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CMS Notice of Termination and Intermediate Sanctions - Suspension of Enrollment and Marketing - for Prescription Drug Plan Contract Number: S6946.

Category: Medicare Plan Providers
Published: Oct, 14 2023 03:10:46

On October 13, 2023, the Centers for Medicare and Medicaid Services (CMS) gave notice of their decision to terminate Clear Spring Health Insurance Company (Clear Spring) Prescription Drug Plan (PDP) contract S6946 on December 31, 2024.

In addition to the termination, CMS also provided notice to Clear Spring that CMS has made a determination to impose intermediate sanctions on PDP contract number S6946. The intermediate sanctions will consist of the suspension of enrollment of Medicare beneficiaries into Clear Spring's contract S6946 Part D plans, and the suspension of all marketing activities to Medicare beneficiaries.  The intermediate sanctions will take effective on October 29, 2023.

From the CMS notification letter:
"CMS has determined that Clear Spring’s contract S6946 failed to comply with Part D Star Ratings requirements by failing to achieve a Part D summary Star Rating of at least three stars for three consecutive years in violation of 42 C.F.R. §§ 423.505(b)(26) and 423.509(a)(4)(x). Specifically, the three consecutive annual Part D Star Ratings for contract S6946 are as follows:
• 2022 Part D Summary Star Rating of 2
• 2023 Part D Summary Star Rating of 1.5
• 2024 Part D Summary Star Rating of 1.5"

"Pursuant to 42 C.F.R. § 423.756(c)(3), the sanction will remain in effect until CMS is satisfied that Clear Spring has corrected the causes of the violations which form the basis for the sanction and the violations are not likely to recur. In addition, pursuant to 42 C.F.R. § 423.509(c)(1)(i), before providing a notice of intent to terminate the contract, CMS provides the Part D plan sponsor with notice specifying the Part D plan sponsor's deficiencies and a reasonable
opportunity of at least 30 calendar days to develop and implement a corrective action plan to correct the deficiencies.

Clear Spring has been on notice of the need to improve its Part D summary Star Ratings performance since the issuance of the 2022 Star Ratings on October 6, 2021. Each year CMS provides PDPs with two preview periods before Star Ratings become public (see 42 C.F.R. § 423.186(h)(2)). During the preview periods, Clear Spring had the opportunity to review
preliminary calculations and seek corrections to the underlying data and calculations before the Star Ratings become public. In addition, Clear Spring received a corrective action notice on February 25, 2022, for its 2022 Star Ratings and on February 24, 2023, for its 2023 Star Ratings.  The corrective action notices informed Clear Spring of its Star Rating, informed Clear Spring that it should take steps to improve its operations for the areas that resulted in a low Star Rating,
and put Clear Spring on notice that its contract will be eligible for termination if it achieves a Part D Summary Star Rating of below three stars for three (3) consecutive years.

Therefore, pursuant to 42 C.F.R. § 423.509(c), Clear Spring has had notice of its insufficient Part D summary Star Ratings and a reasonable opportunity to correct this deficiency by improving its Star Rating performance, which it failed to do."

Read the CMS notice:

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