Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

CMA Alert – Comments on MA Steering, Reimbursement Model; More Sabotage on the Way?

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  1. Advocates Raise Concerns About Inaccuracies and Bias in Draft MEDICARE & YOU Handbook
  2. Center for Medicare Advocacy Submits Comments to CMS about Direct Provider Contracting Proposal
  3. More Health Care Sabotage May Be Coming Soon if Short-Term Plans are Allowed

Advocates Raise Concerns About Inaccuracies and Bias in Draft MEDICARE & YOU Handbook

The Center for Medicare Advocacy, Justice in Aging and the Medicare Rights Center recently sent a letter to the Centers for Medicare & Medicaid Services (CMS) raising “strong objections to serious inaccuracies” in the draft 2019 Medicare & You Handbook, and urged CMS to rectify the errors prior to dissemination. 

As stated in a joint press release about the letter, without fair and accurate information, older adults, people with disabilities and their families cannot make informed choices about their Medicare and health care coverage.  The organizations assert that rather than presenting information in an objective and unbiased way, the draft Handbook’s information about traditional Medicare and Medicare Advantage (MA) distorts and mischaracterizes facts in serious ways.  For example, the draft Handbook:

  • Suggests that MA is the less expensive alternative for beneficiaries;
  • Fails to highlight the clear distinction between traditional Medicare and MA: Traditional Medicare provides access to all Medicare participating providers nationwide, while MA limits access to a set network of providers in a specific geographic area; and
  • Characterizes prior authorization requirements in MA plans, which are restrictions on access to services, as a benefit, rather than as what they are: Mandatory hurdles for MA members not required for individuals in traditional Medicare.

When counseling Medicare beneficiaries about their coverage options within the Medicare program, it is common to point out both the pros and cons of different choices, including the difference between traditional Medicare and MA.[1]  The language in the draft Handbook, following a recent trend (as discussed below), over-emphasizes the benefits of enrolling in an MA plan and minimizes the drawbacks, leaving readers with a misleading overview of the MA program. 

Recognizing the importance of the government presenting information about Medicare in an accurate and unbiased manner, a number of media outlets wrote about the groups’ concerns.[2]   For example, Phil Moeller from PBS stated that the draft Handbook “creates the impression that MA plans are less costly to seniors than original Medicare. This may or may not be true; it depends on the types of coverage selected and a beneficiary’s individual medical needs.”[3] Further, as noted by Bob Herman of AXIOS, “[h]ealth insurers and doctors wouldn't mind these changes because they could make their plans and practices sound more appealing to Medicare enrollees — potentially boosting their income.”[4]

Recent Pattern of Government Favoring MA Enrollment

As noted in an October 2017 CMA Alert, the Center wrote that official CMS Medicare Open Enrollment materials for 2018 – issued in Fall 2017 – tipped the scales to encourage beneficiaries to choose a private Medicare Advantage plan over original Medicare. 

On November 9, 2017, the Leadership Council of Aging Organizations (LCAO), a member coalition of the nation’s non-profit organizations serving older Americans, sent a letter about this issue to CMS and committees of jurisdiction in Congress.

The organizations listed in the letter wrote to express concerns that during the last Medicare open election period, CMS encouraged entities that assist Medicare beneficiaries with enrollment choices to disseminate information that was incomplete, biased towards Medicare Advantage (MA) and often failed to even mention traditional Medicare. The organizations urged CMS to take immediate corrective action to include and accurately portray the benefits and drawbacks of all coverage options in CMS materials. 

Instead of heeding such concerns, CMS has made such bias towards MA even more pronounced in the draft Medicare & You Handbook.

Such efforts to steer Medicare beneficiaries towards enrollment in MA plans is part of a larger pattern among policymakers and administrators to favor the MA program over traditional Medicare.  As the Center noted in a March 2018 CMA Alert, recent changes in law, regulation and sub-regulatory guidance combine to more broadly tip the scales in favor of Medicare Advantage v. traditional Medicare.

