CT Congressional Delegation Urges CMS To Be More Flexible With Enrollment Periods, Strengthen Standards For Medicare Advantage Plans For UHG Enrollees

(Hartford, CT) – In a letter to the Center for Medicare & Medicaid Services (CMS), the Connecticut Congressional Delegation today urged the agency to be more flexible with enrollment periods and strengthen standards for Medicare Advantage plans for UnitedHealth Group enrollees.

“The ability of people to make decisions is further hampered by the providers’ ongoing appeal of their termination by UHG. We ask that you consider the uncertainties that these unresolved appeals can cause in determining how best to serve MA enrollees regarding enrollments for 2014. As we see the effects of network adjustments unfolding in Connecticut, we urge you to review and strengthen the process for determining network adequacy. Additionally, because of the novelty of UHG’s approach and the significant confusion that currently exists for MA enrollees, we ask that you consider allowing additional time to make enrollment decisions for next year by opening an additional enrollment period or extending the current one.”

November 27, 2013

Dear Commissioner Tavenner;

We are writing to urge the Center for Medicare & Medicaid Services (CMS) to expeditiously address the concerns of Connecticut patients who have UnitedHealth Group (UHG) Medicare Advantage (MA) policies.  As you know, members of the Connecticut congressional delegation and Connecticut Attorney General Jepsen have previously contacted your department regarding the disruption to UHG’s provider networks.  Since our initial contact, we now know that UHG has dropped over 2,000 providers from their Connecticut network, notifying Connecticut enrollees only days before they need to decide on Medicare plan for 2014.  UHG’s provider terminations have, for example, resulted in the Yale Medical Group being cut from the network, leaving thousands of patients without their regular physician, and in the city of Norwich, a community of over 40,000, there will not be a single cardiologist available to UHG MA enrollees.  Adding to further confusion, the health care providers may appeal their termination and some have filed lawsuits alleging contract and federal law violations. Rather than assuaging the Medicare population in Connecticut, UHG’s handling of these terminations is intensifying patient and provider confusion. 

While we understand that insurance companies need the ability to adjust their network of providers in response to market realities, the significant disruptions that we are experiencing in Connecticut show an urgent need for CMS to immediately review how the network adjustment was made and address the needs of the consumers in Connecticut moving forward. Network adequacy determinations are typically made when a plan is entering a new market and MA plans are contractually required to maintain the adequacy of their networks. Because provider choice is important for consumers deciding which plan will best meet their needs, we ask that CMS take into account UHG’s dominance in the Connecticut market as a part of determining whether UHG’s approach is appropriate in this case.

While CMS has not affirmatively determined that UHG has violated CMS regulations for MA plans, nor has a court determined that UHG’s termination of its CT providers breached their contracts, we believe that CMS should use the full extent of its authority over MA plans to ensure that beneficiaries do not have to make a final decision regarding their Medicare coverage for next year without the benefit of fully understanding what the network of their current UHG MA plans will look like as of February of next year. MA enrollees only have 10 days left of open enrollment, at which point they may still decide to switch back to traditional Medicare until February 14, but the ongoing uncertainty regarding these plans in Connecticut warrants further action from CMS prior to the day on which Connecticut enrollees must decide on a Medicare Advantage policy.

The ability of people to make decisions is further hampered by the providers’ ongoing appeal of their termination by UHG. We ask that you consider the uncertainties that these unresolved appeals can cause in determining how best to serve MA enrollees regarding enrollments for 2014. As we see the effects of network adjustments unfolding in Connecticut, we urge you to review and strengthen the process for determining network adequacy. Additionally, because of the novelty of UHG’s approach and the significant confusion that currently exists for MA enrollees, we ask that you consider allowing additional time to make enrollment decisions for next year by opening an additional enrollment period or extending the current one.

We look forward to receiving your response. While we are not necessarily opposed to these adjustments, we hope to work with you in the future to ensure that MA enrollees have the necessary information that they need to make decisions about their health coverage. Please contact Laurel Sakai (202-224-2823­) on Senator Blumenthal’s staff with any additional questions.