CMS 2009 Commission Guidance

workingstiff

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The final regs were posted today, in a 45 page document.

If you are interested in reading them, visit the CMS.gov website. (I don't have enough posts to to post the clicky link.)


CMS ISSUES AGENT COMPENSATION REQUIREMENTS FOR MEDICARE ADVANTAGE AND PRESCRIPTION DRUG PROGRAMS

The Centers for Medicare & Medicaid Services (CMS) today issued revised compensation requirements for sales agents and brokers who sell Medicare Advantage and prescription drug benefit plan options to people with Medicare.

“The steps we are taking should help to make sure that brokers and agents are selling health or drug plans that best meet beneficiaries’ needs when open enrollment begins on November 15,” said CMS Acting Administrator Kerry Weems. “The rule we are issuing will help to resolve any confusion about how the private plans should implement compensation structures to meet those needs.”

This CMS interim final rule with comment period modifies regulations issued on Sept. 18, 2008. Those regulations established how health and drug plans should structure the compensation for agents and brokers by reducing existing financial incentives to enroll a beneficiary in a new plan based on the agent’s or broker’s financial interests rather than the beneficiary’s health care needs. The Sept. 18 regulations required that compensation be paid on a six-year cycle, comprised of an initial enrollment year and five renewal years, and that the renewal rate be paid for a beneficiary changing plans during the renewal years. Compensation includes commissions and bonuses as well as other incentives, such as sales awards.

The rule issued today revises the Sept. 18 regulations by:
  • Specifying that all compensation paid to agents and brokers reflect fair-market value based on the commissions paid in the past, adjusted for inflation for similar products in the same geographic area.
  • Requiring that renewal compensation be no more, or no less, than half of the compensation paid for that beneficiary in the initial year of the six-year compensation cycle established in the Sept. 18 rule.
  • Imposing similar limits on payments to organizations such as Field Marketing Organizations (FMOs). These entities are local or national companies that play an important role in helping plans market and sell their Medicare products by using agents and brokers. FMOs also train agents and brokers and help provide other services.
  • Requiring plans to submit to CMS their compensation structures for the previous three years plus the compensation structure they are implementing for 2009. That information must also be provided to agents, brokers, and other third parties under contract to sell their plans. Those rates or structures cannot be changed without prior CMS approval.
  • To prevent churning CMS is still requiring that plans initially pay renewal rate compensation in 2009 rather than the initial year compensation amounts for all plan changes. Once CMS identifies an initial commission was warranted, plans are to retrospectively pay agents and brokers an additional amount for a total payment of the initial compensation rate as filed with CMS.
Other rules from the Sept. 18, 2008, regulations still apply.

The interim final rule with comment period, Medicare Program; Medicare Advantage & Prescription Drug Programs: Clarification of Compensation Plans (CMS 4138-IFC2), is effective today, November 10, 2008. It will be was published in the Federal Register on November 14, 2008. Comments must be submitted by 5:00 p.m. Eastern Standard Time on December 15, 2008.
 
Looks to me like CMS is going to withhold first year commissions until they can determine whether the sale is a plan change, or not. That will take half a year... And, you mean to tell me CMS doesn't know what the carriers paid the last few years-- just who was it that APPROVED those commissions? And, last but not least, fair market? Are we selling commodities? :SLEEP:
 
[IMGREFLECT]
Looks to me like CMS is going to withhold first year commissions until they can determine whether the sale is a plan change, or not.
[/IMGREFLECT]

That's correct, unles you are enrolling someone in their IEP, or IECP, than the carrier should pay first year rates.

Also, CMS is saying that they will audit enrollments next year and periodically notify plans on which commissions should have been paid as first year.

On the flip side, it looks like they have backed away from mandating that plans pay commissions on an as earned basis and recover advanced commissions.
 
That's correct, unles you are enrolling someone in their IEP, or IECP, than the carrier should pay first year rates.

Also, CMS is saying that they will audit enrollments next year and periodically notify plans on which commissions should have been paid as first year.

On the flip side, it looks like they have backed away from mandating that plans pay commissions on an as earned basis and recover advanced commissions.
 
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This CMS crap is getting curiouser and curiouser. I think the Mad Hatter is running the show over there.

New regulations that get rescinded, then surface with new mandates. Their selling methods are silly. But when they mess with my pay check and maybe...just maybe...I don't get paid for several months...forget it.

Perhaps we should advertise our services to the public as advisors or consultants for a fee....and never write up any med advantage.
 
Wellcare paid $ 250 in 2006 in Ohio

And what did Humana pay their brokers and agents for the last 3 years?

What did the captive agent average over the last 3 years? Oh, they don't have to follow these new November 10th rules. Aren't they agents also? :goofy:
 
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