In an article discussing the draft Medicare & You Handbook, Reuters journalist Mark Miller stated:

the handbook problems fit a pattern in the Trump administration, which has taken a number of steps to impede the flow of unbiased health insurance assistance. The administration has twice proposed to eliminate federal funding for State Health Insurance Assistance Programs, which provide critical assistance to 3 million seniors annually with their plan selections, and it has slashed funding for consumer outreach and enrollment assistance for Affordable Care Act coverage.[5]

Conclusion

In our press release relating to the letter the Center, Justice in Aging and the Medicare Rights Center sent to CMS, we stated:

Medicare & You is the official government publication designed to provide beneficiaries with factual information about the Medicare program, their choices for obtaining coverage, and the benefits they can expect. Unfortunately, the draft 2019 Handbook includes inaccurate descriptions of the differences between original Medicare and private Medicare Advantage plans. Without fair and accurate information, older adults, people with disabilities and their families cannot make informed choices about their health care coverage.

The Medicare statute obligates the Secretary of Health and Human Services, and, by extension, CMS, to provide and promote accurate information about the Medicare program.  For example, 42 U.S. Code §1395w-21(d)(1) states: “The Secretary shall provide for activities under this subsection to broadly disseminate information to Medicare beneficiaries (and prospective Medicare beneficiaries) on the coverage options provided under this section in order to promote an active, informed selection among such options. [Emphasis added.]

Recent materials issued by CMS do not meet this criteria.  As journalist Miller notes, “[t]here is still time for Medicare to correct the problems – and CMS should play this straight. Medicare Advantage is doing just fine without using the handbook to tip the scales.”[6]  Given what is at stake for Medicare beneficiaries and the Medicare program, we urge CMS to heed this advice.

[1] See, e.g., the Center’s website at: https://www.medicareadvocacy.org/choosing-between-traditional-medicare-and-a-medicare-advantage-plan/;   also see the following Weekly Alerts – https://www.medicareadvocacy.org/10-questions-to-ask-before-deciding-between-traditional-medicare-and-a-medicare-advantage-plan/; and    https://www.medicareadvocacy.org/what-would-work-better-for-you-deciding-between-traditional-medicare-and-a-medicare-advantage-plan/.  
[2] See, e.g., Inside Health Policy, “Beneficiary Advocates Concerned Medicare Handbook Distorts Program In Favor Of MA” by Michelle M. Stein (5/18/18);  BNA's Health Care Daily Report, “Medicare Advocates: Handbook Slanted Toward Managed Care” by Mindy Yochelson (5/21/18) and BNA Health Care Blog, “Shining Some Light on Traditional Medicare”  by Mindy Yochelson (5/22/18), available at: https://www.bna.com/shining-light-traditional-b57982092796/; FierceHealthcare, “Advocacy groups blast CMS for incorrectly promoting MA plans, misleading beneficiaries” by Mike Stankiewicz (5/21/18), available at: https://www.fiercehealthcare.com/payer/cms-incorrectly-promoting-ma-plans-lying-to-beneficiaries-groups; AXIOS, “Subtle but consequential changes to Medicare's handbook” by Bob Herman (5/24/18), available at: https://www.axios.com/medicare-subtle-but-consequential-changes-to-handbook-1527102518-fd36b6da-af8b-4315-97b3-1160140bf1e1.html; Reuters,  “Ideology threatens to trump facts in official Medicare handbook” by Mark Miller (5/24/18), available at: https://www.reuters.com/article/us-column-miller-medicare/ideology-threatens-to-trump-facts-in-official-medicare-handbook-idUSKCN1IP2Z9;  PBS, “Senior advocates say new draft guide to Medicare distorts facts. Here’s what you need to know” by Phil Moeller (5/25/18), available at: https://www.pbs.org/newshour/economy/making-sense/senior-advocates-say-new-draft-guide-to-medicare-distorts-facts-heres-what-you-need-to-know; and Healthcare Dive, “CMS plugs Medicare Advantage in beneficiary handbook draft” by Meg Bryant (5/25/18), available at: https://www.healthcaredive.com/news/cms-plugs-medicare-advantage-in-beneficiary-handbook-draft/524349/.
[3] PBS, “Senior advocates say new draft guide to Medicare distorts facts. Here’s what you need to know” by Phil Moeller (5/25/18), available at: https://www.pbs.org/newshour/economy/making-sense/senior-advocates-say-new-draft-guide-to-medicare-distorts-facts-heres-what-you-need-to-know.
[4]AXIOS, “Subtle but consequential changes to Medicare's handbook” by Bob Herman (5/24/18), available at: https://www.axios.com/medicare-subtle-but-consequential-changes-to-handbook-1527102518-fd36b6da-af8b-4315-97b3-1160140bf1e1.html.
[5] Reuters, “Ideology threatens to trump facts in official Medicare handbook” by Mark Miller (5/24/18), available at: https://www.reuters.com/article/us-column-miller-medicare/ideology-threatens-to-trump-facts-in-official-medicare-handbook-idUSKCN1IP2Z9.
[6] Id.

