CMS Loosens Medicare Plan Outreach Rules

WASHINGTON BUREAU – The Obama administration now says Medicare Advantage carriers can communicate with enrollees about pending legislation – if the carriers first get enrollees’ permission to send them messages about legislative issues.

Medicare Advantage carriers also must get permission before sending enrollees requests to participate in grassroots advocacy efforts, and carriers must use their own money to finance any enrollee legislative outreach campaigns, according to Teresa DeCaro, acting director of the Medicare Drug and Health Plan Contract Administration Group at CMS.

Plan enrollees can provide consent for legislative outreach communications in writing, by telephone or through the Web, DeCaro writes in a memo issued Friday.

Carriers must agree not to use information collected in connection with legislative outreach efforts “to develop, market, or operate lines of business unrelated to their Medicare plan operations,” DeCaro writes.

CMS officials issued the memo as they were backing away from efforts to punish Humana Inc., Louisville, Ky., for a move to communicate with enrollees about the possible effects of health reform legislation on the Medicare Advantage program.

In September, Humana told 900,000 Medicare Advantage enrollees that pending legislation could lead to program cutbacks.

At the time, CMS infuriated health reform opponents and others by issuing what critics called a “gag order” barring Medicare Advantage carrier legislative mailings to plan enrollees.

CMS now has sent Humana a “notice of non-compliance” in response to the mailing.

CMS has concerns about the “inappropriate distribution of marketing material to Medicare enrollees in violation of your organization’s data use agreement with CMS, as well as statutory and regulatory authority and CMS marketing guidelines,” DeCaro writes in the notice.

A message on the envelope told recipients that the envelope contained “important information about your Medicare Advantage plan–open today!” Instead of providing information about Humana Medicare Advantage services, the September mailing “set forth Humana’s views on pending legislation, and called on beneficiaries to write their members of Congress,” DeCaro writes.

But the notice of non-compliance carries no sanctions, and CMS has dropped further efforts to punish Humana.