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Preparing for the 2024 Annual Enrollment Period

Posted by www.psmbrokerage.com Admin on Thu, Sep 07, 2023 @ 03:58 PM

Prepare for AEP

Preparing for the 2024 Annual Enrollment Period (AEP) in the Medicare market requires strategic planning and a proactive approach to effectively meet the needs of beneficiaries. As this critical period approaches, there are several key steps to consider in order to maximize your success and provide valuable services to your clients.

First and foremost, staying updated on changes to Medicare regulations, plan offerings, and industry trends is paramount. The healthcare landscape is constantly evolving, and being well-informed positions you as a reliable source of information for beneficiaries seeking the right coverage. Attend seminars, webinars, and training sessions provided by insurance carriers to ensure you're up-to-date with the latest developments.

Reviewing your marketing and outreach strategies is essential to engage potential clients during the AEP. Refresh your online presence by updating your website, social media profiles, and other digital channels. Consider creating informative content such as blog posts, videos, and downloadable guides that address common questions and concerns about Medicare plans. Tailoring your messaging to highlight the advantages of different plans can help beneficiaries make informed decisions.

Focusing on compliance is also crucial during the AEP. Familiarize yourself with the Medicare Marketing Guidelines issued by the Centers for Medicare & Medicaid Services (CMS). These guidelines outline the dos and don'ts of marketing Medicare plans. Ensuring that your marketing materials are accurate, transparent, and compliant will maintain your reputation and prevent potential legal issues.

Lastly, anticipate the surge in inquiries and be prepared to offer personalized assistance to beneficiaries. Consider implementing systems to manage incoming queries efficiently, whether through your website, email, or phone. Providing clear and concise information, as well as addressing concerns promptly, can set you apart as a trustworthy advisor. By offering exceptional customer service, you'll establish strong relationships with clients that extend beyond the AEP.

By strategically approaching this period, you'll not only serve your clients effectively but also position yourself as a knowledgeable and reliable Medicare advisor.

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At PSM, we are committed to providing our agents with a range of resources and support to help them succeed. From personalized marketing materials to interactive sales strategies, our goal is to empower agents with the latest tools, technology and mentorship to achieve new levels of success this AEP.

AEP Resources:

Powerful Partnerships:

We are committed to providing our agents with a range of resources and support to help them succeed: Our powerful partnerships include:

Strong relationships with insurance carriers and industry experts to provide agents with access to the best products, tools, and support.

Capital infusion and acquisition strategies to help agents expand their business and reach their ultimate goals.

Dedicated service and mentorship from experienced professionals to help agents build a successful business.

Proprietary lead, training, marketing and enrollment platforms to streamline your sales process and business practices.

Compliance oversight to ensure agents are meeting regulatory requirements and operating ethically.

Succession planning and agency building support to help agents plan for the future and achieve long-term success.

AEP Helpful Guides:

AHIP Certificationmedicare enrollment periodsSEP Guide

Best Practices for Medicare Sales or Educational EventsSell Medicare Plans Onlinean agents guide to dual eligible special needs plans (DSNP) 

Cross-Selling Hospital Indemnity Plans GuideSelling Medicare Supplement PlansSelling Medicare Advantage Plans

We are here to support!

As a reminder, We pride ourselves on a "Do the Right Thing" approach and will go above and beyond to service the needs of our agents. We look forward to having a successful AEP and supporting you with products, technology and the personalized service you have come to expect from PSM. We appreciate the opportunity to earn your business and wish you the best!

 

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Tags: Medicare Advantage plans, CMS, AEP, medicare supplement insurance, Compliance, Marketing, Best Practices, 2024

Benefits of Using a Client Needs Assessment Form

Posted by www.psmbrokerage.com Admin on Mon, Aug 28, 2023 @ 09:18 AM

CNA The assessment form allows insurance agents to gather comprehensive information about the client. This information is crucial for guiding clients towards the most suitable plans. With a clear understanding of the client's needs, agents can recommend plans that align with the client's health requirements and preferences. This ensures that clients enroll in plans that cover their specific healthcare services and medications.

