Medicare Watch

Medicare Rights Submits Comments on 2013 Guidance to Medicare Private Health Plans

Last week, the Medicare Rights Center submitted comments on the 2013 Advance Notice and draft Call Letter, which governs Medicare private health plans, also known as Medicare Advantage (MA) plans, and Medicare prescription drug plans. Many of the comments focused on the Centers for Medicare and Medicaid Services’ (CMS) continued efforts to strengthen the quality of coverage offered under the MA and prescription drug programs. For example, Medicare Rights’ comments applauded CMS for a newly proposed Special Enrollment Period (SEP) that would allow individuals enrolled in a poorly performing plan to switch to a better performing plan at any time of the year. Under the proposed guidance, this SEP would only apply to people enrolled in plans that have had a rating of fewer than three stars for three consecutive years. In addition, individuals would only be able to switch into another MA plan. In its comments, Medicare Rights requested that the parameters of the SEP be expanded to apply to individuals in poorly rated plans regardless of how long the plan has had that rating, and to give individuals the option to switch to Original Medicare with a stand-alone Part D plan.

Medicare Rights’ comments also requested that CMS accept recommendations issued in recent reports by the Department of Health and Human Services’ Office of the Inspector General and the Government Accountability Office. The reports recommended, respectively, that CMS improve fraud detection and reporting by MA plans, and further correct medical coding differences between Original Medicare and MA plans that result in overpayments to private plans. In addition, Medicare Rights’ comments concentrated on new provisions of proposed regulations and Call Letter guidance that would allow certain Special Needs Plans (SNPs), specifically Fully Integrated Dual Eligible SNPs for people with both Medicare and Medicaid, greater flexibility in the extra benefits that they can offer. According to the Call Letter, these extra benefits may include community-based services such as meal delivery and adult day care services. Medicare Rights’ comments requested that CMS reconsider allowing such flexibility in 2013, citing the complexities in determining and administrating appropriate extra benefits. For example, extra benefits offered by plans might already be available as a result of other public programs, and would therefore be duplicative.

Read Medicare Rights’ comments on the 2013 CMS Call Letter for the MA and Medicare prescription drug benefit programs.

Read the 2013 Advance Notice and draft Call Letter.

Medicare Redesigns Notices to be More Beneficiary-Friendly

The Centers for Medicare and Medicaid Services (CMS) released a newly designed Medicare Summary Notice (MSN) this week. The MSN is a notice available online and sent quarterly by mail to individuals enrolled in Original Medicare. It lists the services an individual has received from doctors, hospitals or other health care providers. In redesigning the MSN, CMS has made information on the notice easier to understand. CMS hopes that the redesigned MSN will allow beneficiaries to better identify instances of fraud where Medicare was billed for a service that a beneficiary did not receive. The new MSN also provides clearer guidance on how to file an appeal if Medicare has denied coverage of a claim. For example, it now includes a page that can be filled out and mailed to Medicare if a beneficiary disagrees with a coverage decision that Medicare has made.

The redesign was the result of over 18 months’ worth of research, testing and collaboration with stakeholders, including the Medicare Rights Center, who provided feedback, including on the importance the MSN plays in the ability of Medicare beneficiaries to execute their appeal rights. Other improvements include larger font—making the notice easier to read—definitions of terms used in the notice and more consumer-friendly descriptions of medical procedures. The new MSN will go live on mymedicare.gov later this month and will begin its circulation by mail in early 2013.

Read the CMS press release on the redesigned Medicare Summary Notice.

View a side-by-side comparison of the former and new Medicare Summary Notices.

Medicare Reminder

How Original Medicare covers repairs and maintenance of durable medical equipment (DME) depends on who owns the equipment.

When the supplier owns the DME, the supplier is responsible for maintenance, repairs and replacement parts. While Medicare is paying the supplier a rental fee, the supplier cannot charge a separate fee for repairs and maintenance.

When you own the equipment, you are responsible for getting maintenance, repairs and replacement parts. Medicare will not pay anything for “routine” maintenance and servicing of DME, such as cleaning and checking the equipment. Medicare will pay 80 percent of the Medicare-approved amount for “non-routine” maintenance and repairs once you have met your deductible, as long as you go to a supplier who takes assignment. You will pay the balance if the repairs are not covered by a warranty.

For oxygen equipment, after your 36-month rental period ends, you will no longer have to pay a rental fee, but the supplier will continue to own the equipment. You can keep the DME for two additional years as long as it is still medically necessary. During this time, your supplier must keep your equipment in good working condition and provide supplies, parts and maintenance free of charge in most cases. You may be charged a fee under certain circumstances.

Learn more about Medicare coverage of DME repairs and maintenance at www.medicareinteractive.org

 

Spotlight

Are Americans getting a bad deal on their health care? According to a report recently released by the International Federation of Health Plans (IFHP), Americans paid more than the residents of 24 other developed nations for 22 out of 23 medical services and products. The IFHP’s findings help demonstrate that the rising costs of Medicare and Medicaid are not specific to these programs; rather, the root cause of the problem are the rapidly growing expenses in the health care sector overall.

Read the IFHP’s report.

Read Washington Post columnist Ezra Klein’s analysis of the IFHP’s report.

Read Washington Post columnist Ezra Klein’s response to readers’ comments on his original article.