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

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 End-of-Year Enrollment Processes 2

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 E O Y 3

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 January 1, 2013 Effective Date 4

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 Monthly Certification of Enrollment and Payment Data in HPMS 5

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 Monthly Certification of Enrollment and Payment Data in HPMS 6

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

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

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

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

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

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

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

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

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

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

Questions? 17