Want a custom version with your info and logo? Inquire with your Marketing Representative today and we would be happy to accommodate!

Step 1 - Collecting information through a CNA for all your clients is the optimal method to guarantee your ability to offer coverage options and plan selections that align with their present circumstances.

Step 2 - Engage in the CNA process to gain insights (or refresh your understanding) into your client's Medicare eligibility, existing coverage, and their primary concerns regarding their healthcare coverage.

Step 3 - Utilize the details gathered from the CNA, along with your discussion, to introduce potential plan choices that align with their particular requirements.

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By analyzing the assessment form, insurance agents can identify potential coverage gaps in a client's current or desired plan. This allows agents to suggest supplemental plans to fill those gaps. By involving clients in the assessment process, insurance agents educate them about different coverage options, and potential out-of-pocket costs. This empowers clients to make informed decisions about their healthcare.

 

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Tags: Medicare Advantage, Medicare Supplement, Medicare Part D, Professional Networking, Marketing

Your Guide to Marketing Medicare Plans in Your Community

Posted by www.psmbrokerage.com Admin on Thu, Aug 24, 2023 @ 12:49 PM

Medicare Marketing - LocalIn this guide we will explore some creative and effective marketing ideas to engage with your local community to build a formidable Medicare business. All while staying local and budget-friendly. Added bonus - Learn about a simple idea that is inexpensive and generates fantastic results. Download the guide today.

Building relationships and trust within your community is paramount. By demonstrating a genuine commitment to helping seniors find the right Medicare plans for their needs, you can establish yourself as a valuable resource and trusted partner in healthcare decisions.

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Tags: Medicare Advantage, Medicare Supplement, Medicare Part D, Professional Networking, direct mail, Seminar, Marketing, Local

Benefits of Taking Your Medicare Business Digital

Posted by www.psmbrokerage.com Admin on Mon, Aug 14, 2023 @ 01:43 PM

lEVEL uP

Selling Medicare insurance online offers a host of compelling advantages for both insurance agents and seniors alike. The digital platform provides a broader reach, allowing agents to connect with potential clients regardless of geographical boundaries.

This convenience extends to seniors, who can explore Medicare plans, compare options, and even enroll from the comfort of their homes, eliminating the need for in-person visits. The 24/7 availability of online resources ensures that information is accessible at any time, accommodating different schedules.

Additionally, the efficiency of online operations reduces overhead costs and paperwork, allowing agents to allocate resources more effectively. Through data-driven strategies, agents can deliver personalized recommendations based on clients' needs, enhancing their experience.

With real-time communication, rapid updates, and scalability, selling Medicare insurance online not only streamlines the enrollment process but also provides a dynamic and tailored approach that aligns with the digital age, benefiting agents and seniors alike.

Welcome to a NEW ERA in Medicare enrollment.

PSM has teamed up with SunFire to bring you a revolutionary new tool to write more Medicare business. With our all-inclusive platform, you can sell Medicare plans on your terms. Offer top carriers, receive the best commissions, all with industry-recognized service and support.

SunFire Enrollment Center-2

View our Medicare Solutions portfolio today:

Medicare Supplement Plans  |   Medicare Advantage Plans   |   Part D Prescription Plans

Discover an unparalleled array of valuable resources tailored exclusively for insurance agents serving the senior market. From personalized marketing materials to interactive sales strategies, our goal is to empower agents with the latest tools, technology and mentorship to achieve new levels of success. View Resources.

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Tags: Medicare Advantage plans, medicare supplement insurance, Marketing, Best Practices

Navigating Success: Best Practices When Selling Medicare Insurance to Seniors

Posted by www.psmbrokerage.com Admin on Mon, Aug 14, 2023 @ 01:21 PM

Best Practices - Medicare Sales

Selling Medicare insurance to seniors is a significant responsibility that requires a delicate balance of understanding, empathy, and expertise. As seniors approach retirement and healthcare becomes a central concern, your role in guiding them through their Medicare options is invaluable.

