You have some obsession with this bear petey . What a screwed up name . You must have really admired him. He must have been a hell of a guy . Wish i could have met himDon was here long before you...just using different names.
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I've Solved the Riddle.
Two margaritas in 10 minutes in me and I've realized that peteybear, sirherbie, and goget are all the same person. Happy Cinco de Mayo.
- Rearden
- Thread
- May 5, 2015
Crybabies FMO win suit against CMS
- Thread starter Packerland
- Start date
- 2,431
Which state are you from? I have only lived in California & Texas, 2 big states with only 2 senators and in solid blue or red states. So, the senators couldn’t give a shit unless you’re a big donor. The Reps’ office are more receptive.
I am guessing you are in Wisconsin? It is impressive that you are lobbying and something that we all should be doing.
MedicareWAA
Expert
- 61
Integrity did not “win” anything. They got a court to stop the rule until it can be argued in front of a judge later this month.
Maybe they will win. No one has won yet.
Walter
Maybe they will win. No one has won yet.
Walter
- 29,732
You're the one that picked it.
We aren’t getting the 100/50. That’s been postponed. Our commission is going back to before. Yes, the little guy will hurt in the end. health assessments are gone, 100/50 gone. We don’t know how the carriers are going to pay the FMO but all I hope for is that it is fair for all. I think if FMO’s want to continue to feel worthy, they should diversify these payments they get from the carriers to all their contracted agents and not be selective. That is why you see some agents get no benefit from an FMO and some get everything they ask for. We need to be fair in this market because the carriers and CMS are aware of the problem.And the stupid effing call recording. Yea, let's have every agent wiretap every single person they talk to and then keep AAAAAAAAALL that data indefinitely. GREAT IDEA!
Still not a peep on this from NABIP, who is basically our defacto unofficial union, on that. Or the FMO's. I have nothing against FMO's, but I'm just very tired of agents getting thrown around out here like rag dolls.
We are the ones doing ALL the work, and then some carrier comes along and goes "money?" Nah, you don't need that...just write some of our plans for no money. Yea, how about "NO!"
Or on the Obamadontcare Healthcare Exchange when carriers yanked our pay away from like 97% of insurance plans up until like 5 years ago.
Then you've got CMS out here like...."Oh yea...agents, by the way...we're gonna have you wiretap everyone you speak to, just because. Oh, and don't speak to anyone for 48 hours anymore.
Oh, and here's a bazillion rules you have to follow. Oh, and if you break one, the carriers will probably just cut you and keep all of your pay. Oh, and if you don't pass these tests every year, carriers are gonna keep all of your pay indefinitely. SO. TIRED. OF. IT.
All I know is this injunction or ruling or whatever better not affect our well-deserved raise in renewals.
That has not been postponed. The injunction was for the legality CMS has about how/who carriers contract with and compensate them. Not agent commissions.
- 2,481
So you are recording this crap?
All of mine are walk-ins even though I'm 99% virtual.
- 974
“Arbitrary and Capricious” – A sign of things to come?
On July 3, 2024, the US District Court of Northern Texas issued a Memorandum Opinion and Order in the combined cases of Americans for Beneficiary Choice, et al. v. United States Department of Health and Human Services (Civ. Action No. 4:24-cv-00439) and Council for Medicare Council, et al., v. United States Department of Health and Human Services (Civ. Action No. 4:24-cv-00446).
The Plaintiffs (in this combined case) challenged the Centers for Medicare and Medicaid Services (“CMS”) rule issued earlier this year. The new rules attempt to place reimbursements to third-party firms into the definition of compensation where the prior rules did not include reimbursements into the definition of compensation which would have been subject to the regulatory cap on compensation.
This Memorandum Opinion Order granted the Plaintiffs’ Motion for a Stay in part and denied it in part. The Motion was granted in relation to the new CMS rules around compensation paid by Medicare Advantage and Part D plans to independent agents and brokers who help beneficiaries select and enroll in private plans.
The Court found that the compensation changes were arbitrary and capricious and that the Plaintiffs were substantially likely to succeed on the merits of the case. The Court found that CMS failed to substantiate key parts of the final rule. During the rulemaking process, industry commenters asked for clarification around parts of the rule, but CMS claimed “the sources Plaintiffs criticized were not significant enough to warrant defending them.” The Court found “because CMS failed to address important problems to their central evidence…that members of the public raised during the comment period, those aspects of the Final Rule are most likely arbitrary and capricious.”
