CMS Guidance to LTC Facilities on Disenrollment Issues

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Following is the link to the ‘CMS Memo to Long Term Care Facilities on Disenrollment Issues (05/26/15)’ referenced in the 5/28 MLN Provider eNews:

https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/Downloads/LTCFDisenrollmentMemo052615.pdf

This guidance was issued by CMS in response to complaints received from beneficiaries and their representatives alleging they have been dis-enrolled from their MAPD plan without their consent. “The discharged beneficiary finds out his/her Medicare Advantage (MA) coverage was terminated when he or she tries to access services and/or starts receiving bills for services that he/she believed the MAPD plan should cover.”  In addition, CMS and states have reportedly “…received mass requests, all initiated and completed by LTC facility staff, to opt out or dis-enroll LTC facility residents from MMP coverage under the Financial Alignment Initiative.”

In the guidance, CMS clarifies that, “Only a Medicare beneficiary, the beneficiary’s legal representative or the party authorized to act on behalf of the beneficiary under state law (collectively “the representative”) can request enrollment or voluntary disenrollment from a Medicare plan. This applies equally for beneficiaries receiving care in a nursing facility or skilled nursing facility…”

The guidance details the facility’s responsibility when a change in coverage is requested; the consequences of beneficiary disenrollment by a LTC facility; the 9-State demonstration under the Financial Alignment Initiative; enrollment periods; the Division of Medicare Health Plans Operation(DMHPO) responsibilities; and implications for noncompliance under survey and certification, i.e., citing relevant Residents Rights Requirements. (Evvie Munley, LeadingAge) 

 


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