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Medicare Drug Program News
Medicare Reveals Steps Taken to Improve Service by
Drug Plans
Detailed data shows improvements in call center
wait times
June 30, 2006- Since January, Medicare has taken
more than 1,000 compliance actions to improve prescription drug plan
service to beneficiaries, and in most cases, these actions have resulted
in timely responses by the drug plans, according to the details of
actions taken by Medicare released yesterday.
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Cases when plans did not resolve issues promptly
have resulted in further enforcement actions to achieve compliance, such
as restricting plans’ ability to enroll beneficiaries. One plan with
recurrent service problems has been placed on a track that may result in
termination.
“People with Medicare should be confident that
their prescription drug plans are providing the highest level of care
available,” HHS Secretary Mike Leavitt said. “While most beneficiaries
report satisfaction with their coverage, we want to make sure that
beneficiary complaints are being addressed and resolved quickly.”
Mark B. McClellan, M.D., Ph.D., Administrator of
the Centers for Medicare & Medicaid Services (CMS) said “We are taking
actions to find and fix any problems that beneficiaries may have with
their drug plan delivering the level of service required by Medicare.
We have tens of millions of beneficiaries with drug coverage, we are
filling millions of prescriptions a day at a much lower cost than
expected, and we will remain vigilant about quality service throughout
the Medicare program.”
Medicare’s oversight has included monitoring the
performance of plans’ call centers. In a review of drug plan centers
conducted in April and May 2006, CMS and HHS found:
● 92 percent of all calls made to Medicare
prescription drug plans are answered within five minutes.
● The average wait time for a beneficiary help
line is less than one and a half minutes.
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CMS Says One Plan May Be Terminated, Critics Doubt
It |
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CMS on Wednesday for the
first time released details about agency efforts to regulate health
insurers for service problems related to Medicare prescription drug
plans and said agency officials have sanctioned plans more than 1,000
times this year, the
AP/Seattle Post-Intelligencer
reports.
According to CMS, agency officials have sent
warning letters -- the most common sanction -- 651 times and have
ordered health insurers to submit plans for service improvements in
areas such as response times at call centers 318 times.
In addition, CMS officials imposed more serious
sanctions, which involved temporary restrictions on marketing of
prescription drug plans on the Medicare plan finder tool, 75 times.
CMS officials also have sought to remove one health
insurer, America's Health Choice of Florida, from the Medicare
prescription drug benefit for continued "marketing violations." CMS
Administrator Mark McClellan said that AHCF has demonstrated "a
recurrent pattern of failure to comply," adding that "the plan ... may
well be terminated from the program."
McClellan also said, "When problems do occur, we
want to make sure we resolve them quickly. And if they aren't resolved
quickly, if our beneficiaries aren't getting the service Medicare
requires, then we are taking action to make sure the situation is
resolved or we take steps to get the plan out of the program."
However, Ron Pollack, executive director of
Families USA, said, "CMS is
clearly trying to make sure these private plans stay in the program." He
added, "The administration has bent over backwards to privatize the drug
benefit. It's for this reason that the insurance companies and private
plans know the Bush administration is very reluctant to impose strong
and effective remedies to cure ongoing problems" (Freking, AP/Seattle
Post-Intelligencer, 6/28).
"Reprinted with
permission from kaisernetwork.org You can view the entire
Kaiser Daily Health Policy Report, search the archives, and sign up
for email delivery at
www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser
Daily Health Policy Report is published for
kaisernetwork.org, a free service of The Henry J. Kaiser Family
Foundation. © 2006 Advisory Board Company and Kaiser Family Foundation.
All rights reserved.”
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CMS will continue to monitor plans to assure that
they maintain low wait times. Updated plan-by-plan reports on call
center performance will be reported by CMS ahead of the next open
enrollment period in the fall.
Medicare’s oversight actions begin with direct
contacts with drug plans, which usually result in resolution of the
problem. In cases where this action does not lead to timely resolution,
Medicare follows up with a formal notice to the plan. Since the drug
benefit began, Medicare has issued:
● 651 warning letters to plans, for topics such
as posting errors on the Medicare Personal Plan Finder;
● 152 notices of non-compliance, for topics
including failure to meet call center performance requirements,
particularly in the early months of the program; and
● 318 requests for specific business plans, on
topics such as improving call center performance and the submission of
correct information for the Medicare Personal Plan Finder.
In most cases, these compliance actions led drug
plans to resolve the problem. In cases where the plan does not
effectively resolve the issue, Medicare has taken further enforcement
action. These actions include:
Temporarily restricting plan marketing by removing
information about the prescription drug plan from the Personal Plan
Finder. Medicare has taken such action on 75 occasions, including
cases when plans continued to provide incorrect information about drug
prices and formularies.
Examples include failing to include required
drugs in the plan formulary lists, and restricting access to certain
drugs in circumstances where utilization management is not allowed (for
example, utilization management restrictions on certain drugs for
HIV/AIDS).
These actions to “suppress” plan marketing resulted in plans
taking action to correct the compliance problem.
Imposing a corrective action plan (CAP) on one
plan. This Medicare Advantage prescription drug plan was required to
submit the corrective plan to assure access to “transitional” coverage
of all current medications for new enrollees.
Pursuing the termination of an organization’s
prescription drug plan and Medicare Advantage plan contracts, for a
persistent pattern of failure to comply with Medicare requirements.
Plans are expected to work directly with
beneficiaries to resolve their complaints, but for cases where that does
not work, CMS has established a complaint tracking process for receiving
and resolving individual complaints about plan service. As part of this
process, CMS monitors the number and type of complaints from calls to
1-800-MEDICARE and those referred through CMS local offices. These
complaints may come from beneficiaries, family members, pharmacists, and
others who assist seniors and people with a disability.
In the past month, CMS has received approximately
2.2 complaints per 1,000 Medicare beneficiaries enrolled in prescription
drug plans. The complaint rate for stand-alone prescription drug plans
has averaged about 2.5 per 1,000 beneficiaries, and the complaint rate
for Medicare Advantage prescription drug plans has averaged about 1.6
per 1,000 beneficiaries.
Most of these involve complaints about
enrollment or disenrollment in a plan (the most common type in recent
months), complaints about difficulty in getting needed drugs, and
complaints about the cost of the drugs or incorrect co-pays at the
pharmacy counter. Patterns of complaints, and complaints that cannot be
promptly resolved with a drug plan, result in the further enforcement
actions described previously.
CMS will continue to monitor the performance of
Medicare prescription drug plans and expects to issue plan-level
information on complaints about beneficiary service beginning in
mid-July. Additional plan-level performance data will be issued well
before the annual open enrollment period begins on November 15.
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