[ad_1]
Photo: Jose Luis Pelaez/Getty Images
The Centers for Medicare and Medicaid Services terminated two Centene Medicare Advantage plans in Part C and Part D enforcement actions taken on December 27th.
CMS terminated Part D plans from Centene-owned WellCare Health Insurance of North Carolina and WellCare Health Insurance of Arizona due to poor Medicare Advantage star ratings for three consecutive years.
CMS also notified WellCare of its decision to impose interim sanctions consisting of suspension of enrollment and all marketing activities for these Medicare Advantage plans.
These interim sanctions will come into effect on January 12th. CMS said it will provide WellCare with detailed instructions regarding enrollment and marketing suspensions in a separate communication.
“The basis for this action is that CMS has determined that WellCare has materially failed to perform its contract with CMS by failing to achieve the Part C summary star.”
At least 3-star rating in three consecutive 3-star rating periods,” the notice reads.
CMS said the interim sanctions will continue until it is satisfied that the deficiencies have been corrected and that recurrence is unlikely.
CMS also terminated its Part D contract with Zing Health, which offers three Medicare Advantage plans in Illinois, Indiana, and Michigan. This is in response to his failure to achieve at least 3 stars for the third year in a row in the Part D Overview Star Rating.
Zing was reportedly founded by Health2047, the American Medical Association’s venture fund.
The health plan may appeal the decision.
why is this important
In the 2024 Medicare Advantage Star Ratings, four plans received the lowest rating of two stars. All were owned by Centene.
bigger trends
CMS uses star ratings to determine the quality of Medicare Advantage Part C and D plans. The agency may terminate a plan’s contract if it receives a rating of less than three stars for three consecutive years during the contract period.
X: @SusanJMorse
Email the author: SMorse@himss.org
[ad_2]
Source link
