Can an MA Carrier Exit an Area While Under Sanction?

[wehotex]

I'm sure that it's not possible for them to expand, so I think that the opposite would also be true? Healthspring plans SUCK in my market. I'm wondering if they'll just give up the struggle here, and IF THEY ARE ALLOWED TO DO SO?

 

[yogooglethis]

I'm sure that it's not possible for them to expand, so I think that the opposite would also be true? Healthspring plans SUCK in my market. I'm wondering if they'll just give up the struggle here, and IF THEY ARE ALLOWED TO DO SO?

They have an annual contract with CMS so they can't decide to drop coverage in middle of the year.The DOI and CMS can shut them down however.

 

[TwoCents]

They have an annual contract with CMS so they can't decide to drop coverage in middle of the year.The DOI and CMS can shut them down however.

Untrue. Look at Crestpoint Health out of TN that ceased operation mid-year. They chose to close down; not forced to do so.

Now getting back to the original question about whether or not a company under sanctions could shut down -- I would think so; CMS might even be relieved.

 

[yogooglethis]

Untrue. Look at Crestpoint Health out of TN that ceased operation mid-year. They chose to close down; not forced to do so.

Now getting back to the original question about whether or not a company under sanctions could shut down -- I would think so; CMS might even be relieved.

Is true.They can not violate their MA contract and just shut down because they feel like without consequences. CMS had to approve this and it looks like one of the reasons they did is because CMS and CrestPoint had already had made arrangements to to migrate membership to BCBS of Tenn.

And back to original question: see above statements .



I love me some google:


MSHA: CrestPoint Health insurance plan to cease operations | WJHL

"Mountain States Health Alliance confirmed Wednesday it will shut down CrestPoint Health, the company’s health insurance company operated by its subsidiary Integrated Solutions Health Network.

The change will impact MSHA’s thousands of employees and an unknown number of people who chose CrestPoint Health as their Medicare Advantage coverage.

This week, letters are being sent to CrestPoint Medicare Advantage members notifying them of our mutual decision with the U.S. Centers for Medicare and Medicaid Services (CMS) to cease operations of CrestPoint,” MSHA CEO Alan Levine wrote in a letter to employees. “The termination of the CrestPoint Medicare Advantage Plan will be effective June 1"

 

[TwoCents]

Is true.They can not violate their MA contract and just shut down because they feel like without consequences. CMS had to approve this and it looks like one of the reasons they did is because CMS and CrestPoint had already had made arrangements to to migrate membership to BCBS of Tenn.

And back to original question: see above statements .



I love me some google:


MSHA: CrestPoint Health insurance plan to cease operations | WJHL

"Mountain States Health Alliance confirmed Wednesday it will shut down CrestPoint Health, the company’s health insurance company operated by its subsidiary Integrated Solutions Health Network.

The change will impact MSHA’s thousands of employees and an unknown number of people who chose CrestPoint Health as their Medicare Advantage coverage.

This week, letters are being sent to CrestPoint Medicare Advantage members notifying them of our mutual decision with the U.S. Centers for Medicare and Medicaid Services (CMS) to cease operations of CrestPoint,” MSHA CEO Alan Levine wrote in a letter to employees. “The termination of the CrestPoint Medicare Advantage Plan will be effective June 1"

I never said a plan didn't need CMS' permission to shut down, just that they could mid-year. And now you're just making things up -- "without consequences?" Show me a source for the consequences being faced by Crestpoint.

 

[yogooglethis]

I never said a plan didn't need CMS' permission to shut down, just that they could mid-year. And now you're just making things up -- "without consequences?" Show me a source for the consequences being faced by Crestpoint.

There is no consequences is this event because it seems the carrier had financial problems operating this plan in this market possibly bordering on insolvency and they where pro active and worked it out with CMS to have BCBS take over the membership.Bottomline this is still a Termination of Plan by CMS and the MA contract is unilateral on this.





"Think about it.It's called a Medicare Advantage CONTRACT and the carrier has to bid on what benefits they are going to offer for a calendar year for x amount of monthly reimbursement.If CMS let the carriers quit it any time they want because they miscalculated cost it wouldn't work



https://mgtvwjhl.files.wordpress.com/2016/04/click-here-to-read-letter-from-msha-ceo-alan-levine.pdf


Importantly, because we have worked with CMS, special arrangements are being made for our Medicare
Advantage members to choose among the other very high quality health plans in our region, and these
opportunities are being communicated directly to the members. As you may know, we are proud that
CrestPoint achieved 4-Star ratings, making our plan among the highest quality. We are very grateful to
our team members at CrestPoint who worked hard to build it into a reliable plan.
I am pleased to share with you that we have also negotiated an arrangement with Blue Cross Blue Shield
of Tennessee for our own team member health plan administration. Your CrestPoint card remains good
until the new plan year begins July 1st
. You will receive your new Blue Cross cards prior to July 1st, and
you will be able to enjoy full use of the coverage beginning July 1st
.
This change came after much deliberation by the Mountain States Board and by the Board of ISHN upon
management’s recommendation. Given the magnitude of external changes in the health care market,
and the many important demands we have for capital and investment into our system, we believe the
need for this change came down to one simple question: What do the stakeholders in our region care
most about? The answer, honestly, is they expect us to provide well-capitalized hospitals, investment
into recruitment and retention of physicians, investment into technology that improves care, and
ensuring access to services where we alone add value. Where other well-capitalized companies are
already in the insurance market, it is therefore difficult to justify the ongoing major investment required
to continue in that space, particularly given that CrestPoint was offering something that was already
readily available in the market."