Below is a letter California Health Advocates submitted to the Centers for Medicare and Medicaid Services (CMS) calling for the end of marketing and eventual elimination of D-SNP “look-alikes”. D-SNP look-alikes do not genuinely serve the needs of people on Medicare and Medi-Cal (also known as duals or dual eligibles) and interfere with the development of truly integrated products that are subject to specific rules and oversight. CHA also calls for further alignment of Medicare and Medicaid benefits and provides specific recommendations that would make the programs easier for beneficiaries to navigate and provides efficiencies for states and plans.
March 1, 2019
Centers for Medicare and Medicaid Services
P.O. Box 8016
Baltimore MD 21244-8010
Submitted electronically: regulations.gov
Re: CMS-2018-0154: Advance Notice of Methodological Changes for Calendar Year (CY) 2020 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2020 Draft Call Letter
California Health Advocates (CHA) appreciates the opportunity to provide comments on the above-referenced Notice. CHA is a not-for-profit organization dedicated to providing quality Medicare, Medicare Supplement, and long-term care insurance information, training, and education. CHA supports the local Health Insurance Counseling and Advocacy Programs (HICAP) with training, materials and technical assistance. HICAP is California’s State Health Insurance Assistance Program (SHIP).
Our comments address two issues: integration and D-SNPs; and alignment of Medicare and Medicaid benefits. They are based on our ongoing work with dual eligible beneficiaries and the issues we see them face on a daily basis.
We have very serious concerns about D-SNP look-alikes. We believe that CMS should do all that it can to stop the marketing of these products which do not genuinely serve the needs of duals and also interfere with the development of truly integrated products that are subject to specific rules and oversight. We have look-alike plans in our state and have experienced the following concerns:
- Beneficiaries and HICAP counselors are confused about these plans as they are identified in Medicare’s website Plan Finder as “Medicare Advantage” plans, not D-SNPs, yet they are marketed as similar to D-SNPs. Non dual-eligible beneficiaries are not interested in these plans because often they are too expensive.
- They create confusion for dual-eligible beneficiaries because they do not see any benefit to join these “look-alike” plans as they are not real D-SNPs.
- These plans do not coordinate with Medi-Cal (California’s Medicaid).
- Potential improper billing of co-pays for those dual eligibles who inadvertently enroll in one of these plans is a serious concern.
- They create further conflict in CCI demonstration counties because these “look-alike” plans do not coordinate with Medi-Cal as stated earlier. In addition, they could interfere with access to on-going coordinated healthcare coverage for critical treatments and access to participating providers and non-Medicare services such as transportation, CBAS, etc.
- They further complicate the work of HICAP counselors, most of them volunteers, who are dedicated to provide clear, unbiased, and informed choices to Medicare beneficiaries.
We urge CMS to work to eliminate look-alikes or curtail them as much as possible. We stress that the rise of look-alikes and their negative effects on beneficiaries and on integration efforts is the result of plan actions, not beneficiaries. Dual eligible beneficiaries in our state need clear, non-misleading choices that offer genuine benefits. D-SNP look-alikes instead confuse and can draw beneficiaries away from other options that may better meet their needs.
D-SNP Administrative Alignment Opportunities
We appreciate the commitment of CMS to continue to seek opportunities to create better alignment between the Medicare and Medicaid programs. Alignment makes the programs easier for beneficiaries to navigate and provides efficiencies for states and plans.
Our thoughts on alignment opportunities are based on the experiences in our state with D-SNPs and with the dual eligible demonstration currently underway.
Flexibility in design of integrated beneficiary communications: We appreciate the work that CMS is undertaking to develop simpler and more integrated documents to communicate benefit information to plan enrollees. The dual demonstration project in California has a robust, active and successful outreach and communications program. In counties where D-SNPs are present, HICAP counselors are able to explain the benefits of these plans and understand the importance of ensuring that beneficiaries understand the value of D-SNPs. Integrated clear messaging both by CMS and plan marketing is critical.
Alignment of supplemental benefits with Medicaid coverage: We have seen situations where supplemental benefits offered by D-SNPs or other Medicare Advantage plans have overlapped with Medicaid-covered services or otherwise created difficulties for individuals who also have Medicaid benefits. Beneficiaries are often confused about who will provide and cover their needed supplemental benefits, (e.g. dental, vision, hearing, transportation) normally covered by the state’s Medicaid.
Ombuds: The demonstration ombudsman program may have played an important role in helping beneficiaries navigate the program and in identifying systemic issues. As CMS moves forward with D-SNPs, having an ombuds program to assist D-SNP enrollees would also be very valuable. However, it is critical that the ombuds coordinates its mission and work with the local HICAP/SHIP. It is the “boots-on-the-ground” counselor that often is the one tackling the many issues that beneficiaries encounter with coverage and delivery of their healthcare.
Thank you for the opportunity to comment on the Call Letter.
Consultant & Training Specialist
California Health Advocates