Cath Lab Digest

CMS
Says Insurers Can Communicate about Healthcare Reform

Having been shut out of the reform debate for the better
part of a month, private health insurers contracting with the Centers for
Medicare & Medicaid Services (CMS) to administer Medicare health plans were
informed in mid-October that they could once again communicate with
beneficiaries about healthcare reform legislation and other issues not
specifically related to beneficiaries’ health plans. A pair of memoranda issued
to insurers clarified the use of beneficiary information obtained from CMS and
the prohibition on using federal funds for non–plan-related activities designed
to influence state or federal legislation or appropriations. CMS said plan
sponsors are permitted to send current members information about health-related
issues as long as federal funds are not used and the materials include
instructions describing how the recipients may opt out of receiving such
communications.

Humana began sending letters to Medicare plan beneficiaries
in August and September stating that proposed funding cuts for Medicare
Advantage as well as spending reductions for traditional Medicare and Medicaid
programs included in healthcare reform drafts could result in a reduction of
benefits. In September, CMS’ Medicare Drug and Health Plan Contract
Administration Group informed Humana that CMS was investigating their
communications and instructing them to end all mailings to beneficiaries and
remove any related materials from their Web site. Humana agreed to discontinue
the mailings, and other Medicare providers were instructed to refrain from
disseminating similar materials or posting them on the Web.

At the time, Jonathan Blum, acting director of CMS,
expressed concerns that materials sent by Humana may have violated Medicare
rules by appearing to contain Medicare Advantage and prescription drug benefit
information, which must be submitted to CMS for review. CMS asked all other
Medicare plan sponsors to refrain from mailing similar materials and began an
investigation into whether a potential violation had occurred.

The investigation into the Humana letter was prompted by a
request from Sen. Max Baucus (D-MT), chairman of the Senate Finance Committee,
who accused Humana of misleading seniors. When the gag order was issued, the
proposed legislation receiving the most attention was Sen. Baucus’ Chairman’s
Mark: America’s Healthy Future Act, which was undergoing voting and markup in
the Senate Finance Committee. Republicans in Congress had threatened to hold up
the confirmation process for nominees to federal health posts if the gag order
and investigation were not discontinued. At press time, the House had just
passed HR 3962, the Affordable Health Care for America Act, and the process of
merging House and Senate bills was under way.