PFFS Plans - STOP SELLING!

GreenSky

Guru
5000 Post Club
15,326
Henderson, NV
CMS has ordered all companies to cease writing PFFS plans until they comply with new regulations.

I received this:


<SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: Arial"><FONT face=Verdana><FONT size=2>Pyramid Life: Today’s Options has just informed us that CMS has ordered a temporary suspension of Medicare Advantage sales effective Friday, June 22. CMS is recertifying all companies to bring them all into compliance.
 

Attachments

  • Press Release 061507.pdf
    30.1 KB · Views: 28
I was just about to post on this subject.

The following companies have agreed to halt marketing PFFS plans for now:

Unitedhealthcare
Humana
Coventry
Sterling
Universal American Financial
Wellcare

According to Humana, all HMO and PPO plans will still be offered.
 
[FONT=Verdana, Arial, Helvetica, sans-serif]NRHA Testifies on Medicare Advantage PFFS Plans
Brock Slabach details concerns for rural seniors to powerful
[/FONT][FONT=Verdana, Arial, Helvetica, sans-serif]Ways and Means Subcommittee[/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif](Washington, D.C.) On May 22, NRHA board member, Brock Slabach, told the U.S. House Ways and Means Subcommittee on Health that certain rapidly growing Medicare plans impede access to health care in rural America. Mr. Slabach outlined the NRHA’s concerns for rural patients and providers alike over the growth of Medicare Advantage Private Fee-for-Service plans (PFFS) in rural America in his testimony before the committee.

[/FONT]​
[FONT=Verdana, Arial, Helvetica, sans-serif]"Rural Medicare beneficiaries deserve a Medicare plan that is sensitive to their needs and provides security to the fragile rural health care safety net," testified Mr. Slabach. He further stated that as these plans gain more and more market share in rural communities, "the consequences to rural health are potentially quite negative."

[/FONT]​
[FONT=Verdana, Arial, Helvetica, sans-serif]Mr. Slabach then outlined several of the NRHA’s concerns that Medicare Advantage PFFS plans harm rural seniors’ access to care, including concern that such plans often reimburse providers at rates far lower than under traditional Medicare. For example, numerous PFFS plans do not comply with the cost-based reimbursement requirements for Critical Access Hospitals established in the Balanced Budget Act of 1997. "These plans have the potential of completely undoing the reimbursement structure that Congress created," said Mr. Slabach.

[/FONT]​
[FONT=Verdana, Arial, Helvetica, sans-serif]Mr. Slabach also testified that PFFS plans are often confusing to seniors, contain gaps in coverage and are sold with questionable marketing tactics. "We can and must do better for our rural seniors," Slabach told the committee.

[/FONT]​
[FONT=Verdana, Arial, Helvetica, sans-serif]Private Fee-For-Service has experienced enormous growth following Medicare Advantage payment increases made by the Medicare Modernization Act of 2003. In 2003, less than 26,000 beneficiaries were enrolled in PFFS plans, but by April 2007 that number had exploded to nearly 1.5 million – a growth of more than 5600 percent. Though only a small percentage of rural Medicare beneficiaries are enrolled in Medicare Advantage Plans, the NRHA is concerned because enrollment has doubled in the last year, making rural enrollment one of the fastest growing demographics of MA plans.

[/FONT]​
[FONT=Verdana, Arial, Helvetica, sans-serif]Private Fee-For-Service plans are different from other MA plans. They are exempt from many of the rules and reporting requirements that apply to other MA plans. Additionally, MA Plans are paid on average 112 percent of fee-for-service Medicare. However, PFFS plans are located in geographic areas where payments are on average 119 percent of what it would cost to care for the same beneficiaries in traditional Medicare.[/FONT]​
[FONT=Verdana, Arial, Helvetica, sans-serif]Subcommittee Chairman, Fortney "Pete" Stark (D-CA) said, "the alarming growth in these overpaid plans … results in increased premiums for all Medicare beneficiaries and shortened solvency of the Hospital Insurance Trust Fund."

[/FONT]​
[FONT=Verdana, Arial, Helvetica, sans-serif]Mr. Slabach also outlined the NRHA’s recommendations and told the Committee that, as it works to modify the Medicare Advantage PFFS program, it must:[/FONT]​
  • [FONT=Verdana, Arial, Helvetica, sans-serif] Ensure that rural providers receive equitable reimbursements in amounts no less than they would be paid by traditional Medicare;[/FONT]
  • [FONT=Verdana, Arial, Helvetica, sans-serif] Require CMS to engage with rural health experts regarding how to determine and enforce rural community access standards and mandate MedPAC, which advises Congress on Medicare, to have proportional rural representation; and[/FONT]
  • [FONT=Verdana, Arial, Helvetica, sans-serif] Provide the Federal Office of Rural Health Policy expanded authority to provide technical assistance and outreach on ways rural providers can collaborate in the review of MA contracts. [/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]For complete testimony of the NRHA and other witnesses, http://waysandmeans.house.gov/hearings.asp?formmode=detail&hearing=561&comm=1
[/FONT]​
[FONT=Verdana, Arial, Helvetica, sans-serif]The NRHA is a national nonprofit organization, with nearly 15,000 members that provides leadership on rural health issues. The Association’s mission is to improve the health and wellbeing of rural Americans and to provide leadership on rural health issues through advocacy, communications, education, and research. The NRHA membership is made up of a diverse collection of individuals and organizations, all of whom share the common bond of an interest in rural health. Mr. Slabach also serves as hospital administrator of a critical access hospital and three Rural Health Clinics, all in Mississippi.[/FONT]​
 
I couldn't edit the original post to be more clear on who did what so thanks to everyone for filling in the blanks.

By the way, CMS designed the PFFS plans and approved them. Now they decided they don't like the way they are being sold.

Am I the only one who is fed up with the government providing healthcare? Medicare was and is a bad idea from the start. MA plans were even worse. When you combine Medicare with MA (effectively free visits to doctors), costs skyrocket.

Rick
 
Look at the bright side

Now folks will have to buy a medicare supplement, during the interim.

Sales will shoot up again, maybe co's will even give us better incentives, like bonuses or higher %.

Maybe we should telemkt existing MA's and convert them back to original Medicare. Oh what a mess that would be.....all those agents living on all those advances.

Wonder if there is a backlash from the medical community on MA's, and they are refusing the co-pays. That would cramp the PFFS big time.

Oh well...just found out that the ANY ANY pLAN IS paying commissions on apps in force Jan-Mar. Checks to post by Wed.
 
It looks like 7 companies will be halting the sales of their MA plans....I know there are more than 7 different MA companies.....do you think all of them will have to pull out until this gets straightened out?
 
It looks like 7 companies will be halting the sales of their MA plans....I know there are more than 7 different MA companies.....do you think all of them will have to pull out until this gets straightened out?

Definitely. Pyramid said ok to sell until 7/22 so I suspect the others are going to announce something similar on Monday.

This affects ALL companies writing PFFS plans.

And I just got a commission bump with Pyramid on Monday, just in time to NOT write any business.

I would not be surprised if the market stays shut until 2008 season.

Rick
 
I am so excited. I hope these plans go south so I can write TONS of med supp biz. O gosh, I cant wait, I knew this day would come. :D

Well, I hope they put a hault forever. I guess I shouldn't get my hopes up yet. I honestly doubt it was a voluntary hault. It is probably more like, "you either stop selling or we will make you stop selling. How do you want it to look in the press?"
 
Back
Top