retiree and my health plan is Medicare. I am retired 13 years and never have had any problem with my Medicare coverage. Most of my doctors accept Medicare and I have been very pleased with their services.

I have become increasingly troubled by the targeted ads to seniors on TV telling viewers that time is running out for them to sign up for Medicare Advantage plans or other similar plans. It sounds as if they don’t sign up for Medicare Advantage they will lose their original Medicare coverage.

There is one particular ad of a woman who misses her train and then equates this to people who don’t sign up for Medicare Advantage or other similar plans.

Where are our original Medicare Plan ads? How are we fighting back? I know that Medicare works for me as well as my husband and find no fault with its coverage. Yes, they only cover 80% of the total bill, but many doctors who accept Medicare have agreed to accept this as full payment minus the deductible.

I am afraid that with so much money being spend on these negative ads, or ads that do nothing but frighten people into thinking that they must sign up for a Medicare Advantage plan or lose their original Medicare coverage, that we will lose the original Medicare Health Coverage that all seniors are entitled to.

I don’t see us fighting back. And we better, sooner rather than later, or we will lose our much deserved and needed original Medicare Health Coverage.

Concerned in New York,
 
A.L.

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Health Care Sabotage: Administration Doubles Down on States’ Ability to Undermine ACA

We have previously written about new guidance from the Administration that will make it easier for states to both ignore Affordable Care Act (ACA) coverage and consumer protection rules, and weaken the ACA Marketplace.

Last week, the Centers for Medicare & Medicaid Services (CMS) issued waiver concepts about how states can implement the new guidance. As Kaiser Health reported, “It is intended to roll back key elements of Obama-era requirements, which were designed to promote enrollment in ACA plans that cover a broad range of medical needs and meet uniform national standards.” In the name of “innovation,” these waivers would virtually allow states to create a separate Marketplace by expanding the use of less comprehensive coverage that does not meet ACA standards. These plans, having lower premiums, would attract younger healthier consumers while leaving older sicker people in ever more expensive ACA plans.

The new guidance also allows states to disregard ACA rules governing the use of subsidies to purchase insurance. The ACA currently restricts the use of subsidies to help low-income consumers purchase ACA-compliant coverage. Under the newly issued guidance, states may expand or further restrict who is eligible for a subsidy or allow subsidies to be used for this junk insurance. States would also be allowed to base subsidies on age instead of income. This is a complete reversal of longstanding policy regulating the use of these subsidies, which is critical to the strength of the ACA Marketplace.

There is some doubt as to whether this guidance from CMS passes legal muster. As the Washington Post reports, “Reps. Richard E. Neal (Mass.), ranking minority-party member of the Ways and Means Committee, and Frank Pallone Jr. (N.J.), his counterpart on Energy and Commerce, dispatched a letter Thursday to the secretary of HHS and two other Cabinet members in which they contended that the waiver concepts are illegal.” In an analysis, the Brookings Institution also casts doubt on the legality and permissibility of this guidance, which was developed outside of a formal rule making process. We strongly urge all federal agencies to be transparent regarding opportunities for public comment and active in promoting such opportunities, in order to gather broad feedback from stakeholders and the public. This is especially true of regulatory matters affecting the health care of millions of consumers.

In a speech last week to the American Legislative Exchange Council, CMS Administrator Verma is quoted as saying “So, I am having a real hard time understanding all of the criticism leveled at this Administration. Critics see subterfuge. The reality…we’ve delivered stabilization.” This is clearly not true. The Center for Medicare Advocacy has extensively highlighted actions taken by the Administration that have weakened not stabilized the ACA. Criticism of the Administration’s actions has certainly been warranted. If it looks like health care sabotage, then it must be health care sabotage.

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