skip to Main Content

You’ve Got Mail: CMS Boldly Goes Digital

You’ve Got Mail: CMS Boldly Goes Digital

Just out — the Centers for Medicare and Medicaid Services (CMS) has endorsed a digital strategy for Medicare Advantage and Part D plans. This will be a game changer and mean huge savings for health plans over time.shutterstock_1024358836
Long insistent that seniors were not tech savvy enough to receive communications through digital media, CMS began opening up just a bit in the current year. It allowed certain large technical documents, such as the Evidence of Coverage (EOC), to be available on the web as long as members were notified and could get a hard copy as needed. In the Medicare Communications and Marketing Guidelines (MCMG) announced on July 20, 2018, CMS has now approved health plans providing almost all communications digitally beginning in 2019.

As we note above, this has huge cost-savings implications, but at the same time has cost, compliance, and HIPAA implications in the shorter term.

  • Cost – Between now and 2019, if plans want to take advantage of the opportunity to provide communications digitally, they must set up the necessary infrastructure. This will take some time and short-term money:
    • CMS is requiring that individuals opt into the digital provision of communications. This means that plans will need to set up processes to “opt in” with consent throughout the member experience, record emails and other formats of digital communication, have a process to update digital information, and have a mechanism for individuals to opt out and receive hard copies of materials on request. The date and time of the digital fulfillment must still be recorded as with hard copies for compliance purposes. In addition, if the copy is posted on a website or portal, an email or other digital communication must be sent directing the member to the posting area.
    • Two obvious means of providing communications digitally include email as well as member portal postings (whether generically or specific to members.) Each has its own implementation strategy and overhaul of existing systems and processes. It, too, will mean always deploying a dual strategy to fulfillment, as some will want hard copies and others digital.
    • One exception to opt in is the provision of the EOC, directories and formularies via websites to existing members as well as new members who enroll throughout the year. Plans must still notify members via mail of the availability on the website prior to new plan year notification requirements and throughout the year as updates necessitate.
    • Important note: While Section 100.2.2, Electronic Delivery of Required Materials, of the guidance says that plans can provide “any materials” in a digital fashion, Section 100.4 overrides this by making it clear that certain communications (e.g., certain member enrollment and Low-Income Subsidy communications) must be mailed as a hard copies. We will seek clarification of this from CMS.
  • Compliance – If plans do fulfill via digital means, they must ensure they meet regulatory time frames for certain communications, such as prior authorization, appeals and grievance decision letters. As an example, plans would need to ensure constant email scrubbing and monitor both email and portal fulfillment. Recording digital fulfillment dates and times will also be key for program audits. Education on accessing these letters and communications will be key to ensure no rise in CTM complaints to CMS or increases in appeals and grievances. We bet plans will go light here initially and opt first to fulfill other communications digitally. However, plans should also think about how the new digital strategy done right can make timeliness issues go away for regulatory communications. If emails are right, the guidance suggests the second the email is sent and a communication posted, letter fulfillment is complete. No waiting for confirmation from a mail house.
  • HIPAA – Plans will also need to be ever mindful of HIPAA implications. A clear and secure strategy to posting generic vs. member specific information will be important. If communications include PHI, secure, encrypted emails would need to be used. Plans will need to tighten security on their portals given what will be increased use and public exposure over time.

Notwithstanding the major considerations that plans will need to think through to implement the digital strategy, we applaud CMS for going here. CMS is getting bold. Earlier, it had announced two other watershed changes for the programs:

  • The ability for plans to include non-traditionally covered benefits in their Medicare Advantage bid design to address aging and other specific challenges that seniors face. These could include in-home visits, expanded transportation, home improvements, and more. While the change occurred very late to impact 2019, plans should begin planning now for new services for 2020.
  • Building on the Value Based Insurance Design pilot, CMS is also allowing enhanced benefits for sub-populations within an overall benefit design to address the unique needs of certain members. This will mean that the multiply co-morbid could receive reduced cost-sharing and additional benefits and services to meet their needs, especially if no Special Needs Plans is available. Again, likely a 2020 plan focus as well.

Marc Ryan

Marc S. Ryan serves as MedHOK’s Chief Strategy and Compliance Officer. During his career, Marc has served a number of health plans in executive-level regulatory, compliance, business development, and operations roles. He has launched and operated plans with Medicare, Medicaid, Commercial and Exchange lines of business. Marc was the Secretary of Policy and Management and State Budget Director of Connecticut, where he oversaw all aspects of state budgeting and management. In this role, Marc created the state’s Medicaid and SCHIP managed care programs and oversaw its state employee and retiree health plans. He also created the state’s long-term care continuum program. Marc was nominated by then HHS Secretary Tommy Thompson to serve on a panel of state program experts to advise CMS on aspects of Medicare Part D implementation. He also was nominated by Florida’s Medicaid Secretary to serve on the state’s Medicaid Reform advisory panel.

Marc graduated cum laude from the Edmund A. Walsh School of Foreign Service at Georgetown University with a Bachelor of Science in Foreign Service. He received a Master of Public Administration, specializing in local government management and managed healthcare, from the University of New Haven. He was inducted into Sigma Beta Delta, a national honor society for business, management, and administration.

Back To Top