CMS has released guidance for long term care (LTC) facilities, including nursing facilities and skilled nursing facilities, on beneficiary disenrollments. According to the guidance, “CMS continues to see an unacceptable practice of LTC facilities disenrolling beneficiaries from Medicare advantage prescription drug plans (MAPDs) and enrolling them into stand-alone drug plans (PDPs) without the beneficiary’s or the representative’s knowledge and/or complete understanding. This action automatically returns the beneficiary to Original Medicare coverage for those services covered by Parts A and B. This practice is noncompliant with regulatory requirements.” Likewise, CMS has observed similar, unacceptable practices among LTC facilities serving Medicare-Medicaid (dually eligible) enrollees eligible to join a Medicare-Medicaid plan as part of a nine-state demonstration under the Financial Alignment Initiative. CMS encourages LTC facilities to review its guidance to ensure compliance with federal regulations and guidance concerning changes to facility residents’ Medicare plan coverage.
This article is presented for informational purposes only and is not intended to constitute legal advice.