To excel in this field, here are essential best practices to consider:

1. In-Depth Knowledge: Medicare is a complex program with multiple parts and options. To gain seniors' trust, you must have a thorough understanding of the various plans, coverage options, enrollment periods, and eligibility criteria. Be prepared to explain these intricacies clearly and simply.

2. Educational Approach: Seniors may be unfamiliar with the nuances of Medicare. Offer educational resources, seminars, or workshops to provide insights into how Medicare works, the differences between Part A, B, C, and D, and the potential out-of-pocket costs. Empower them to make informed decisions.

3. Personalized Consultations: Every senior's healthcare needs are unique. Schedule one-on-one consultations to assess their medical history, current health conditions, and prescription drug requirements. This information will help tailor your insurance recommendations to their specific needs.

4. Build Trust Through Transparency: Honesty and transparency are crucial. Clearly outline the benefits, limitations, and potential costs associated with each Medicare plan. Highlight any potential gaps in coverage and explain how supplementary insurance, such as Medigap or Medicare Advantage, can fill those gaps.

5. Address Affordability Concerns: Many seniors are on fixed incomes, so cost considerations are paramount. Explain the cost structures of different plans, including premiums, deductibles, co-pays, and out-of-pocket maximums. Discuss ways to manage costs while ensuring comprehensive coverage.

6. Communicate Effectively: Seniors may have varying comfort levels with technology. Offer multiple communication channels, including in-person meetings, phone calls, and printed materials. Adapt your approach to their preferences to ensure clear and effective communication.

7. Emphasize Preventive Care: Seniors often prioritize maintaining good health. Highlight Medicare's emphasis on preventive services, wellness visits, and screenings that can help them proactively manage their well-being.

8. Address Prescription Drug Coverage: Many seniors rely on prescription medications. Explain how Medicare Part D covers prescription drugs and discuss the importance of enrolling in a plan that aligns with their medication needs.

9. Simplify the Enrollment Process: The enrollment process can be overwhelming. Provide step-by-step guidance to help seniors navigate the paperwork and deadlines associated with Medicare enrollment.

10. Showcase Your Expertise: Highlight your experience and expertise in the Medicare insurance domain. Share case studies or success stories that showcase how your guidance has benefited other seniors.

11. Stay Up-to-Date: Medicare regulations and policies evolve. Stay informed about the latest updates and changes to ensure your advice is current and accurate.

12. Offer Post-Sale Support: Your relationship with seniors doesn't end after they enroll in a Medicare plan. Be available to address their questions, assist with claims, and provide ongoing support as their healthcare needs evolve.

Selling Medicare insurance to seniors goes beyond selling a policy – it's about offering a compassionate service that enhances their quality of life. By demonstrating your deep understanding of their healthcare concerns, presenting clear options, and providing continuous support, you become a trusted partner in their healthcare journey. Remember, every interaction is an opportunity to make a meaningful difference in the lives of the seniors you serve.

 

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Tags: Medicare Advantage plans, medicare supplement insurance, Marketing, Best Practices

CMS Memo: Definition of Marketing

Posted by www.psmbrokerage.com Admin on Mon, May 15, 2023 @ 11:24 AM

CMS Memo- Definition of Marketing

Date: May 10, 2023

To: Medicare Advantage Organizations, Medicare Advantage-Prescription Drug Plans, Prescription Drug Plan Sponsors, and Section 1876 Cost Plans

From: Kathryn A. Coleman, Director

Subject: Definition of Marketing

📑 Download the official announcement

In order to ensure Medicare beneficiaries are making enrollment decisions based on up-to-date and accurate information, the Centers for Medicare & Medicaid Services (CMS) is issuing this memo to clarify the definition of marketing for Medicare Advantage-Prescription Drug Plans, stand-alone Prescription Drug Plans, 1876 Cost Plans, and Third-Party Marketing Organizations (TPMOs).

