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CMS making changes for Medicare plans


CMS wants to reduce low-value plans and improve information systems to help seniors shop for the best coverage options

The Centers for Medicare and Medicaid Services (CMS) seeks to make it easier for beneficiaries to select appropriate coverage by reducing the number of low-enrollment plans and those with indistinguishable benefit options, according to Jonathan Blum, acting director of CMS's Center for Drug and Health Plan Choices, which governs Part C and D programs.

Two sponsors discontinued private fee-for-service (PFFS) offerings last spring, and more are expected to follow suit as new curbs on PFFS plans kick in for 2011. Even so, all parts of the country will have some Part C plans next year, Blum reported at last month's Medicare conference, sponsored by America's Health Insurance Plans.

A top CMS priority is to eliminate discriminatory enrollment and marketing activities. CMS is looking hard at insurer cost-sharing policies that impose high copays for services used by chronically ill patients. Plans have to communicate coverage and cost changes "in the most responsible way," Blum said, adding that CMS has its eye out for "bait-and-switch" sales ploys and has "diminished tolerance" for fraud and abuse.

The agency wants to ensure that capitated payments support high-quality benefits and appropriate coverage, and that benefits paid for are actually received by patients. More regulations governing Part C are in the works, with an eye to finalizing more consumer protection rules next year.

A related initiative is to evaluate payment policies to ensure that plans are paid accurately and fairly. While reform legislation could make significant changes in payments to MA plans, CMS intends to collect more data to determine how payment influences delivery of services and to ensure that appropriate payment policies lead to better outcomes.


Despite efforts to help seniors learn about appropriate plan coverage, CMS officials fear the abundance of coverage choices offered each year makes it difficult for beneficiaries to navigate the system. Blum said that CMS Web site tools provide too much information or may not provide the right information. The agency wants to assess what factors help a beneficiary understand coverage options and lead to enrollment in a certain plan, including the role of brokers and Web sites.

Seniors also may benefit from proposals to begin the annual open enrollment period earlier to avoid the end-of-year rush. Such a change would put pressure on CMS to distribute plan information earlier and would alter marketing and enrollment operations by insurers.

Efforts to improve the Medicare Web site and beneficiary information services on Part C and D coverage options provide a model for developing more extensive government-sponsored insurance exchanges, as proposed in reform legislation. CMS essentially operates an "exchange" for seniors, which illustrates the importance of accurate payment and benefit information and useful plan quality measures for beneficiaries to be able to navigate choices.

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