CMS Notice of Enrollment Suspension for Prescription Drug Plan Contract Number S5795 (USAble Mutual Insurance Company) for contract year (CY) 2019.
On September 20, 2018, the Centers for Medicare and Medicaid Services (CMS) gave notice to USAble Mutual Insurance Company (“USAble”) that CMS "has made a determination to prohibit the enrollment of new enrollees under the Medicare Part D Prescription Drug Plan (PDP) contract S5795 for contract year (CY) 2019."
USAble failed to meet the 85% medical loss ratio (MLR) threshold requirements for four consecutive years (2014, 2015, 2016, and 2017) and, as per the Social Security Act, when an organization fails to meet the 85% MLR threshold for three or more consecutive years, CMS must suspend the "organization’s ability to accept new enrollments in the plans it offers under the non-compliant contract for the following contract year.
"As a result of this determination, USAble will be prohibited from accepting any Part D plan enrollments which would be effective January 1, 2019, through December 1, 2019. This action will include the removal of S5795 from the list of PDPs from which beneficiaries may make an election during the CY 2019 annual election period (AEP), which runs between October 15, 2018, and December 7, 2018. In addition, since USAble is currently under an enrollment suspension, USAble may not accept and process enrollments for CY 2018. "
In the correspondence to USAble, CMS noted that "[s]hould USAble report an MLR of at least 85% for CY 2018, CMS will allow the sponsor to resume enrolling new members for coverage that becomes effective on or after January 1, 2020. In such an instance, CMS would allow USAble to offer plans under S5795 to beneficiaries during the CY 2020 AEP, which will be held between October 15, 2019, and December 7, 2019. However, if USAble reports that the MLR for contract S5795 is below 85% for CY 2018, that will mean that the contract has failed to meet the MLR requirement for the fifth consecutive year, and the contract will be terminated."
Read the CMS notice:
https://www.cms.gov/ Medicare/ Compliance-and-Audits/ Part-C-and-Part-D-Compliance-and-Audits/ Downloads/ USAbleSuspension092018.pdf