Regulations at 42 CFR §§ 422.2260 and 423.2260 define marketing as communication materials and activities which meet specific intent and content standards.

  • The intent component of the definition of “marketing” is met when any material or activity is intended to draw a beneficiary's attention to plan or plans, influence a beneficiary's decision-making process when selecting a plan, or influence a beneficiary's decision to stay enrolled in a plan (that is, retention-based marketing).

  • The content component of the definition of “marketing” is met when any material or activity includes or addresses plan benefits, benefits structure, premiums, or cost sharing; measuring or ranking standards; or rewards and incentives.

To date, CMS has permitted the mentioning of widely available benefits (i.e., vision, dental, premium reduction, and hearing) in materials or activities without those materials or activities being considered marketing subject to the marketing regulations. We did not believe the general descriptions were made with sufficient intent to draw attention to a particular plan or subset of plans. This interpretation was predicated on the assumption that a beneficiary would be unlikely to make an enrollment decision based on widely offered benefits advertised without information on the associated costs for enrollees. CMS monitors both organization and TPMO marketing by reviewing marketing and communication materials and activities, reviewing complaints received through 1-800-Medicare, and listening to marketing and enrollment calls.

Due primarily to the recent proliferation of TPMO advertising, we have found, however, through our surveillance, reviews, and discussions with interested parties that many beneficiaries do inquire and some enroll based on the original advertisement of these types of benefits. Beneficiaries have contacted agents, made calls to 1-800 numbers, and responded to flyers asking about the dental, vision, hearing, and cost-savings being marketed. Therefore, we are expanding our interpretation of the regulatory definition of “marketing” to include content that mentions any type of benefit covered by the plan and is intended to draw a beneficiary's attention to plan or plans, influence a beneficiary's decision-making process when selecting a plan, or influence a beneficiary's decision to stay enrolled in a plan (that is, retention-based marketing) and thus subject to review.

As stated above, marketing requires both intent and content. Content that beneficiaries can receive benefits such as dental, vision, cost-savings, and/or hearing services is sufficient information about plan benefits, benefits structure or cost sharing to meet the content standard in the definition of marketing in §§ 422.2260 and 423.2260. Further, the use of these statements in advertisements and activities directed to Medicare beneficiaries clearly meets the intent standard. Therefore, beginning July 10, 2023, any material or activity that is distributed via any means (e.g., mailing, television, social media, etc.) that mentions any benefit will be considered marketing and must be submitted into HPMS. This clarification, along with the new marketing safeguards codified in the Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly final rule (CMS-4201-F), will help ensure that beneficiaries have accurate information when shopping for Medicare coverage and are protected from potentially misleading marketing activities.

Questions may be sent to marketing@cms.hhs.gov. Please copy your Marketing Reviewer.

Tags: CMS, Compliance, Marketing

Lead Generation Advice for Today’s Savvy Agents

Posted by www.psmbrokerage.com Admin on Thu, May 11, 2023 @ 10:01 AM

Lead Generation Advice for Today’s Savvy Agents

The number one question facing agents in today’s complex lead generation environment is, “what lead generation technique is best?” What we’ve learned is that the most effective Medicare lead generation approach involves a smart mix of techniques to attract, engage, and nurture customers across a variety of channels. This approach ensures you are reaching customers in the places and spaces where they're most comfortable communicating. Remember: be where your customers are.

EMPATHY IS POWERFUL

The most successful agents start with a compassionate understanding of a customer’s life journey and demonstrate empathy and knowledge.

People eligible for Medicare can find navigating the process complex. Therefore, it's critical to employ a comprehensive approach to building a thoughtful content strategy to communicate and inform. Effective lead generation starts by providing your target audience with education. Approaching your content marketing strategy by understanding the customer journey and motivations puts you in a stronger position to answer the most meaningful questions.

