Your Weekly Medicare Consumer Advocacy Update
Medicare Rights Submits Comments on CMS 2017 Call Letter
Medicare Rights Comments on CMS’ Proposed Changes to Medicare Advantage and Part D in 2017
Last week, the Medicare Rights Center submitted comments in response to the Centers for Medicare & Medicaid Services (CMS) 2017 Advance Rate Notice and draft Call Letter (2017 Call Letter) for the Medicare Advantage (MA) and Part D programs. The 2017 Call Letter proposes a variety of updates, including changes to payment methodologies designed to improve the accuracy of payments to plans serving beneficiaries dually eligible for Medicare and Medicaid, and modifications to payment structures for employer-sponsored MA plans. CMS also seeks comments on policies to improve the accuracy of MA plan provider network directories, Part D plan audits related to auto-forwarded appeals cases, and opportunities to improve beneficiary access to medications for people turned away at the pharmacy counter.
On the one hand, Medicare Rights’ comments are supportive of many of the proposed changes, which seek to improve the accuracy of payment structures and strengthen plan accountability. The comments express concern, on the other hand, about the lack of progress made on promised improvements to Part D coverage and appeals processes. Medicare Rights continues to hear from people with Medicare who face persistent confusion and challenges when denied access to a medication at the point of sale and encourages CMS to strengthen the Part D appeals process.
Medicare Reaches Key Payment Benchmark Almost a Year Ahead of Schedule
The Department of Health and Human Services (HHS) recently announced that it reached an important benchmark to tie 30 percent of Medicare payments to the quality of care delivered instead of the quantity of services provided. According to HHS, as a result “…over 10 million Medicare patients are getting improved quality of care by having more time with their doctors and better coordinated care.”
Through tools established by the Affordable Care Act (ACA), such as the Center for Medicare and Medicaid Innovation, various alternative payment models are currently being tested to give Medicare the ability to pay providers for high value care—meaning better quality care at a lower cost. Examples of these models include Accountable Care Organization (ACOs), advanced primary medical homes, and more recent models that bundle payments for “episodes of care.”
Prior to the ACA, Medicare paid next to nothing through alternative payment models, and in 2015 HHS set a goal to shift 30 percent of Medicare payments to the new models. According to HHS, as of January 2016, $117 billion out of $380 billion spent in the Medicare fee-for-services program are issued through alternative payment models.
“We reached this goal in partnership with the thousands of providers who collaborated with us in innovation,” said Dr. Patrick Conway, Deputy Administrator for Innovation & Quality and CMS Chief Medical Officer. “It’s in our common interest—as patients, providers, businesses, health plans, taxpayers—to build a health care delivery system that delivers better care; spends health care dollars more wisely; and makes individuals and communities healthier.”
Volume 7, Issue 7
Medicare’s General Enrollment Period (GEP) is coming to an end on March 31. If you did not enroll in Medicare when you originally became eligible for it, you can sign up during the GEP, which is from January 1st through March 31st of every year. Your coverage will begin July 1st of the year you sign up. You will have to pay a Part B premium penalty for every year you delayed enrolling in Medicare Part B.
A judge in the US District Court of Connecticut preliminarily approved a class action settlement about Administrative Law Judge (ALJ) hearing delays for Medicare beneficiaries. The fairness hearing will be held on May 31, 2016.
The proposed settlement in the case of Exley v. Burwell, 3:14-cv-1230 (JAM) (D. Conn.), addresses delays that Medicare beneficiaries have been experiencing at the ALJ level of review. The class includes any Medicare beneficiary who has requested an ALJ hearing but did not have a decision issued within 90 days of the date the request for a hearing was filed.
Among other things, the settlement calls for the Office of Medicare Hearings and Appeals (OMHA) to continue its policy of providing all beneficiary appellants with priority over other appellants in receiving ALJ decisions, to designate a Headquarters Division Director to oversee inquiries about appeals initiated by beneficiary appellants, and to address any complaints or questions concerning the processing of those appeals. OMHA will also establish a toll-free help line for beneficiary appellants to be answered by the Division Director’s staff. OMHA will also introduce a new, more user-friendly ALJ hearing request form that allows beneficiaries to self-identify, and will also publish data about the length of processing time for beneficiary appeals.