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Many medicare beneficiaries have asked how the new Medicare Improvements for Patients and Providers Act of 2008 would affect our local Rocky Mountain HMO cost contract in Mesa County.  Below you will find Section 167 of the Act.  In this Act, bascially Rocky Mountain HMO would have to have convincing evidence and reasons why they are unable to become Medicare Advantage Plans to continue this cost contract.  As of the 2008, there are currently 32 different Medicare Advantage Plans available in Mesa County with likely more options in 2009.  In our opinion it would be very diffcult to defend a cost contract to be continued in this area.

SEC. 167. ACCESS TO MEDICARE REASONABLE COST CONTRACT PLANS.

(a) Extension of Reasonable Cost Contracts- Section 1876(h)(5)(C)(ii) of the Social Security Act (42 U.S.C. 1395mm(h)(5)(C)(ii)), as amended by section 109 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173), is amended by striking `January 1, 2009′ and inserting `January 1, 2010′ in the matter preceding subclause (I).

(b) Requirement for at Least Two Medicare Advantage Organizations To Be Offering a Plan in an Area for the Prohibition To Be Applicable- Subclauses (I) and (II) of section 1876(h)(5)(C)(ii) of the Social Security Act (42 U.S.C. 1395mm(h)(5)(C)(ii)) are each amended by inserting `, provided that all such plans are not offered by the same Medicare Advantage organization’ after `clause (iii)’.

(c) Revision of Requirements for a Plan That Are Used To Determine if Prohibition Is Applicable-

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  (1) IN GENERAL- Section 1876(h)(5)(C)(iii)(I) of the Social Security Act (42 U.S.C. 1395mm(h)(5)(C)(iii)(I)) is amended by inserting `that are not in another Metropolitan Statistical Area with a population of more than 250,000′ after `such Metropolitan Statistical Area’.

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  (2) CLARIFICATION- Section 1876(h)(5)(C)(iii)(I) of the Social Security Act (42 U.S.C. 1395mm(h)(5)(C)(iii)(I)) is amended by adding at the end the following new sentence: `If the service area includes a portion in more than 1 Metropolitan Statistical Area with a population of more than 250,000, the minimum enrollment determination under the preceding sentence shall be made with respect to each such Metropolitan Statistical Area (and such applicable contiguous counties to such Metropolitan Statistical Area).’.

(d) GAO Study and Report-

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  (1) STUDY- The Comptroller General of the United States shall conduct a study of the reasons (if any) why reasonable cost contracts under section 1876(h) of the Social Security Act (42 U.S.C. 1395mm(h)) are unable to become Medicare Advantage plans under part C of title XVIII of such Act.

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  (2) REPORT- Not later than December 31, 2009, the Comptroller General of the United States shall submit to Congress a report containing the results of the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.

In response to emails that Insurance Advisors Agency, Inc. sent our Colorado congressmen, Wayne Allard had this to say:

“Thank you for contacting me about Medicare. I appreciate your taking the time to write about this issue. Medicare for seniors is an important issue to me and I have worked diligently to maintain quality Medicare coverage. During my tenure in the Senate I sponsored a number of pieces of legislation that aim to ensure the continued stability of the Medicare program. Unfortunately, many of my colleagues in the Senate are more interested in temporary, minor fixes to our current Medicare system, even if it is to the detriment of millions of seniors who take part in the Medicare Advantage program. I believe it is wrong to take options away from seniors and place greater control of their health into the hands of bureaucrats. Choice and competition are necessary to fit the needs and desires of beneficiaries and ensure long term solvency of the program. The funding cuts to the Medicare Advantage Program in House Resolution 6331, the “Medicare Improvements for Patients and Providers Act of 2008″, will put many Colorado seniors at a disadvantage. That is why I supported different bi-partisan legislation which contained identical physician reimbursement language to HR 6331. I had hoped a bi-partisan solution to this issue could be reached. I am hopeful that in the future Congress will work to pass legislation that enacts long- term reform and fixes the physician reimbursement formula for longer than a few months. I am very appreciative of your comments. We share a common goal: access to quality Medicare benefits for seniors. I will continue to work towards that goal on the behalf of all Coloradans and seniors. For more information regarding this and other important issues, please feel free to visit my website at http://allard.senate.gov . I look forward to hearing from you in the future.

Colorado lawmakers passed about 50 bills dealing with healthcare this year.  We have posted some information on a couple of them (see below).  Some of the bills add additional regulations for insurance companies in Colorado which could cause additional administrative costs for the providers and the insurers.  These bills are intended to make health care more readily available to people and promote consumer protection in the insurance industry.  Democrats & Republicans are at odds as to whether or not these bills will actually improve coverage options and healthcare for the average consumer. 

… if the Colorado House Democrats have anything to say about it.  In May of 2008 House Bill 1407, the Insurance Accountability Act of 2008, was passed.  The Bill is aimed at strengthening penalties for the unreasonable conduct of an insurance carrier, and making appropriation in connection with that. 

Consumers can expect this bill to give Colorado’s Commissioner’s office increased ability to deter unreasonable conduct by a Colorado insurer, help consumers recover their damages, and clarifies the definition of resitution.  The Commissioner’s office can charge an insurance company a $3,000 minimum fine for any violation of any law, rule, or prior lawful order regarding these issues - and up to $30,000 maximum fine.

Providing Coloradans with fair and accessible insurance coverage is the goal of this FAIR Act (Fair Accountable Insurance Rates) presented by the Colorado Democratic House of Representatives.  The Bill passed into Act in early June 2008 and will become effective on January 1, 2009.  The Act is designed to make insurance carriers and companies accountable for rate changes - the most significant piece of this is that ALL insurance companies must submit any rate increases to the Colorado Commissioner 60 days prior to the rate change effective date.  Any insurance company doing business in CO must fulfill the Commissioner’s requirements for a proposed rate increase:

• benefits provided must be reasonable in relation to the premiums charged;
• the rate increase must not be unjust, unfair, inequitable, discriminatory, excessive, or inadequate;
• claims experience and data must justify the increase; OR
• filing must be complete.

Also included are reports to the Commissioner regarding certain cost changes (since previous rate filings) due to catastrophic loss, medical costs and commissions.  The insurance company providing coverage in CO must explain all of these issues to the Commissioner who makes the information public by posting it on their website. 

WHAT does this mean to you, the consumer?  Insurance companies will be deterred from “knee-jerk” reactions based on losses & profitability, consumer’s can simply go to http://www.dora.state.co.us/Insurance/ to view any proposed rate increases for their type of plan/policy and insurance company.