 

 

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Center for Medicare Advocacy Submits Comments to CMS about Direct Provider Contracting Proposal

As discussed in a previous CMA Alert, the Centers for Medicare & Medicaid Services (CMS) recently issued a Request for Information on a proposal relating to “direct provider contracting” or “DPC” which, according to CMS, “would allow providers to take further accountability for the cost and quality of a designated population in order to drive better beneficiary outcomes.”

The Center submitted comments on May 25, 2018.   As an overarching comment, we noted that “the current proposal is so ambiguous that it is difficult to provide meaningful feedback and specific recommendations without more substance offered.”   

According to Politico Pulse (5/29/18), the Center and other beneficiary advocates were not alone in expressing concern about the vagueness of the proposal.  Reporter Dan Diamond noted that provider groups urged caution, and “CMS needs to either provide more detail about its proposed ‘direct provider contracting’ model or scrap it altogether, several influential groups told the agency.”

Later in the Center’s comments, we stated:

“CMS appropriately states that it ‘wants to ensure that beneficiaries receive necessary care of high quality in a DPC and that stinting on needed care does not occur.’  We appreciate this sentiment, but it does not necessarily mesh with the above-referenced guiding principle of ‘reducing regulatory burden.’  Often, what providers view as burdens, including notice, reporting and other requirements, serve as important oversight tools for the regulator and protections for consumers.  This or other models should not start from a premise of erasing existing rules in an effort to ensure maximum provider flexibility, then seek ways to potentially back-fill vital consumer protections by guessing about what safeguards should be put in place in an undefined model.” 

The Center expressed strong reservations about the proposal, but suggested that “should CMS move forward, at the very least, it must provide other, more fleshed out iterations on which to comment before proceeding further.”

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More Health Care Sabotage May Be Coming Soon if Short-Term Plans are Allowed

This week, Politico reported the President as saying "I have my two Alexes [Azar and Acosta]… coming out with plans that are phenomenal plans, phenomenal plans,” and that “They’ll be out over the next four weeks [and] it's going to cover a tremendous amount of territory." The report goes on to say that “Trump specifically mentioned association health plans…” and “The Trump administration also is expected to finalize its regulations on short-term health plans.”

We have previously highlighted how destructive these types of short-term, junk plans could be to both the individual and small-group markets, and the adverse impact on older consumers and those with disabilities. The expansion of Association Health Plans would weaken important consumer protections guaranteed by the ACA. These plans would also destabilize the market and raise costs for other consumers. Under a recently proposed rule, these plans could be treated like large employer plans, which don’t have to play by the same ACA coverage rules as the individual or small group markets.

Similarly, Short-Term Limited-Duration Insurance does not have to comply with ACA consumer protections. This so called “insurance” is junk coverage which offers nothing but minimal catastrophic protection for consumers. This “coverage” has high out of pocket costs, annual and lifetime limits, discriminates against individuals who need care the most, and doesn’t even cover basic health care services.

These plans are certainly not “phenomenal plans,” as touted by the President.

In a recent report showing the impact of Short-Term Limited-Duration Insurance and the repeal of the individual mandate, the Center for American Progress indicates that “Estimated premium increases due to these acts of marketplace sabotage average $1,013 nationally for benchmark premiums for a 40-year-old individual.”

We urge the Administration not to move forward with efforts to unleash these plans on the ACA Marketplace that would erode coverage protections, especially for individuals with complex care needs. 

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