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Enrollment - PowerPoint PPT Presentation

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Enrollment
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  1. CMS logo Enrollment Enrollment Processing and Guidance Updates Jim Slade and Patty Helphenstine September 5, 2012 Image of 5 medical staff

  2. End-of-Year Enrollment Processes • Review the HPMS memo scheduled for publication in mid September • Timeline • Rollover and Terminating Plan MARx Transaction Processing • Plan Reports and System User Interface (UI) Availability 2

  3. E O Y • Plan Submitted Rollover/Termination actions • Only for limited, approved scenarios • Will tentatively be due on October 9, 2012, by 5:00pm EDT (refer to memo for final date) • Do not submit your own rollover actions unless required to do so • Reconcile immediately 3

  4. January 1, 2013 Effective Date • MARx can accept January 1, 2013, effective dates as of October 6, 2012 • This operational timeframe does not change the AEP, which still begins on October 15 4

  5. Monthly Certification of Enrollment and Payment Data in HPMS • Background • Plans must certify their enrollment and payment data on a monthly basis • Before implementation of this change, it’s a hard copy process • Benefit • No more hard copy certifications 5

  6. Monthly Certification of Enrollment and Payment Data in HPMS • First certification due in HPMS on October 6, 2012, for August 22, 2012, monthly payment reports • Last certification using the old process is due September 8, 2012, for July 25, 2012, monthly payment reports 6

  7. Policy Clarifications for 2013 • Issued HPMS memorandum on August 7, 2012 • Clarified policies and adjusted models for MA and PDPs • Revised requirements in effect for enrollments having effective date of January 1, 2013, or later 7

  8. Policy Clarifications - SNPs • Verification of eligibility for a Special Needs Plan (SNP) is a required element of the enrollment application • Clarified that SNPs should consider enrollment requests incomplete until SNP specific eligibility is verified within “incomplete” timelines 8

  9. Policy Clarifications – Involuntary Disenrollment • All disenrollments made necessary because the plan or CMS determined the individual is no longer eligible to remain enrolled • All disenrollments for out of area, even if member tells plan of the move 9

  10. Policy Clarifications – Involuntary Disenrollment • Plans implementing failure to pay premiums disenrollment policy must apply equally to all members • Includes individuals initially in Direct Bill with Premium Withhold after enrollment • Direct Bill status months apply to plan’s grace period 10

  11. Policy Clarifications – New Enrollment Combination Notice • New optional model enrollment acknowledgement and confirmation notice for PBP changes within the same organization • Required to be sent within 7 calendar days of the TRR indicating CMS accepted the enrollment into the new PBP 11

  12. Policy Clarifications – Good Cause • Cases with NO Part D-IRMAA, plan must provide access to services when: • full payment of required amounts is received by Good Cause payment due date; • The plan is contacted by the CMS caseworker; OR • Receive notification of reinstatement on TRR • Cases with Part D-IRMAA, plan must provide access to services when: • Receive notification of reinstatement on TRR; OR • The plan is contacted by the CMS caseworker 12

  13. Policy Clarifications – Good Cause • Modified models for failure to pay premiums and disenrollment for non-payment of Part D-IRMAA • Ch. 2: Ex. 20, 21, 21a • Ch. 3: Ex. 20, 21, 21a • Included new referral to plan if member believes there was a mistake 13

  14. Policy Clarifications – Good Cause • Separated Good Cause information from situations of possible error • Simplified language on requesting Good Cause reinstatements • Removed MADP language in section regarding enrollment periods 14

  15. Policy Clarifications – Reinstatements • Modified Communication to be sent to member in response to TRC 713 • Use of Model Acknowledgement of Reinstatement notice • Ch. 2, Ex. 25a • Ch. 3, Ex. 22a • Includes information on plan premiums 15

  16. Part D-IRMAA Update • Improvements to premium payment processing are being made • Temporarily suspending Part D-IRMAA disenrollment’s for non-payment until improvements are complete • RRB disenrollments still occurring monthly • Monthly notices continue to encourage payment 16

  17. Questions? 17