CMS Releases Details on Drug Plan Regulation
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."
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).