On September 2, 2021, the Centers for Medicare & Medicaid Services (CMS) provided notice to UnitedHealthcare of Arkansas, Inc. (“United of Arkansas”) (contract H3464), UnitedHealthcare of New Mexico, Inc. (“United of New Mexico”) (contract H6526) and UnitedHealthcare of the Midwest, Inc. (“United of the Midwest”) (contract H0169) that CMS has made a determination to prohibit the enrollment of new beneficiaries under the Medicare Advantage-Prescription Drug (MA-PD)
for contract year (CY) 2022.
UnitedHealthcare of Arkansas, Inc. (“United of Arkansas”)
As a result of this determination, United of Arkansas will be prohibited from accepting any MAPD plan enrollments for 2022; this prohibition is effective for any enrollments beginning January 1, 2022, through December 1, 2022. This action will include the removal of H3464 from the list of MA-PD plans from which beneficiaries may make an election during the CY 2022 Annual Election Period (AEP), which runs between October 15, 2021, and December 7, 2021.
However, United of Arkansas
may continue to accept and process enrollments that become effective on or before December 1, 2021.
During CY 2022, all individual market plans offered under H3464 will be precluded from accepting any new enrollees, including those beneficiaries already enrolled in a United of Arkansas MA-PD plan who may want to elect a different plan offered under the same contract.
Pursuant to sections 1857(i) and 1860D-22(b) of the Act, if United of Arkansas has employer group plans, it may apply for an employer group waiver in order to continue to enroll members into their existing employer group plans, although CMS will not permit United of Arkansas to add new employer group plans to contract H3464 for CY 2022.
United of Arkansas must ensure that its marketing and communications materials and activities are not misleading to beneficiaries, and therefore must accurately reflect the fact that the plans under H3464
are not available for enrollment during 2022. Enforcement actions, as described in 42 C.F.R. Parts 422 and 423 Subparts K and O, may be imposed if CMS finds that United of Arkansas has engaged in activities that could mislead or confuse Medicare beneficiaries or misrepresent the plan. See 42 C.F.R.§§ 422.2262 and 423.2262.
If United of Arkansas submits a CY 2021 report in 2022 for H3464 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, 2023. In such an instance, CMS would allow United of Arkansas to offer plans under H3464 to beneficiaries during the CY 2023 AEP, which will be held between October 15, 2022, and December 7, 2022.
In the event that the CY 2021 MLR report for H3464 again shows an MLR below 85%, enrollment under that contract will remain closed during CY 2023. Furthermore, CMS reminds United of Arkansas that if it fails to report an MLR of at least 85% for five consecutive years for H3464, CMS must terminate that contract.
Read the CMS sanction notice:
https://www.cms.gov/files/document/UnitedofArkansasSanction09022021.pdf
UnitedHealthcare of New Mexico, Inc. (“United of New Mexico”)
As a result of this determination, United of New Mexico will be prohibited from accepting any MA-PD plan enrollments for 2022; this prohibition is effective for any enrollments beginning January 1, 2022, through December 1, 2022. This action will include the removal of H6526 from the list of MA-PD plans from which beneficiaries may make an election during the CY 2022 Annual Election Period (AEP), which runs between October 15, 2021, and December 7, 2021. However, United of New Mexico
may continue to accept and process enrollments that become effective on or before December 1, 2021.
During CY 2022, all individual market plans offered under H6526 will be precluded from accepting any new enrollees, including those beneficiaries already enrolled in a United of New Mexico MA-PD plan who may want to elect a different plan offered under the same contract. Pursuant to sections 1857(i) and 1860D-22(b) of the Act, if United of New Mexico has employer group plans, it may apply for an employer group waiver in order to continue to enroll members into their existing employer group plans, although CMS will not permit United of New Mexico to add new employer group plans to contract H6526 for CY 2022.
United of New Mexico must ensure that its marketing and communications materials and activities are not misleading to beneficiaries, and therefore must accurately reflect the fact that the plans under H6526
are not available for enrollment during 2022. Enforcement actions, as described in 42 C.F.R. Parts 422 and 423 Subparts K and O, may be imposed if CMS finds that United of New Mexico has engaged in activities that could mislead or confuse Medicare beneficiaries or misrepresent the plan. See 42 C.F.R.§§ 422.2262 and 423.2262.
If United of New Mexico submits a CY 2021 report in 2022 for H6526 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, 2023. In such an instance, CMS would allow United of New Mexico to offer plans under H6526 to beneficiaries during the CY 2023 AEP, which will be held between October 15, 2022, and December 7, 2022. In the event that the CY 2021 MLR report for H6526 again shows an MLR below 85%, enrollment under that contract will remain closed during CY 2023. Furthermore, CMS reminds United of New Mexico that if it fails to report an MLR of at least 85% for five consecutive years for H7522, CMS must terminate that contract.
Read the CMS sanction notice:
https://www.cms.gov/files/document/UnitedofNewMexicoSanction09022021.pdf
UnitedHealthcare of the Midwest, Inc. (“United of the Midwest”)
As a result of this determination, United of the Midwest will be prohibited from accepting any MA-PD plan enrollments for 2022; this prohibition is effective for any enrollments beginning January 1, 2022, through December 1, 2022. This action will include the removal of H0169 from the list of MA-PD plans from which beneficiaries may make an election during the CY 2022 Annual Election Period (AEP), which runs between October 15, 2021, and December 7, 2021. However, United of the Midwest
may continue to accept and process enrollments that become effective on or before December 1, 2021.
During CY 2022, all individual market plans offered under H0169 will be precluded from accepting any new enrollees, including those beneficiaries already enrolled in a United of the Midwest MA-PD plan who may want to elect a different plan offered under the same contract. Pursuant to sections 1857(i) and 1860D-22(b) of the Act, if United of the Midwest has employer group plans, it may apply for an employer group waiver in order to continue to enroll members into their existing employer group plans, although CMS will not permit United of the Midwest to add new employer group plans to contract H0169 for CY 2022.
United of the Midwest must ensure that its marketing and communications materials and activities are not misleading to beneficiaries, and therefore must accurately reflect the fact that the plans under H0169
are not available for enrollment during 2022. Enforcement actions, as described in 42 C.F.R. Parts 422 and 423 Subparts K and O, may be imposed if CMS finds that United of the Midwest has engaged in activities that could mislead or confuse Medicare beneficiaries or misrepresent the plan. See 42 C.F.R.§§ 422.2262 and 423.2262.
If United of the Midwest submits a CY 2021 report in 2022 for H0169 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, 2023. In such an instance, CMS would allow United of the Midwest to offer plans under H0169 to beneficiaries during the CY 2023 AEP, which will be held between October 15, 2022, and December 7, 2022. In the event that the CY 2021 MLR report for H0169 again shows an MLR below 85%, enrollment under that contract will remain closed during CY 2023. Furthermore, CMS reminds United of the Midwest that if it fails to report an MLR of at least 85% for five consecutive years for H0169, CMS must terminate that contract.
Read the CMS sanction notice:
https://www.cms.gov/files/document/UnitedoftheMidwestSanction09022021.pdf
Background:
The Social Security Act requires Medicare
Advantage organizations to maintain a medical loss ratio (MLR) of at
least 85%. The statute further provides, that when an organization fails
for three consecutive years to meet the 85% threshold, CMS must suspend
that organization’s ability to accept new enrollments in the plans it
offers under the non-compliant contract for the contract year following
submission of the report (i.e., the second contract year after the third
consecutive year in which the organization failed to meet the minimum
MLR).