YES! THE AGING POPULATIONS ARE ONLINE

Traditionally, conventional marketing materials such as direct mail, print ads, referral programs, and educational brochures were sent directly to the customer’s home address. TV or radio spots were market-specific, but still targeted customers in their hometowns. Over the past ten years, a different dynamic has emerged.

It’s no secret that the internet has changed everything, and social media platforms are now viewed as the primary source of mainstream news and information across all age demographics, even the aging population.

The adoption of social media by the aging population can supercharge your online marketing efforts when they are shared with your target’s entire social networks, exponentially expanding your potential customer base.

BE BOLD, GET CREATIVE!

Building a content strategy is the process of establishing your personal brand, defining your relationship goals with target audiences, and creating a plan to deliver valuable and engaging content.

There are six key steps in developing a robust, effective content strategy:

  1. Determine what you want to achieve with content and define your goals
  2. Identify what your customers are looking for and build your content around this critical question
  3. Review your existing content bank to identify what you can reuse to build credibility and bring customers into your funnel
  4. Create an annual content plan, and outline the types of content you'll create and the channels you'll use to distribute it
  5. Establish your space. With your plan in place, start creating your content. Make sure it is high-quality and engaging, and always relates back to your target audience
  6. Analyze and optimize: Regularly track and measure the performance of your content and adjust your content strategy based on these insights

Most agents make the mistake of thinking of offline and online marketing as two entirely separate marketing approaches. The most-successful agents understand that using precise online data is a force multiplier for boosting the effectiveness of traditional
Medicare lead generation campaigns.

IF YOU READ NOTHING ELSE, READ THIS!

  • Medicare lead generation isn't about whom you reach; it’s about what you teach
  • Understand your target audience and their life journey. Remember that a small amount of empathy and understanding will go a long way in relationship building
  • The most effective Medicare lead generation approaches involve a mix of techniques to attract, engage, and keep customers
  • Establishing an online presence is essential for any business looking to reach new customers
  • Creating a content strategy is the process of defining your goals and creating a plan to deliver valuable and engaging content to Medicare eligible customers
  • Think about data differently and apply it across all marketing efforts

 

 

Tags: Lead Generation, Marketing

New CMS Rules To Impact Medicare Advantage Marketing

Posted by www.psmbrokerage.com Admin on Thu, May 11, 2023 @ 09:02 AM

New CMS Rules To Impact

On Wednesday, April 5, the Centers for Medicare & Medicaid Services (CMS) issued long-awaited rules pertaining to, among other matters, the marketing of Medicare Advantage (MA) plans. These rules were developed with the intention of protecting Medicare beneficiaries from misleading or deceptive advertising practices. Our leadership quickly activated a task force to study the newly published rules in detail and clarify their implications for our agents' businesses.

The new rules go into effect on June 5 and will be applicable on Sept. 30 for coverage beginning January 1, 2024. This means that they will impact activities that will take place during this year’s Medicare Annual Enrollment Period (AEP), which begins on Oct. 15.

What can you do now?

While the new CMS rules are applicable on Sept. 30, there are steps agents and agencies can start right now.

  • Audit lead generation and marketing materials and evaluate against the newly issued CMS regulations. Lead generation and marketing materials include:
    • Internet ads
    • Direct mail pieces
    • Call scripts
    • Web pages
    • Emails
  • Identify marketing materials, including materials that mention plan benefits, premiums, and cost-savings; and evaluate.
  • Be cautious where the Medicare logo is used on any advertising or in a misleading manner when used for MA or PDP marketing.

PSM anticipates rolling out insight and guidance over the coming weeks. While these efforts are underway, please continue to adhere to current compliance guidelines and submit any marketing materials developed over the normal course of business through your usual approval processes.

