FOR BREAKING NEWS VISIT www.qns.com SEPTEMBER 1, 2016 • HEALTH • The queens CourieR 53 ▶health Feds concerned over bad deals for Medicare & Medicaid patients Open enrollment for Medicare and Medicaid programs is approaching, and last month, the governing body overseeing both federal health care programs expressed concerns that some customers may be coerced into purchasing overly expensive health insurance marketplace plans. The Centers for Medicare & Medicaid Services (CMS) issued a request for information seeking public comment on concerns that some health care providers and provideraffiliated organizations may be steering people eligible for, or receiving, Medicare and/or Medicaid benefits into Affordable Care Act-compliant individual market plans, including Health Insurance Marketplace plans, for the purpose of obtaining higher reimbursement rates. CMS also sent letters to all Medicare-enrolled dialysis facilities and centers informing them of this announcement. The request for information and letters to providers focus on situations where patients may be steered away from Medicare or Medicaid benefits, which can, among other concerns, result in beneficiaries experiencing a disruption in the continuity and coordination of their care as a result of changes to their network of providers. “Ensuring access to high-quality patient care is a top priority for us. We are concerned about reports that some organizations may be engaging in enrollment activities that put their profit margins ahead of their patients’ needs,” said CMS Acting Administrator Andy Slavitt. “These actions can limit benefits for those who need them, potentially result in greater costs to patients, and ultimately increase the cost of Marketplace coverage for everyone.” “It is improper to influence people away from Medicare or Medicaid coverage for the purpose of financial gain,” said Shantanu Agrawal, M.D., CMS deputy administrator and director of the Center for Program Integrity. “Our goal is to protect patients from being unduly influenced in their decisions about their health insurance options, and to protect the integrity of all the programs we oversee.” Currently, third-party payment of premiums and cost sharing of qualified health plans in the individual market by health care providers such as physicians, medical facilities or affiliated nonprofit organizations are discouraged, but the ultimate decision about accepting those payments is left to health insurance companies. This guidance does not apply to certain federal, state or local government programs, Ryan White HIV/AIDS programs or Native American tribes, tribal organizations and urban Native American organizations, which are expressly permitted to pay insurance premiums for consumers under CMS regulations. Recently, concerns have been raised that certain providers or organizations affiliated with specific providers may steer consumers into individual market plans, including Marketplace health plans, because they would receive higher payment rates under a private plan than under Medicare or Medicaid. CMS is also considering potential regulatory and operational options to prohibit or limit premium payments and routine waiver of cost-sharing for qualified health plans by health care providers, revisions to Medicare and Medicaid provider enrollment rules, the imposition of civil monetary penalties for individuals that fail to provide correct information about consumers enrolling in a plan, and potential changes that would allow issuers to limit their payment to health care providers to Medicarebased amounts for particular services and items of care. bestof.qns.com Nominated for A QUEENS COURIER AND QNS.COM CONTEST Best Home Health Aides Vote for Us!
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