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What Does CMS’s New Rule Regarding Electronic EOCs Mean for Health Plans?

June 14th, 2018 | by Doug Pray

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In its 2019 annual notice, The Centers for Medicare & Medicaid Services (CMS) issued regulatory changes that impact how and when health plans must provide Evidence of Coverage (EOC) documents to members.

What the Rule Allows

The rule brings the following major changes to Medicare Advantage Organizations (MAOs), Medicare Prescription Drug Plans (PDPs), and section 1876 Cost Plans:

  • The Annual Notice of Change (ANOC) and the Evidence of Coverage (EOC) documents are now two independent documents with different delivery requirements and flexibilities. Beginning with Contract Year 2019, ANOCs and EOCs no longer need to be combined in the mailing due to members by September 30.
  • Health plans may now share EOCs electronically rather than printing and mailing the documents
  • Health plans will now have until October 15 to either ensure receipt of the EOC by members, or provide EOCs electronically

Benefits for Health Plans

CMS estimates this new rule has the potential to save health plans $54 million a year. These savings will come from eliminating or significantly reducing expenses related to printing, fulfillment and postage for the EOCs.

Beyond the monetary savings, health plans now have more time to produce the lengthy EOCs. In addition to having two more weeks until these documents are due to members, health plans that will provide EOCs electronically will also free up part of the timeline previously dedicated to printing and mailing.

Words of Caution

Because health plans now have an extra two weeks to create and share EOCs with enrollees, CMS will have even more rigorous oversight of these documents.

Given the monetary and time savings that come with this new rule, health plans may feel like they’ve just won the lottery. However, just as lottery winners can squander their good fortune, health plans can also be at risk of mismanaging their windfall – time.

Plans will have to better manage their external and internal resources to get the full benefit of the extra time and reprieve on printing and mailing the EOCs. For example, subject matter experts (SMEs) may see the longer timeline as an opportunity to tinker with content. The risk is they may waste this time making changes that are confusing to members or outside of “model” language accepted by CMS. Not only does this waste time, but it also puts the documents at risk of errors, thus creating the need to issue erratas and increased CMS scrutiny.

Health plans should stay disciplined with workflows and procedures, despite the extra time now allowed. CMS has explicitly stated that the extra time for EOC creation “will also provide an additional two weeks for MA organizations and Part D plan sponsors to prepare, review, and ensure the accuracy of the EOC, provider directory, pharmacy directory, and formulary documents. CMS considers the additional time for the EOC important due to the high number of errors that plans self-identify in the document through errata sheets they submit…” This means plans need to use the time wisely and get these documents right the first time. CMS will be watching.

Questions Health Plans Must Ask Themselves

This new rule brings a host of questions health plans will need to ask in order to achieve compliance and take full advantage of these changes. These questions include, but are not limited to:

  • Will we still print and mail EOCs to all members? If so, will we mail them with the ANOCs and LIS Riders (due by September 30)? Or, will we provide the EOCs electronically (due October 15)?
  • If we provide the EOCs electronically:
    • We must mail members a Notification that the EOCs will be available by October 15, where to access them and how to request a printed copy. Will that notice be mailed with the ANOCs or mailed separately?
    • How will we document that members have received this notification about opting out of printed EOCs? How can we tie this notice to each members’ record so that a call center representative can easily find the document when a member calls, thereby enabling a more positive customer service experience?
    • Where will we display the electronic EOCs on our website and how will members find and access them? Do we need to create or update our member portal infrastructure? How can we make it as easy as possible for members to find their specific documents?
    • How will we ensure the website and the electronic EOCs are compliant with Section 508 rules and regulations?
    • How will we make printed copies of EOCs available to members who request them? Will we print a limited number of copies to pull from the shelves or will we use on-demand printing and fulfillment?

Enhance Experiences with the ePresentment Module

Having anticipated this opportunity for health plans to provide members with materials electronically, the Cody team developed a new module in the CodySoft® suite that addresses issues plans will face. The ePresentment Module™ gives health plans one platform to manage communications through the entire lifecycle, from member opt-in to tracking and analytics of a member’s interaction with a given communication.

The ePresentment Module:

  • Provides plans with an ePresentment compliance document server that manages plan member databases, member “opt-in” preferences, and distribution of compliance documents via the existing plan member portal, a secure link in email or conventional mail, depending on member preference.
  • Provides plans with an option for a “branded” online Member Portal, where members can easily access a personalized home page and electronic materials specific to them.
  • Provides plans with an administrative “back-end” function to allow customer service and plan marketing managers to access member opt-in data, locate member documents, track ePresentment and USPS mailed materials, and manage email distributions.
  • Complies with current CMS regulatory requirements, as well as provides flexibility to expand its functionality to more document types as CMS rules change over time.

In short, the ePresentment Module makes it easier for health plans to track members’ preferences and deliver required and requested information in a customer service-centered manner.

If your plan needs help navigating the changes created by this new CMS rule, our consultants and tools can help. Contact us today for a consultation or software demo.


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