Regulators critical of Medicare snags and no-show CMS

A representative from the Centers for Medicare & Medicaid Services was scheduled to dial in to a recent meeting of state regulators to hear concerns about Medicare administration.

But CMS never joined the call, which made regulators more annoyed.

“It's unfortunate CMS is not here to hear us,” said Martin Swanson, deputy director and general counsel for the Nebraska Department of Insurance.

Between 50% to 60% of older Americans are enrolled in some form of a Medicare Advantage plan, according to various sources. But many hospitals and health systems are ending their contracts with MA plans over issues like excessive prior authorization denial rates and slow payments from insurers.

In Nebraska, the Great Plains Health Innovation Network announced last summer that it would stop contracting with MA plans in 2025.

It caused “a ripple effect” throughout the state, Swanson said during the Senior Issues Task Force meeting, with some hospital systems following suit, while others remained in the MA market.

“We waited six months for a response from CMS on what to do,” Swanson said. “We're the ones that get the calls despite us not really having the jurisdiction over MA plans.”

The task force met during the National Association of Insurance Commissioners’ summer meeting in Minneapolis. A message seeking comment from CMS was not answered. The agency recently announced several rule changes.

MA availability concerns are not limited to Nebraska, said Shannon Hohl, market oversight bureau chief at the Idaho Department of Insurance.

“We just continue to have concerns overall with the direction of the Medicare Advantage programs, whether it is companies pulling out of areas or reducing their footprint in our state,” Hohl said. “At the same time, the growth in the market, the number of seniors moving in that direction [is increasing].”

Seniors are iffy on email

Andria Seip is a senior health policy specialist with the Iowa Insurance Division. She wanted to talk to a CMS representative about Plan Finder, a CMS-run comparison site that helps people eligible for Medicare evaluate and choose among different policies and plans.

Delivering a report for a colleague within Iowa’s senior health insurance program, Seip said Plan Finder failed users during the last open-enrollment period. Plan Finder booted people from certain zip codes out of the site, she said, and only one person could be logged into an account at once. Likewise, long-term care pharmacies are not listed.

CMS requires an email address for some aspects of being a Medicare client, and that is also causing headaches, Seip said.

“[I]n Iowa and rural Iowa, especially, there are a lot of seniors who just don't have email addresses,” she explained. “Maybe there are areas that don't have great internet.”

Joylynn Fixx, director of life and health for the West Virginia Offices of the Insurance Commissioner, said many senior citizens in her state "don't even know what an email is" and are forced to find a relative or a neighbor to help.

"I'm also frustrated about CMS," she added. "They can be here for all the other meetings, but they can't be here for this one. That's pretty telling.”

The task force voted unanimously to draft a letter of concern to send to CMS.

What is an SEP?

Ron Henderson, deputy commissioner for the Louisiana Department of Insurance, wanted to ask CMS to clarify what constitutes a Special Enrollment Period.

“We have agents who are changing our seniors into plans that don't benefit them, can't work, and their doctors are out of that network and that plan,” Henderson explained.

In general, an SEP is a window outside the standard open enrollment period when a person can sign up for, drop, or change a Medicare Advantage plan, Medicare prescription drug plan, or certain other CMS-administered coverage because of specific qualifying events.

Some LDI staffers are spending 60% to 70% of their day re-enrolling people in plans they were already in, or on the phones with CMS to get clients straightened out, Henderson said. It is often out-of-state agents who are convincing seniors to change their enrollment, he added.

“I wish CMS was here to answer those questions and give us some clarity as to when they're going to make it clear to these particular agents, ‘Hey, you guys can't do this,’” Henderson said.

The Louisiana senior health insurance program is 100% funded with a federal grant.

“Our commissioners have been very upfront about making sure we take care of our employees who work in our SHIP division,” Henderson said. “But what happens if that funding goes away? It is a big issue for us.”

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InsuranceNewsNet Senior Editor John Hilton has covered business and other beats in more than 20 years of daily journalism. John may be reached at [email protected]. Follow him on Twitter @INNJohnH.