On August 29, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a Notice of Release of Enrollment Suspension for Prescription Drug Plan Contract Number: S5795 (USAble).

On July 26, 2019, USAble reported an Medical Loss Ratio (MLR) above 85%, thereby meeting the minimum MLR requirement for CY 2018. As a result, USAble is no longer in violation of CMS requirements and CMS is releasing the enrollment suspension for contract S5795 effective January 1, 2020.                                                               

Additionally, CMS will allow USAble to offer plans under contract S5795 to new beneficiaries during the CY 2020 Annual Election Period (AEP), which will be held between October 15, 2019 and December 7, 2019.

Read the CMS notice:
https://www.cms.gov/Medicare/ Compliance-and-Audits/Part-C-and-Part-D-Compliance-and-Audits/Downloads/ USAbleSanctionRelease082919.pdf


CMS Notice of Enrollment Suspension for Prescription Drug Plan Contract Number S5795 (USAble Mutual Insurance Company)

On September 26, 2017, the Centers for Medicare and Medicaid Services (CMS) gave notice to USAble Mutual Insurance Company (“USAble”) that CMS "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) 2018."

USAble failed to meet the 85% medical loss ratio (MLR) threshold requirements for three consecutive years (2014, 2015, and 2016) and, as per the Social Security Act, when an organization fails for three consecutive years to meet the 85% MLR threshold, 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, 2018, through December 1, 2018.  This action will include the removal of S5795 from the list of PDPs from which beneficiaries may make an election during the CY 2018 annual election period (AEP), which runs between October 15, 2017, and December 7, 2017.  However, USAble may continue to accept and process enrollments that become effective on or before December 1, 2017."

In the correspondence to USAble, CMS noted that "[s]hould USAble submit a CY 2017 report in 2018 for S5795 that demonstrates it has achieved an MLR of at least 85%, CMS will allow the sponsor to resume accepting enrollments that become effective on or after January 1, 2019.  In such an instance, CMS would allow USAble to offer plans under S5795 to beneficiaries during the CY 2019 AEP, which will be held between October 15, 2018, and December 7, 2018."

Current members of Medicare plans under this contract (S5795) are not affected by the sanctions and may remain with their 2017 Medicare plan into 2018.

Read the CMS notice:
https://www.cms.gov/Medicare/ Compliance-and-Audits/Part-C-and-Part-D-Compliance-and-Audits/Downloads/ USAble_Sanction_09-26-17.pdf