Should you have questions related to the CMS announcement, please email them to info@psmbrokerage.com

 

 

Tags: Medicare Advantage, CMS, Marketing

2024 Medicare Advantage and Part D Final Rule (CMS-4201-F)

Posted by www.psmbrokerage.com Admin on Mon, May 01, 2023 @ 11:56 AM

1-Apr-13-2023-03-27-46-9666-PM

Background

On April 5, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that revises the Medicare Advantage (MA or Part C), Medicare Prescription Drug Benefit (Part D), Medicare Cost Plan, and Programs of All-Inclusive Care for the Elderly (PACE) regulations to implement changes related to Star Ratings, marketing and communications, health equity, provider directories, coverage criteria, prior authorization, network adequacy, and other programmatic areas. This final rule also codifies regulations implementing section 118 of Division CC of the Consolidated Appropriations Act, 2021, and section 11404 of the Inflation Reduction Act, and includes provisions to codify existing sub-regulatory guidance in the Part C, Part D, and PACE programs. 

In this final rule, CMS is not addressing comments received on the provisions of the proposed rule that we are not finalizing at this time. Rather, the agency will address them at a later time, such as in possible future rulemaking, as appropriate.

This fact sheet discusses the major provisions of the final rule. The final rule can be downloaded here: https://www.federalregister.gov/public-inspection/current.

Enhancements to Medicare Advantage and Medicare Part D

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Ensuring Timely Access to Care: Utilization Management Requirements

CMS has received numerous inquiries regarding the use of prior authorization by Medicare Advantage plans and the effect on beneficiary access to care. In the rule, CMS finalizes impactful changes to address these concerns and to advance timely access to medically necessary care for enrollees.

The final rule clarifies clinical criteria guidelines to ensure people with MA receive access to the same medically necessary care they would receive in Traditional Medicare. This aligns with recent Office of Inspector General (OIG) recommendations. Specifically, CMS clarifies rules related to acceptable coverage criteria for basic benefits by requiring that MA plans must comply with national coverage determinations (NCD), local coverage determinations (LCD), and general coverage and benefit conditions included in Traditional Medicare regulations. CMS is also finalizing that when coverage criteria are not fully established, MA organizations may create internal coverage criteria based on current evidence in widely used treatment guidelines or clinical literature made publicly available to CMS, enrollees, and providers. In the final rule, CMS more clearly defines when applicable Medicare coverage criteria are not fully established by explicitly stating the circumstances under which MA plans may apply internal coverage criteria when making medical necessity decisions. CMS believes that permitting the use of publicly accessible internal coverage criteria in limited circumstances is necessary to promote transparent, and evidence-based clinical decisions by MA plans that are consistent with Traditional Medicare.

The final rule also streamlines prior authorization requirements, including adding continuity of care requirements and reducing disruptions for beneficiaries. CMS’ final rule requires that coordinated care plan prior authorization policies may only be used to confirm the presence of diagnoses or other medical criteria and/or ensure that an item or service is medically necessary. Second, this final rule requires coordinated care plans to provide a minimum 90-day transition period when an enrollee currently undergoing treatment switches to a new MA plan, during which the new MA plan may not require prior authorization for the active course of treatment. Third, to ensure prior authorization is being used appropriately, CMS is requiring all MA plans establish a Utilization Management Committee to review policies annually and ensure consistency with Traditional Medicare’s national and local coverage decisions and guidelines. Finally, to address concerns that the proposed rule did not sufficiently define the expected duration of “course of treatment,” the final rule requires that approval of a prior authorization request for a course of treatment must be valid for as long as medically reasonable and necessary to avoid disruptions in care in accordance with applicable coverage criteria, the patient’s medical history, and the treating provider’s recommendation.

Together, these changes will help ensure enrollees have consistent access to medically- necessary care while also maintaining medical management tools that emphasize the important role MA plans play in coordinating medically-necessary care.

