CMS Weighs New Regulations for Medicare Advantage Plans

At a Senate Finance Committee hearing on Wednesday, acting CMS Administrator Kerry Weems said that the agency is considering new regulations for Medicare Advantage plan providers, CongressDaily reports.

Weems said CMS is considering regulations on how and where private insurance agents selling MA plans can contact beneficiaries, as well as on how companies handle agents' commission (Johnson, CongressDaily, 2/13).

Weems said that CMS has taken steps to correct marketing abuses by MA plan providers, including a "secret shopper" program launched last year to ensure that plans were complying with marketing guidelines. He said that the initiative uncovered 696 violations and that one private fee-for-service plan was placed on a marketing and enrollment freeze during the annual open-enrollment period. Two other plan providers were given corrective action plans, Weems said.

Finance Committee Chair Max Baucus (D-Mont.) and other lawmakers at the hearing called on Weems to allow states to have greater authority over MA plans, saying that state insurance commissioners have more firsthand knowledge about program abuses and can act more quickly to stop them. Weems said CMS and states share information about MA plans, but granting states authority would make MA more difficult to administer, and different regulations among states would make it more difficult for providers to offer MA plans across state lines (Carey, CQ HealthBeat, 2/13).

Baucus also questioned Weems about whether the agency would ban in-home marketing of MA plans and other aggressive sales tactics. Weems said, "I'm not going to say ... that we will ban absolutely in-home marketing," adding, "We are considering a range of things."

Baucus said that he intends to include new restrictions on private MA plans in Medicare legislation that also would stop a 10% cut to Medicare physician payments.

Sen. Olympia Snowe (R-Maine) said CMS should provide more data on MA plans, which are paid on average 12% more than traditional Medicare. Weems said CMS supports changing the law to require more reporting on MA plans.

Sen. Jay Rockefeller (D-W.Va.) also questioned Weems about an Aug. 17, 2007, policy directive that requires states to enroll 95% of children in families with incomes less than 200% of the federal poverty level before they can expand State Children's Health Insurance Program coverage to children in families with incomes greater than 250% of the poverty level (CongressDaily, 2/13).