Need to Know

from Asclepios Your Weekly Medicare Consumer Advocacy Update (Medicare Rights Center) October 30, 2008 • Volume 8, Issue 44 For at least three years, regulation of Medicare private health and prescription drug plans has been done pretty much on the fly. Typically, when the Centers for Medicare & Medicaid Services (CMS) discovers that private plans are not doing what they are supposed to, the agency makes it a requirement. Before the start of the drug benefit in 2006, CMS told plans it expected them to provide temporary supplies of drugs while people waited for the plan to approve coverage. When it became clear—after an outcry from advocates—that plans were not living up to CMS’s expectations, transitional policies became mandatory. Now plans have to “attest”—swear—that they will provide such transitional supplies, which can be a lifeline for someone trying to keep their diabetes, or blood pressure, in check. Just as often, CMS guidance is used to soften the rules. Insurance company lobbyists squawk at some requirement—special needs plans don’t want to call new enrollees’ doctors to verify they have the condition covered by the plan, for example—and CMS issues guidance that gives plans new flexibility. For the last week, plan representatives and members of Congress, insurance agents and social workers at senior housing complexes, have been waiting for new guidance from CMS on what plans will be allowed to pay as marketing commissions for 2009. The rules change every day. Even for the insurance companies, who get a constant stream of information from CMS over secure channels, it is tough to keep up. For everyone else, it’s impossible. CMS has no system for making new regulatory guidance covering “Medicare Advantage” and prescription drug plans publicly available. If people with Medicare, and their counselors and caregivers, can’t find out what their rights are, how can they demand that the plans respect their rights? If senior center directors can’t find out the new marketing rules that plans must follow, how can they make sure the marketing reps that visit their premises are playing by the rules? It is unacceptable to run the Medicare Advantage program and the Part D program according to rules that are not made available to the general public. We need to know.