2-Apr-13-2023-03-29-48-0508-PM

Protecting Beneficiaries: Marketing Requirements

The final rule also takes critical steps to protect people with Medicare from confusing and potentially misleading marketing while also ensuring they have accurate and necessary information to make coverage choices that best meet their needs. The proliferation of certain television advertisements generically promoting enrollment in MA plans has been a specific topic of concern. To address these concerns, CMS is prohibiting ads that do not mention a specific plan name as well as ads that use words and imagery that may confuse beneficiaries or use language or Medicare logos in a way that is misleading, confusing, or misrepresents the plan. In the rule, CMS also reinstates important protections that prevent predatory behavior and finalized changes that strengthen the role of plans in monitoring agent and broker activity. CMS is also finalizing requirements to further protect Medicare beneficiaries by ensuring they receive accurate information about Medicare coverage and are aware of how to access accurate information from other available sources.

CMS is finalizing 21 of the 22 provisions we proposed, with 17 of the 21 provisions being finalized as proposed. The four provisions CMS is finalizing but modifying include: permitting agents to make Business Reply Cards available at educational events; requiring an agent to tell prospective enrollees how many plans are available from the  organization for whom the agent sells; extending the length of time agents are able to re-contact beneficiaries to discuss plan options to twelve months; and allowing an agent to meet with a beneficiary without waiting the full 48-hour cooling off period when the timeframe runs up against the end of an election period, or a beneficiary faces transportation or access challenges, or the beneficiary voluntarily walks into an agent’s office. CMS will continue to explore including the provision that is not being finalized in this rule in possible future rulemaking.

3-Apr-13-2023-03-30-01-6709-PM

Strengthening Quality: Star Ratings Program

CMS continues improvements to the Star Ratings program by finalizing new methodological enhancements to further drive quality improvement for all enrollees. In this rule, CMS finalizes a health equity index (HEI) reward, beginning with the 2027 Star Ratings, to further encourage MA and Part D plans to improve care for enrollees with certain social risk factors. CMS also reduces the weight of patient experience/complaints and access measures to further align with other CMS quality programs and the current CMS Quality Strategy. In addition, CMS includes an additional rule for the removal of Star Ratings measures and removes the 60 percent rule that is part of the adjustment for extreme and uncontrollable circumstances. The changes will further drive quality improvement and health equity in MA and Part D.

Advancing Health Equity

CMS is committed to advancing health equity for all, including those who have been historically underserved, marginalized, and adversely affected by persistent poverty and inequality.[1] CMS is clarifying current rules, expanding the example list of populations that MA organizations must provide services in a culturally competent manner. These include people: (1) with limited English proficiency or reading skills; (2) of ethnic, cultural, racial, or religious minorities; (3) with disabilities; (4) who identify as lesbian, gay, bisexual, or other diverse sexual orientations; (5) who identify as transgender, nonbinary, and other diverse gender identities, or people who were born intersex; (6) who live in rural areas and other areas with high levels of deprivation; and (7) otherwise adversely affected by persistent poverty or inequality.

Studies demonstrate low digital health literacy, especially among populations experiencing health disparities, continues to impede telehealth access and worsen care gaps particularly among older adults. CMS is finalizing requirements for MA organizations to develop and maintain procedures to offer digital health education to enrollees to improve access to medically necessary covered telehealth benefits. In addition, CMS is enhancing current best practices by requiring MA organizations to include providers’ cultural and linguistic capabilities in provider directories. This change will improve the quality and usability of provider directories, particularly for non-English speakers, limited English proficient individuals, and enrollees who use American Sign Language. Finally, CMS is requiring that MA organizations’ quality improvement programs include efforts to reduce disparities.  

