CARA Act Implementation Gives Medicare Plans Additional Opportunities to Impact Drug Abuse

[Northeast Agent]

I attended a D-SNP training today for 2019 and something was mentioned that I was unaware of:

"The final rule also limits the ability of all dually eligible (duals) or low-income subsidy (LIS) beneficiaries to move (via a special enrollment period) from one MA plan to another to one change per calendar quarter in the first nine months of the calendar year. In an additional reform, those duals and LIS members who are identified as at-risk or potentially at-risk for prescription drug abuse under such drug management programs will have their ability to make plan changes further limited."

I was completely unaware of this new Act. Good to know about the prescription drug abuse and changing plans with Duals. Due to HIPAA and privacy laws, this may explain why if you put someone on a SNP plan and it gets canceled.

CARA Act Implementation Gives Medicare Plans Additional Opportunities to Impact Drug Abuse - MedHOK

 

[TwoCents]

Well, "canceled" isn't really the word to use here. The application could be rejected/denied if someone is flagged by a drug program as being a (potential) drug abuser if trying to use the SEP for LIS/duals.

 

[Northeast Agent]

Thanks, TwoCents.

My point was, since this will be happening sometimes and the carriers can't tell the agent why, due to HIPPA we should be aware of CARA.