August 1, 2022
In This Issue
The Omnipod: Covered under Part B or Part D?
Helping Your Medicare Clients Understand and Utilize their Prescription-Drug Benefits
IRMAA: Billing Confusion Part 2 and Handy FAQs to Use with Your Clients
New Symposium Announced
Government Affairs Report
Did You Know?
Helpful Hints

•  August 2: Kentucky AHU Medicare Summit
•  August 22-24: Florida AHU Medicare Symposium
•  August 23: Alabama AHU Medicare Summit
•  August 23-25: Senior Summit Live
•  August 24-25: Minnesota AHU Medicare Summit
•  September 15: Metro Detroit AHU Medicare Summit
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Government Affairs Report
by John Greene

Legislative Update
We are working with Rep. Kurt Schrader to schedule a time to introduce his bill to address COBRA as creditable coverage. We have cosponsors lined up in three committees of jurisdiction to launch introduction. We do not have a Senate companion bill, but we expect to have an opportunity to add this provision to an Omnibus bill at the end of the year.

The observation status bill, H.R. 3650 in the House and S. 2048 in the Senate stand a better chance of making the cut at the end of the year as part of the Omnibus package because the bills are bipartisan and identical in the House and the Senate.  While this has scored high in terms of the cost to the federal government in the past, new evidence shows that beneficiaries who are admitted under observation status tend to repeatedly cycle through the hospital and cost Medicare more than those who receive the skilled nursing care they need. We are hopeful that this new evidence will offset other costs and allow the bill to move forward.

We are still working with legislators on a bill to equalize the consumer protection for Part D beneficiaries for an OEP. It has been coming together and we hope to have an opportunity to include this as part of the end of year package. CMS has indicated that they can implement this quickly so we would hope for an early effective date.

Regulatory Update
Advocates, SHIP and agents have decried the T.V. ads for years for the misleading claims they make. The Joe Namath ads are reviled and have become the poster child for misleading seniors into contacting call centers that switch the beneficiaries into plans that may not fit their needs. CMS released a proposed rule, CMS-4192-P, CY 2023 Medicare Advantage and part D Proposed Rule which included a provision on Marketing and Communications Oversight. NAHU convened the FMO Council to discuss the proposal to require agents to record enrollment encounters and particularly, the definition of Third-Party Marketing Organization (TPMO) which in the proposed rule included agents. It was clear the this was the key to the underlying rule. In our response letter on March 7, we discussed the role of the independent agent and how the new definition of TPMO did not fit the role of the agent or address the root cause of complaints associated with the ads marketing plans.

Following the release of the final rule, NAHU again convened the FMO Council to discuss the final rule and began discussions with CMS officials on the rule. On July 11, NAHU sent a letter to CMS Administrator Chiquita Brooks-LaSure outlining our concerns regarding the rule and again requested a delay in implementation given the very short notice to comply with the October 1st date and the need to collect further data during the AEP.

While we wait for a final determination from CMS, there are a number of service providers who have  technology for recording.  Some systems are affordable but may offer little flexibility and the costs for the more sophisticated systems can be high. Some FMOs are looking at solutions for their agents to help offset this cost.  In the meantime, we will continue to defend independent agents and brokers in their role as beneficiary advocates whose roles extend far beyond enrollment.

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