CMS Issues Guidance to LTC Facilities Concerning Medicare Advantage Disenrollment

CMS released a memorandum concerning beneficiary disenrollment from Medicare Advantage (MA) plans and alleges that LTC facilities are inappropriately encouraging Medicare beneficiaries to dis-enroll from MA plans and dual demonstrations.  Click here for AHCA’s summary of the CMS memorandum.

CMS stresses that any change in a beneficiary’s health care coverage must be initiated by the beneficiary or his/her representative.  If the facility is asked to assist in changing the beneficiary’s health coverage, the facility must take specific steps to ensure compliance with regulations concerning enrollment/disenrollment and resident rights.  Facilities must:

1.  Explain both orally and in writing the impact to the beneficiaries if they change to a stand-alone drug plan and Original Medicare. Additional information on what to include can be found on CMS’s site, click here.
2. Develop written policies and procedures regarding the process of assisting beneficiaries with changing their health care coverage.  Additional information on what to include can be found on CMS’s site, click here.

AHCA is reviewing the CMS memo and has reached out to CMS to initiate a dialogue on this subject.