The Centers for Medicare & Medicaid Services has lifted its marketing and enrollment ban on Aetna Medicare, according to an Aetna news release.
CMS originally sanctioned Aetna due to improper administration of the Medicare drug benefit in the plan's national standalone prescription drug plan and its 25 Medicare Advantage prescription drug contracts, according to an April 2010 CMS news release. CMS said Aetna did not fully meet its obligations to Medicare beneficiaries.
Aetna failed to meet obligations by:
• Failing to ensure that existing beneficiaries could continue to receive drugs they had been receiving in 2009 that were not on the plans' formularies in 2010
• Improperly processing coverage determinations and expedited appeal requests in cases where delays would jeopardize the life or health of the enrollee
• Applying prior authorization and step therapy drug requirements that had not been approved by Medicare
• Failing to take timely and proper steps to ensure enrollees are eligible for the Part D low-income subsidy
Although Aetna has remediated these deficiencies, Medicare Prescription Drug Plans will not receive any new low-income subsidy assignees from CMS. However, low-income subsidy members can choose to enroll in Aetna products.
Aetna has resumed marketing of its Medicare Advantage and Prescription Drug Plan products and may begin enrolling beneficiaries with effective dates beginning July 1.
Read the Aetna news release on its Medicare products.
Read the April 2010 CMS news release on Aetna.
Related Articles on Payors:
University of Pittsburgh Medical Center, Highmark Contract May End in 2012
Illinois Medicaid Enrolls 40,000 Individuals Into Private Health Plans
Interest Will Shift From Medicare ACOs to Private Payors, Consultant Says
CMS originally sanctioned Aetna due to improper administration of the Medicare drug benefit in the plan's national standalone prescription drug plan and its 25 Medicare Advantage prescription drug contracts, according to an April 2010 CMS news release. CMS said Aetna did not fully meet its obligations to Medicare beneficiaries.
Aetna failed to meet obligations by:
• Failing to ensure that existing beneficiaries could continue to receive drugs they had been receiving in 2009 that were not on the plans' formularies in 2010
• Improperly processing coverage determinations and expedited appeal requests in cases where delays would jeopardize the life or health of the enrollee
• Applying prior authorization and step therapy drug requirements that had not been approved by Medicare
• Failing to take timely and proper steps to ensure enrollees are eligible for the Part D low-income subsidy
Although Aetna has remediated these deficiencies, Medicare Prescription Drug Plans will not receive any new low-income subsidy assignees from CMS. However, low-income subsidy members can choose to enroll in Aetna products.
Aetna has resumed marketing of its Medicare Advantage and Prescription Drug Plan products and may begin enrolling beneficiaries with effective dates beginning July 1.
Read the Aetna news release on its Medicare products.
Read the April 2010 CMS news release on Aetna.
Related Articles on Payors:
University of Pittsburgh Medical Center, Highmark Contract May End in 2012
Illinois Medicaid Enrolls 40,000 Individuals Into Private Health Plans
Interest Will Shift From Medicare ACOs to Private Payors, Consultant Says