Update: On August 31, 2020, Centers for Medicare & Medicaid Services (CMS) stated that CMS is releasing the enrollment suspension for contract H5322 effective January 1, 2021. Additionally, CMS will allow Care Improvement Plus to offer plans under contract H5322 to new beneficiaries during the CY 2021 Annual Election Period (AEP), which will be held between October 15, 2020 and December 7, 2020.
Read the CMS sanction release notice:
CMS Notice of Enrollment Suspension for Medicare Advantage-Prescription Drug Contract Number H5322 (Care Improvement Plus) for plan year 2020
On September 11, 2019, the Centers for Medicare & Medicaid Services (CMS) provided notice to Care Improvement Plus South Central Insurance Company ("Care Improvement Plus") that CMS made a determination to prohibit the enrollment of new beneficiaries under the Medicare Advantage-Prescription Drug (MA-PD) contract H5322 for contract year (CY) 2020.
As a result of this determination, Care Improvement Plus will be prohibited from accepting any MA-PD plan enrollments which would be effective January 1, 2020, through December 1, 2020. This action will include the removal of H5322 from the list of MA-PD plans from which beneficiaries may make an election during the CY 2020 Annual Election Period (AEP), which runs between October 15, 2019, and December 7, 2019. However, Care Improvement Plus may continue to accept and process enrollments that become effective on or before December 1, 2019
Current members of Medicare plans under this contract (H5322) are not
by the sanctions and may remain with their 2019 Medicare plan
into 2020. However, during CY 2020, all individual market plans offered under H5322 will be precluded from accepting any new enrollees, including those beneficiaries already enrolled in a Care Improvement Plus MA-PD plan who may want to elect a different plan offered under the same contract.
If Care Improvement Plus submits a CY 2019 report in 2020 for H5322 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, 2021. In such an instance, CMS would allow Care Improvement Plus to offer plans under H5322 to beneficiaries during the CY 2021 AEP, which will be held between October 15, 2020, and December 7, 2020. In the event that the CY 2019 MLR report for H5322 again shows an MLR below 85%, enrollment under that contract will remain closed during CY 2021. Furthermore, CMS reminds Care Improvement Plus that if it fails to report an MLR of at least 85% for five consecutive years for H5322, CMS must terminate that contract.
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).
Care Improvement Plus has reported to CMS the following MLRs for MA-PD contract H5322: 71.3% for CY 2016, 83.9% for CY 2017, and 84.1% for CY 2018. Based on this plan sponsor-reported information, CMS has determined that Care Improvement Plus has failed to meet the 85% MLR threshold for three consecutive years.
Read the CMS sanction notice:
https://www.cms.gov/Medicare/ Compliance-and-Audits/Part-C-and-Part-D-Compliance-and-Audits/Downloads/ CareImprovementPlusSanction091119.pdf