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Medicare Rights Opposes Potential New Medicare Model that Puts Beneficiaries at Risk Last week, the Medicare Rights Center submitted comments to the Center for Medicare & Medicaid Innovation (CMMI) in response to a request for information on a potential new Medicare model. CMMI—an offshoot of the Centers for Medicare & Medicaid Services (CMS), which is the agency that oversees the Medicare program—was created to develop and test new ideas in health care delivery. Most of these ideas involve different ways of paying providers such as doctors or hospitals. In this request for information, CMMI asked interested parties to provide input on ways to design and test a model for Direct Provider Contracting (DPC). In a DPC model, a beneficiary could choose to join a primary care or specialty provider’s practice and potentially gain certain benefits such as reduced cost sharing or increased services that Medicare does not generally pay for. While this idea may be intriguing, CMMI did not provide any detail on how such a model would work, which

leaves some dangerous options on the table. For example, CMMI did not rule out a DPC model including what is known as “private contracting” or “balance billing.” If private contracting were permitted, Medicare providers would be allowed to require beneficiaries to negotiate individually for their care and to sign contracts obligating them to pay costs in excess of Medicare’s allowed fees. Beneficiaries would not be able to rely on current Medicare rules that set limits on what participating providers can charge. This means providers could charge whatever they chose, and some people with Medicare would be priced out of health care. Losing this essential protection is just one of the ways a DPC model could potentially put beneficiaries at risk. Another potential aspect of a DPC model—a per-person permonth or capitated payment— might encourage doctors and

hospitals to withhold care. With a capitated payment, as seen in most managed care plans, providers may have an incentive to provide less care because they are not paid more for additional services. We also spotted areas where a DPC model design might encourage providers to discriminate against people with poorer health or chronic conditions. It is important that models be designed so that there is no “cherry picking” of healthier patients to save money on care. These issues make it necessary for CMMI to ensure there is robust oversight of any DPC model. While Medicare Rights supports innovations in Medicare that increase access, quality, and affordability of care, we do not support ideas that strip beneficiaries of their fundamental protections, lead to worse outcomes, or increase costs. Because CMMI was not clear about what any future DPC model might include, we

responded to many potential ideas that were not necessarily being contemplated. In our comments, we urged CMMI to provide further opportunities to comment on DPC proposals as details are fleshed out. We also requested that CMMI engage Medicare beneficiaries in all levels of model design to ensure these vital voices are heard. We will continue to monitor and comment on model development to ensure beneficiaries have the protections they need in all aspects of the Medicare program. Read our comments. Read more about the request for information. Read more about consumer protections in CMMI models.

CMS Expands the Extension of Needed Relief for Marketplace Enrollees Who Missed Medicare Enrollment This week, the Centers for Medicare & Medicaid Services (CMS) expanded the timelimited equitable relief opportunity to people who are enrolled in Marketplace plans but could have enrolled in Medicare Part B during their Special Enrollment Period (SEP), which was available to them after they lost their or a spouse’s job-based insurance. Time-limited equitable relief lifts the burden of lifetime late enrollment penalties and gaps in health coverage for people with Marketplace plans who mistakenly missed signing up for Medicare.

Last October, CMS announced a yearlong extension of time-limited equitable relief, through September 30, 2018, a critical exception for certain Marketplace enrollees who delayed or declined Medicare enrollment. CMS’ decision to expand equitable relief will help even more people hampered by costly penalties and those going without needed health care. Medicare Rights applauds CMS for doing right by people new to

Medicare, and we look forward to working with our agency  Call the Medicare Rights partners, State Center’s free national Health helpline at 1-800-333-4114 Insurance Assistance Programs  Call the State Health (SHIPs), local Social Security Insurance Assistance Offices, and others to help Program (SHIP) at 1-877people access this critical relief. 839-2675 or visit the For more information on time-  Contact the Social Security limited equitable relief and how Administration at 1-800to apply, see Medicare Rights’ 772-1213, or go online resource, to, or  Medicare Interactive, and: visit your local Social  Read the Fact Security office Sheet updated by CMS

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RI ARA June 10, 2018 E-Newsletter


RI ARA June 10, 2018 E-Newsletter

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