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Medicare Compliance



2022 Medicare Marketing Final Rule

Advocates, SHIP and agents have decried misleading Medicare enrollment T.V. ads for years. The Joe Namath ads are reviled and have become the posterchild for misleading seniors into contacting call centers that switch the beneficiaries into plans that may not fit their needs. CMS released a proposed rule, CMS-4192-P, CY 2023 Medicare Advantage and Part D proposed rule which included a provision on Marketing and Communications Oversight. NAHU convened the FMO Council to discuss the proposal to require agents to record enrollment encounters and particularly, the definition of Third-Party Marketing Organization (TPMO), which included licensed agents. In our comment letter we submitted to the administration on March 7, we discussed the role of the independent agent and how the new definition of TPMO did not fit the role of the agent or address the root cause of complaints associated with the ads' marketing plans. At the same time, we entered into conversations with our counterparts at AHIP to discuss the rule and we were aligned on the role of the agent, call centers and marketing and called on CMS to delay this part of the rule until further stakeholder discussions could be held.

Following the release of the final rule, NAHU again convened the FMO Council to discuss the final rule and began discussions with CMS officials on the rule. We also continued compare notes with AHIP. On July 11, NAHU sent a second letter to CMS Administrator Chiquita Brooks-LaSure outlining our concerns regarding the rule and again requested a delay in implementation given the very short notice to comply with the October 1 date and the need to collect further data during the AEP.

On August 8, NAHU responded to a request for information from CMS regarding various aspects of the Medicare Advantage program. In our response, NAHU made it clear that the Medicare marketing final rule issued in May would threaten the success of the Medicare Advantage program if implemented as written. To learn more about this response, click here.

On August 10, NAHU submitted a letter prepared by the the Agent Alliance to CMS Administrator Chiquita Brooks-LaSure regarding the agency's Medicare marketing final rule. As we state our letter, the final rule needlessly groups licensed and certified agents and brokers with unscrupulous third-party marketing organizations in its telephonic recording requirements.

NAHU submitted a letter on September 7 to the CMS Division of Surveillance, Compliance and Marketing. Despite repeated comments and inquiries by NAHU, CMS has yet to delay the rule or to provide guidance on its implementation ahead of this year’s AEP. If these requirements go into effect before the AEP, licensed agents and brokers will need guidance from the administration on how to comply with the regulations. Clear and concise answers to these questions posed in our new letter will provide clarity for the thousands of agents and brokers preparing for this year’s AEP. It will also provide NAHU with the insight necessary to create a library of resources for NAHU members who work with Medicare beneficiaries, so that you can be sure you are correctly complying with the new rule.

*NEW*  On September 19, long-time NAHU ally Senator Susan Collins (R-ME) sent a letter to CMS Administrator Chiquita Brooks-LaSure in regards to the Medicare marketing final rule. In her letter, Senator Collins acknowledges the problems with the final rule as it is written and requests that CMS provide clear guidance that will assist licensed agents and brokers in complying with these regulations.

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NAHU has released new, informative flyers for you and your Medicare clients, including the newest information on navigating enrollment periods. Click here to access them.

CMS, the federal agency that regulates the Medicare program, also regulates the Medicare’s Part C and D products you may be recommending to beneficiaries. NAHU will post compliance issues or other information you need to know as a Medicare specialists serving Medicare beneficiaries. If there is an issue or concern, you can contact us here.

COVID-19

Administration Drives Telehealth Services in Medicaid and Medicare

CMS expanded the list of telehealth services that Medicare Fee-For-Service will pay for during COVID-19. The agency is also providing additional support to state Medicaid and Children’s Health Insurance Program (CHIP) agencies in their efforts to expand access to telehealth. 

History of Observation Status and Current Developments, Including Suspension of 3-Day Rule Due to COVID-19

A recent news article on the JAMA Health Forum explored the recent history of and recent policy changes in hospital observation care payment policy and the 3-day rule brought about by the COVID-19 pandemic.

CMS Increases Medicare Payment for High-Production Coronavirus Lab Tests

Medicare will pay the higher payment of $100 for COVID-19 clinical diagnostic lab tests making use of high-throughput technologies developed by the private sector that allow for increased testing capacity, faster results, and more effective means of combating the spread of the virus. Medicare will pay laboratories for the tests at $100 effective April 14, 2020, through the duration of the COVID-19 national emergency.

CMS Issues Waivers of Observation Status Due to COVID-19

On March 14 2020, CMS issued two waivers to aid skilled nursing facilities in addressing the national COVID-19 outbreak. CMS is waiving both the 3-Day Stay and Spell of Illness requirements – nationally.

CMS Issues Guidance to help Medicare Advantage and Part D Plans Respond to COVID-19

On March 10, 2020 CMS issued guidance where they outlined the flexibilities MA and Part D plans have to waive certain requirements to help prevent the spread of COVID-19. 

CMS Releases Fact Sheet on Telehealth

On March 9, 2020, CMS released a fact sheet on telehealth, coverage and payment related to COVID-19.

General Medicare News

Medicare Advantage: Beneficiary Disenrollments to Fee-for-Service in Last Year of Life Increase Medicare Spending

The Government Accountability Office found that Medicare Advantage beneficiaries in the last year of life disproportionately disenrolled to enroll in fee-for-service, indicating possible issues with their care. Shifting end-of-life costs to fee-for-service increased Medicare spending by hundreds of millions of dollars.

Inspector General Warns About New Social Security Benefit Suspension Scam

Beneficiaries have been receiving fraudulent letters threatening suspension of Social Security benefits due to COVID-19 or coronavirus-related office closures. Social Security will not suspend or discontinue benefits because their offices are closed. Read more here.

NAIC and Medigap C & F

The Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”) prohibits new sales of Medigap Plans C and F for newly eligible beneficiaries beginning in 2020. NAIC outlines model regulation deadlines and requirements to states effective January 1, 2020.