Would alerting the public that a Medicare plan was hit with a fine be helpful for Medicare beneficiaries or just an unnecessary embarrassment for the health plan?
That’s a question the Medicare agency is pondering as it works to finalize 2019 guidance for the Medicare Advantage and Part D drug programs.
The Centers for Medicare & Medicaid Services has proposed a “civil money penalty” symbol or icon be placed next to the name of insurers that got one.
Plans can get the penalty for small and large missteps of program rules.
No word yet on what the symbol would look like but it probably won’t be attractive. The icon would be on the agency's Medicare Plan Finder, an online program that beneficiaries use to search for health plans. Medicare considers it one more tool to help beneficiaries make better informed choices on plans appropriate for them.
The large lobbying group for seniors said the symbol would showcase important differences among the available plan options. It recommended that Medicare start with consumer testing to ensure that the symbol is designed so that beneficiaries interpret it appropriately.
But plan representatives and their attorneys have a host of reasons why it’s a bad idea.
For example, Brian Dickerson, a partner in the Washington office of FisherBroyles LLP, said the icon could negatively affect negotiations between the agency and the penalized plan.
Currently, plans may want to negotiate a settlement in order to put the penalty behind them. But if there's potential for “branding” with the icon, the sponsor might try to fight the penalty rather than settle, he told me.
Some penalties are given for major violations resulting in enrollment freezes, and others are for minor violations resulting in a fine, the Pharmaceutical Care Management Association, a Washington-based trade association that represents pharmacy benefit managers, pointed out. Although penalties vary, there would be just one icon.
It’ll be a couple more weeks before we know whether the agency will go with the icon or side with the plans.
The final guidance will out be out in early April.
Read my full story here.
Stay on top of new developments in health law and regulation, and learn more, by signing up for a free trial to Bloomberg Law.
All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to firstname.lastname@example.org.
Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)
Notify me when updates are available (No standing order will be created).
This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to email@example.com.
Put me on standing order
Notify me when new releases are available (no standing order will be created)