One of the Plaintiffs, Americans for Beneficiary Choice, also challenged the consent requirement of the final rule. The final rule states that personal beneficiary data collected by a third party marketing organization (“TPMO”) can only be shared with another TPMO if the beneficiary gives prior express written consent. The Plaintiff argued that the consent requirement is “in tension with HIPAA’s broader purpose of facilitating data sharing” and CMS stated that HIPAA might facilitate data sharing, but that does not limit CMS’s ability to limit certain harmful data-sharing practices. The Court denied the Motion to Stay regarding the consent requirement, but interestingly stated that Plaintiff’s “claim regarding the Consent Requirement may ultimately have merit, [Plaintiff]’s current briefing does not demonstrate a substantial likelihood of success at this stage”.
What does this mean now that we are less than 90 days from the start of the 2025 Medicare Advantage/Part D contract year?
It doesn’t. While this case does show that courts are willing to look critically at agencies' rulemaking process, the FCC’s 1:1 consent requirement is different than the compensation changes set forth by CMS.
The FCC arguably just clarified the existing rule around prior express written consent by requiring the consent to “authorize no more than one identified seller”.
CMS, on the other hand, attempted to make wholesale changes and “began to set fixed rates for a wide range of administrative payments that were previously uncapped and unregulated as compensation.”
There is still the IMC case against the FCC , so there is the possibility (albeit small) there could be relief coming in that case. However, the advice here is to continue planning for obtaining consent to share personal beneficiary data AND single seller consent.
[EXTERNAL LINK] - “Arbitrary and Capricious” – A sign of things to come?
On July 3, 2024, the US District Court of Northern Texas issued a Memorandum Opinion and Order in the combined cases of Americans for Beneficiary Choice, et al. v. United States Department of Health and Human Services (Civ. Action No. 4:24-cv-00439) and Council for Medicare Council, et al., v. United States Department of Health and Human Services (Civ. Action No. 4:24-cv-00446).
The Plaintiffs (in this combined case) challenged the Centers for Medicare and Medicaid Services (“CMS”) rule issued earlier this year. The new rules attempt to place reimbursements to third-party firms into the definition of compensation where the prior rules did not include reimbursements into the definition of compensation which would have been subject to the regulatory cap on compensation.
This Memorandum Opinion Order granted the Plaintiffs’ Motion for a Stay in part and denied it in part. The Motion was granted in relation to the new CMS rules around compensation paid by Medicare Advantage and Part D plans to independent agents and brokers who help beneficiaries select and enroll in private plans.
The Court found that the compensation changes were arbitrary and capricious and that the Plaintiffs were substantially likely to succeed on the merits of the case. The Court found that CMS failed to substantiate key parts of the final rule. During the rulemaking process, industry commenters asked for clarification around parts of the rule, but CMS claimed “the sources Plaintiffs criticized were not significant enough to warrant defending them.” The Court found “because CMS failed to address important problems to their central evidence…that members of the public raised during the comment period, those aspects of the Final Rule are most likely arbitrary and capricious.”
One of the Plaintiffs, Americans for Beneficiary Choice, also challenged the consent requirement of the final rule. The final rule states that personal beneficiary data collected by a third party marketing organization (“TPMO”) can only be shared with another TPMO if the beneficiary gives prior express written consent. The Plaintiff argued that the consent requirement is “in tension with HIPAA’s broader purpose of facilitating data sharing” and CMS stated that HIPAA might facilitate data sharing, but that does not limit CMS’s ability to limit certain harmful data-sharing practices. The Court denied the Motion to Stay regarding the consent requirement, but interestingly stated that Plaintiff’s “claim regarding the Consent Requirement may ultimately have merit, [Plaintiff]’s current briefing does not demonstrate a substantial likelihood of success at this stage”.
What does this mean now that we are less than 90 days from the start of the 2025 Medicare Advantage/Part D contract year?
- The consent requirement is still moving forward – While the memorandum order hints at the possibility of it being rejected, as of right now, TPMO’s must get prior express written consent before sharing personal beneficiary data with another TPMO.
- The fixed-fee and contract-terms restrictions in the final rule have had their effective date’s stayed until this suit is resolved. Therefore, the compensation scheme that was in place last year is essentially the same for those two sections.
It doesn’t. While this case does show that courts are willing to look critically at agencies' rulemaking process, the FCC’s 1:1 consent requirement is different than the compensation changes set forth by CMS.
The FCC arguably just clarified the existing rule around prior express written consent by requiring the consent to “authorize no more than one identified seller”.
CMS, on the other hand, attempted to make wholesale changes and “began to set fixed rates for a wide range of administrative payments that were previously uncapped and unregulated as compensation.”
There is still the IMC case against the FCC , so there is the possibility (albeit small) there could be relief coming in that case. However, the advice here is to continue planning for obtaining consent to share personal beneficiary data AND single seller consent.
[EXTERNAL LINK] - “Arbitrary and Capricious” – A sign of things to come?
Virtual walk-ins, ftw!
- 2,481
Not that hard. I'm using 32" monitors.
