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CMS Admonishes Facilities on Unauthorized Managed Care Disenrollments

The Centers for Medicare and Medicaid Services (CMS) issued guidance reminding long term care facilities that only a Medicare beneficiary or the beneficiary's legal representative may request enrollment in, or voluntary disenrollment from, a Medicare managed care plan. The guidance was issued in response to complaints from beneficiaries and their representatives, alleging that long term care facilities have disenrolled them from their Medicare Advantage Prescription Drug (MAPD) plans without their informed consent.

CMS noted that beneficiaries are discovering that their Medicare Advantage (MA) coverage was terminated when they try to access services and/or receive bills for services that should have been covered by the MAPD. In addition, the guidance reports that CMS and states have “…received mass requests, all initiated and completed by LTC facility staff, to opt out or disenroll LTC facility residents from Medicare-Medicaid Plan (MMP) coverage under the Financial Alignment Initiative.” (Memo to Long Term Care Facilities on Disenrollment Issues, 05/26/15).  

The guidance details the steps that should be taken when a change in coverage is requested and the consequences of improper beneficiary disenrollment by a long term care facility. In particular, CMS indicates that state survey agencies will be monitoring compliance with regulations applicable to unauthorized disenrollments, and that CMS will treat unauthorized disenrollments as fraud and abuse incidents and report them to the Medicare Drug Integrity Contractor.  

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383, ext. 24