Officials may also let Medicare agents ask about consumers'
financial concerns.
Medicare program managers want to give health
insurers more flexibility over pay for agents and brokers.
Officials at the Centers for Medicare and
Medicaid Services (CMS) have proposed lifting the current $100 limit on
Medicare Advantage plan enrollment fees.
Instead, an insurer would have to keep a
producer’s total Medicare plan sales compensation under the “fair market value”
compensation limit for the year. This year, for example, the annual producer
compensation limit for a Medicare Advantage plan enrollment in most of the
country is $510 for a new sale and $255 for a renewal sale.
Resources
·
An
article about Medicare Advantage plan agent and broker compensation summary
data is available here.
The proposed change would also apply to
producer compensation for sales of Medicare Part D prescription drug plans.
CMS would lift the prescription drug plan
referral fee limit, which is now $25.
Instead, a Medicare drug plan issuer would
have to keep all producer compensation for a sale, including referral fee payments,
under the fair market value limit, which is $78 per year for a new sale, and
$39 per year for a renewal sale.
The Packet
CMS announced the proposal last week, in
an 895-page packet of Medicare program draft regulations and regulation notes.
Along with the producer comp provisions, the
packet includes:
·
Rules related to
fighting opioid abuse.
·
Rules governing the
creation of new Medicare plan options for people with severe kidney disease.
·
An effort to increase
the importance of patient ratings and patient complaints in the Medicare
Advantage and Medicare drug plan quality rating programs.
·
A rule that will let a
Medicare Advantage plan make some of use of telehealth services providers to
meet provider network adequacy standards for enrollee access to dermatologists,
cardiologists, neurologists, ear doctors, and psychiatrists.
·
A requirement that each
Medicare drug plan issuer offer a ”beneficiary real-time benefit tool” by
Jan. 1, 2022.
The real-time benefit tool would give a drug
plan enrollee a simplified version of the drug benefits information that the
enrollee’s doctor sees.
CMS is preparing to publish the packet in the
Federal Register, the government’s official rulemaking publication, Feb. 18.
Comments on the draft regulations are due
April 6.
Medicare Plans
The Medicare Part A program covers enrollees
inpatient hospital bills.
The Medicare Part B program pays physician and
outpatient services bills.
Medicare Part C lets private insurers
offer consumers alternatives to using Original Medicare Part A and Part B
coverage as is. The biggest Medicare Part C program, the Medicare Advantage
program, provides access to plans that look somewhat like
employer-sponsored health maintenance organization, preferred provider
organization and fee-for-service plans.
The Medicare Part D program lets private plans
offer Medicare enrollees prescription drug coverage.
Medicare Producer
Compensation
CMS uses the terms “referral fee” and
“finder’s fee” to refer to money paid to an agent or broker in exchange for the
producer’s help with locating someone who needs Medicare coverage, without the
producer having to complete a sale.
CMS officials say in the introduction to the
new draft regulations that CMS uses the term “compensation” to refer to
commissions, bonuses, gifts, prizes, awards, and referral or finder fees.
“By eliminating the individual referral fee
limit, we are restructuring the regulation to only provide for referral fees
within the scope of fair market value,” officials say.
Officials acknowledge that efforts to regulate
referral fees generated a great deal of discussion in 2009, when they were
developing the official Medicare Advantage “call letter” for 2010.
“We solicit comment on whether removing the
limit on referral/finder’s fees would generate concerns such as those” that
cropped up in 2009, officials say.
“Fair Market Value”
Officials explain in the introduction to
the new draft regulations what the term “fair market value” means in connection
with Medicare plan producer compensation.
Medicare program managers based the
original Medicare Advantage fair market value producer comp caps on 19,000
producer compensation 2006 and 2007 records that plans submitted around 2008,
according to CMS.
The original Medicare Advantage plan cap was
$400 per year in most of the country.
Since then, CMS has adjusted the producer comp
caps for inflation using a Medicare Advantage “growth rate,” or inflation
adjustment rate.
CMS started out setting the Medicare drug plan
fair market value limit at $50 per year, and it has used a Medicare drug plan
inflation adjustment rate to adjust the drug plan fair market value limit for
inflation, officials say.
Medicare Communications & Marketing
Guidelines
CMS officials say they also want to put a
reorganized version of marketing rules given in a manual, the Medicare
Communications & Marketing Guidelines, into federal regulations.
“CMS does not intend to change policy
expressed in those regulations,” officials say.
But officials do define the term “marketing”
in the proposed regulations, and they list information about enrollee rewards
and incentives programs as a type of content that must comply with
CMS Medicare plan marketing guidelines.
The Medicare plan marketing guidelines apply
to any communications developed by the insurers’ “downstream entities,” such as
distributors or agents, but only the insurers, not the downstream entities, can
submit materials to CMS for review and approval for use, officials say.
CMS already has a regulation that keeps agents
and others from making unsolicited calls to Medicare plan enrollees. Officials
say they want to update that regulation to apply to unsolicited direct messages
from social media platforms.
In a section that updates the rules for
Medicare Advantage-related events and marketing appointments, CMS seems to make
room for Medicare Advantage agents to provide holistic reviews of consumers’
needs.
A Medicare Advantage agent may not “market
non-health-related products, such as annuities,” to consumers, according
to the draft regulations.
But an agent who has a personal marketing
appointment with a consumer may “review the individual needs of the beneficiary
including, but not limited to, health care needs and history, commonly used
medications, and financial concerns,” according to the draft regulations.
Allison Bell, ThinkAdvisor's insurance editor, previously was
LifeHealthPro's health insurance editor. She has a bachelor's degree in
economics from Washington University in St. Louis and a master's degree in
journalism from the Medill School of Journalism at Northwestern University. She
can be reached at abell@alm.com or on Twitter at @Think_Allison.
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