FPCA UPDATE: Medicare, Medicaid and SCHIP Extension Act of 2007–September 26 Bulletin

The Centers for Medicare & Medicaid Services (“CMS”) has released the following informational papers related to Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (“SCHIP”):

• Group Health Plan (“GHP”) Data Elements: Who Must Be Reported?

• Registration Process For Section 111 Responsible Reporting Entities

• MMSEA Section 111 GHP PAPER Registration Process: Registration Attachment and Instructions for the for Current VDSA/VDEA Partners That are Section 111 Responsible Reporting Entities

To read past SCHIP updates or sign up to receive related bulletins, click here.

NAIC Issues Medicare Update

The National Association of Insurance Commissioners (“NAIC”) has released a White Paper on the regulation of Medicare private plans and Medicare Advantage and Medicare prescription drug plans.

The White Paper includes a detailed background and analysis of the issue, including recent efforts to strengthen marketing rules by Congress and CMS, as well as ongoing information-sharing efforts between the CMS and state insurance regulators.

A copy of the NAIC press release is reprinted below.

Should you have any questions or comments, please do not hesitate to contact Colodny Fass. 

Medicare White Paper Addresses Marketing Abuses

NATIONAL HARBOR, Md. (Sept. 24, 2008) – The National Association of Insurance Commissioners (NAIC) today adopted a white paper on the regulation of Medicare private plans – Medicare Advantage plans and Medicare prescription drug plans.

“State insurance regulators firmly believe that limiting the states’ regulatory authority over Medicare private plans has severely hurt consumers and has preempted the states from enforcing their laws regarding unfair trade practices laws,” said NAIC President and Kansas Insurance Commissioner Sandy Praeger. “In many cases, the states have been unable to address abuses in marketing and sales practices because they cannot properly assist consumers who file complaints about a plan sponsor.”

Since the enactment of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), a high number of troubling problems and abuses in the marketing and sales of Medicare private plans have been reported. The MMA included provisions that prohibited state regulators from holding plans accountable for their marketing practices, the acts of their agents or from providing assistance to consumers enrolled in Medicare private plans.

In response, the NAIC formed a subgroup to examine this issue and to develop a white paper on potential solutions. The white paper provides a wide range of suggested policy improvements intended to strengthen the marketing and sales of Medicare private plans.

Some of the suggestions made by state insurance regulators include:

• Roll back federal preemption provisions over MA and Part D plans to the way it was prior to the MMA, in order to allow states to better protect consumers.
• Discourage the use of vague and confusing plan names.
• Prohibit cross-selling on non-Medicare-related products (such as annuities, life insurance, etc.) during a Medicare private plans sales appointment.
• Prohibit cold calls in the marketing of Medicare private plans.
• Develop suitability standards in the sale of all Medicare private plans.
• Require agents and brokers to meet state continuing education requirements.

The white paper also includes a detailed background and analysis of the issue, including recent efforts to strengthen marketing rules by the Congress and U.S. Centers for Medicare and Medicaid Services (CMS), as well as ongoing information-sharing efforts between CMS and state insurance regulators.

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