Helaine Fingold Quoted in “Major Changes to EOC Distribution Will Reduce Plan Burden”

AIS Health: Radar on Medicare Advantage

Helaine I. Fingold, Senior Counsel in the Health Care & Life Sciences practice, in the firm’s Baltimore office, was quoted in AIS Health: Radar on Medicare Advantage, in “Major Changes to EOC Distribution Will Reduce Plan Burden.”

Following is an excerpt:

Of the many plan-friendly changes CMS has made to the Medicare Advantage and Part D program for 2019 and beyond, the latest one is about to save organizations a lot of money and time … not to mention more than a few trees. That is the elimination of the requirement that plans produce and distribute hard copies of their annual evidence of coverage (EOC) documents containing detailed plan and benefits information. Icing on the cake is that they will have an extra two weeks to make those files available to beneficiaries, which will give plans more time to ensure accuracy and likely reduce the need to issue errata sheets, industry experts say.

According to a May 23 notice implementing changes finalized in the 2019 MA and Part D rule published in April, CMS gave plans the option to provide the EOC electronically for enrollee receipt no later than Oct. 15, 2018, when the Annual Election Period (AEP) begins. CMS clarified that the annual notice of coverage (ANOC), which informs enrollees of changes to their plan benefits for the upcoming contract year, must still be sent as a hard copy to enrollees by Sept. 30, when the EOC was formerly required to be in enrollees’ hands as well. Separating the dates of delivery so that the ANOC is received 15 days prior to open enrollment will allow enrollees to “focus on materials that drive decision-making during the AEP,” CMS suggested in the final rule.

“It’s not a huge area but it really is a significant change and shows CMS trying to bring Medicare and certainly the Medicare Advantage plans more into the electronic age,” remarks Helaine Fingold, a senior counsel in the Health Care and Life Sciences practice in the Baltimore office of Epstein Becker Green. “It’s definitely a win for plans.” …

CMS Will Expect More Accurate EOCs …

“CMS has always had an expectation of accuracy, so I believe that will continue,” weighs in Fingold. “They’ve always enforced and come after the plans when there have been errors regardless, so I think this gives the plans even less of an excuse. But CMS has always taken a hard line in addressing errors in these materials.”

And while the new electronic delivery option and extended deadline don’t necessarily come with new compliance risks, a potential challenge for plans will be how to communicate the changes to beneficiaries to avoid confusion and formal complaints.

“There may be complaints or things where people aren’t necessarily understanding the new approach; it might take some time for enrollees” to figure out how to obtain the document online or that they need to request a hard copy, suggests Fingold.

“You may have to make [the EOC] available on the 15th but enrollees can find their way to the website and may be looking for it on the 5th and calling to say they can’t find it. So, managing the enrollees’ expectations to make sure that they understand the timing and the process is probably going to be the largest challenge, and I think plans may want to do a little more handholding around those things,” she says.