Improving Access to Behavioral Health

CMS recognizes the importance of building strong MA behavioral health networks that improve timely access to services. CMS is finalizing policies strengthening network adequacy requirements and reaffirming MA organizations’ responsibilities to provide behavioral health services. Specifically, CMS will: (1) add Clinical Psychologists and Licensed Clinical Social Workers as specialty types for which we set network standards, and make these types eligible for the 10-percentage point telehealth credit; (2) amend general access to services standards to include explicitly behavioral health services; (3) codify standards for appointment wait times for primary care and behavioral health services; (4) clarify that emergency behavioral health services must not be subject to prior authorization; (5) require that MA organizations notify enrollees when the enrollee’s behavioral health or primary care provider(s) are dropped midyear from networks; and (6) require MA organizations to establish care coordination programs, including coordination of community, social, and behavioral health services to help move towards parity between behavioral health and physical health services and advance whole-person care.

Implementation of Certain Provisions of the Consolidated Appropriations Act, 2021 and the Inflation Reduction Act of 2022

The final rule also makes changes to the Part C and D programs stemming from the Inflation Reduction Act (IRA) of 2022 and the Consolidated Appropriations Act (CAA), 2021.

Making Permanent: Limited Income Newly Eligible Transition (LI NET) Program

LI NET currently operates as a demonstration program that provides immediate and retroactive Part D coverage for eligible low-income beneficiaries who do not yet have prescription drug coverage. In this final rule, CMS is making the LI NET program a permanent part of Medicare Part D, as required by section 118 of the CAA.

Enhancing Financial Stability: Expanding Low-Income Subsidies Under Part D

CMS is finalizing regulations to expand eligibility for the full low-income subsidy (LIS) benefit (also known as “Extra Help”) to individuals with incomes up to 150% of the federal poverty level who meet eligibility criteria. Beginning January 1, 2024, this change will provide the full low-income subsidy to those who currently qualify for the partial subsidy. This implements section 11404 of the IRA and will improve access to affordable prescription drug coverage for approximately 300,000 low-income individuals with Medicare. 

Implementation of Certain Provisions of the Bipartisan Budget Act of 2018 and the Consolidated Appropriations Act, 2021

Finally, the rule finalizes several changes stemming from federal laws related to the Part C and D programs—including the Inflation Reduction Act (IRA) of 2022, the Consolidated Appropriations Act (CAA) of 2021, and the Bipartisan Budget Act (BBA) of 2018.

Source: https://www.cms.gov/newsroom/fact-sheets/2024-medicare-advantage-and-part-d-final-rule-cms-4201-f 

 

 

Tags: Medicare Advantage, Medicare Part D, CMS, star ratings, Marketing

Come see PSM at the 2023 Medicarians Conference

Posted by www.psmbrokerage.com Admin on Thu, Apr 20, 2023 @ 11:13 AM

medicarians-1

WHAT IS MEDICARIANS

THE FUTURE OF SENIOR HEALTH, WEALTH, AND AGETECH
__________________________

image-png-Apr-20-2023-03-36-26-3518-PMMedicarians is the home of the product creators, distributors, provider networks, plan administrators, venture investors, and innovators helping the people live longer, better lives both physically, financially, and mentally. https://medicarians.com/ 

WHO SHOULD ATTEND

Brokers, Agencies & Distribution Partners

•  Network with product owners and administrators in health, wealth, and aging
•  Develop partnerships with leading participants in the industry
•  See what tools and technology can accelerate your business

 Startups, AgeTech Innovators, and Technology Providers

•  Gain visibility into what the leading players in senior care and aging seek
•  Meet thought leaders and leave with deep insight into the forces shaping the industry
•  Understand the competitive landscape to position yourself for success
VENUE
MEDICARIANS 2023 WILL TAKE PLACE AT THE MGM GRAND HOTEL IN LAS VEGAS, NEVADA.

The Medicarians hotel room block at the MGM Grand is now full. But, rooms are still available at the MGM Grand as well as The Signature at the current public rate.

 

Tags: Medicare Advantage, Medicare Part D, Professional Networking, CMS, star ratings, Marketing

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