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CMS May Share Medicare Program Oversight With States

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An official at the Centers for Medicare and Medicaid Services startled state regulators here Saturday by saying that her agency will consider sharing authority over Medicare Advantage marketing.

“You need to be specific about what you need,” said Abby Block, director of the Center for Beneficiary Choices at the CMS, which oversees the Medicare Advantage program. “But we seek a partnership, not a dueling relationship.”

Block made those remarks at a Medicare private plans subgroup session at the fall meeting of the National Association of Insurance Commissioners, Kansas City, Mo.

Block declared Sept. 11, at the newly formed Medicare private plans subgroup’s first public hearing, that state regulation of Medicare Advantage plans “is neither appropriate nor feasible.”

Block insisted at the private plans subgroup hearing that the federal government must maintain oversight over Medicare managed care programs.

“I see a little movement from Abby Block,” said Guenther Ruch, a Wisconsin insurance regulator who was chair of both the Sept. 11 private plans subgroup hearing and of the Sept. 29 subgroup session.

The NAIC formed the Medicare private plans subgroup in response to congressional hearings focusing on allegations that agents have sold private Medicare Advantage plan coverage to older consumers who did not understand what they were buying or could not afford the co-payments.

This weekend, before Block spoke at the second subgroup hearing, Evelyn Gay told hearing attendees about Medicare Advantage marketing problems in Georgia.

Gay, project director for the Georgia Legal Services Elder Rights Project, Garfield, Ga., said agents have been selling Medicare Advantage coverage to residents of group homes for people suffering from mental illness.

State insurance regulators have complained that federal preemption of Medicare Advantage plan marketing oversight has limited their ability to handle complaints about agents.

Block said this weekend that the CMS could have Medicare Advantage carriers submit lists of agents who have been barred from selling plan coverage as a result of carrier actions or CMS actions.

CMS officials could give the list of barred agents to the states and other Medicare Advantage carriers to keep problem agents from continuing their abusive practices at other carriers, Block said.

“We’ll evaluate it for awhile; give it a fair trial,” Block said.

If the agent list program fails to work, the CMS will look into the idea of permitting states to license Medicare Advantage plan agents, Block said.

Ruch, the Wisconsin insurance regulator, said states do not want “anything that interferes with CMS preemption authority.”

In addition to the ability to license Medicare Advantage agents, states will seek the ability to examine marketing plans and licensing along with the authority to conduct market conduct exams, Ruch said.

Block said the CMS will look into those requests.


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