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Medicare Compliance



CMS is the federal agency that regulates the Medicare program, including Medicare Part C and D, markets you may be assisting beneficiaries with coverage recommendations. 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.

NEW! CMS COVID-19 Guidance

CMS Issues Waivers of Observation Status Due to COVID-19

On March 14, 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, 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, CMS released a fact sheet on telehealth, coverage and payment related to COVID-19.

Error in Medicare Handbook Regarding Part B Special Enrollment

The 2020 edition of “Medicare & You,” the official U.S. government Medicare handbook, states:

“After your Initial Enrollment Period is over, you may have a chance to sign up for Medicare during a Special Enrollment Period. If you didn’t sign up for Part B (or Part A if you have to buy it) when you were first eligible because you’re covered under a group health plan (with 20 or more employees) based on current employment (your own, a spouse’s, or a family member’s (if you have a disability)), you can sign up for Part A and/or Part B. . . 

*Correction: Group health plans, for the purpose of Medicare Part B Special Enrollment Period eligibility, can be any size, and a beneficiary need not have been covered under a large group health plan to have the late enrollment penalty waived. NAHU has confirmed that this is an error exclusive to the printed “Medicare& You” handbook, and not a change in regulation.  The correct information is provided here on the CMS website.

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.

Medicare Plan Finder Updates from CMS

A first phase of improvements has been announced by CMS for the Medicare Plan Finder!

NAHU has been working continuously to advocate for improvements to the new Medicare Plan Finder, and CMS appreciates the comments they’ve received on the new tool. They are continuing to work on improvements for the upcoming Annual Enrollment Period, and have already announced a few updates to the system. More updates are expected in the coming weeks.

CMS released updated Q&As, now with this list of MPF improvements that are planned to be in place by the start of AEP on October 15, 2019:

  • Display drug tier costs
  • Link directly from MyMedicare.gov to new Plan Finder
  • Integrate partial gap coverage into cost sharing
  • Adding Original Medicare info and card for comparison
  • Add sort option for total cost (plan premium + drug costs)
  • Add footnote for excluded drugs
  • Maintain filters and SNP selections when using back button
  • Add option to add mail order on pharmacy selection page
  • Refine the ZIP code entry process
  • Show distinction between preferred in-network versus in-network pharmacy on the Costs-by-Phase table
  • Add note about over-the-counter drugs to drug lookup page
  • Add option to compare a third retail pharmacy when mail order isn’t selected
  • Improve Print Format
  • Various backend technical updates to prepare for display of 2020 plans

CMS has added several new resources to the Plan Finder page on their National Training website and encourage you to access these for information and training.  A few highlights to note: