This year, the Centers for Medicare & Medicaid Services (CMS) released model documents for the Annual Notice of Changes (ANOC) and Evidence of Coverage (EOC) documents on May 31, which may seem to allow ample time for production. However, CMS continues to issue required changes and corrections to those documents throughout the summer months, as they did on August 8th this year when CMS issued both a set of newly revised models, and the annual corrections memo on the same day. Constant change puts the industry literally on the edge of their seats until the required September drop dates, which means your organization could be making edits right up to the final hour with little or no time left for a formal review.
Let’s hit the starting blocks with the initially released changes for ANOCs and the EOCs shared between the two document types, and then we’ll change lanes to provide specific changes for them individually. Note: It’s important to cross-reference this information to the CMS Model Corrections memo, and the new models that were just released on August 8 to capture additional updates.*
We’ve found CMS has not included all changes that appear in the new model to show in the corrections memo, and vice-versa, so you’ll want to keep your eyes peeled for additional tweaks. To help ease your review process, here are a few model updates for you to explore, and best practices to consider for meeting CMS’ unforgiving timelines.
Shared updates for EOC and ANOC model types include:
- Insulin language. For plans with drug coverage, CMS replaced insulin verbiage, previously required for Senior Savings Model participants, with verbiage that now applies based on the passing of the Inflation Reduction Act’s (IRA) insulin coverage.
- Quotation marks. CMS changed the placement of quotation marks by removing them from all instances of select phrases including clinical research study. CMS then added quotation marks around all instances of terms including “drug list.” Watch the font style for verbiage impacted by quotes; we’ve noticed a revolving door with font style to add or remove bold and italics on select terms where this punctuation changed.
- Relationship references. CMS replaced each appearance of “spouse” with “domestic partner.”
Sample updates to the EOCs
- Use of bullets. It’s a variety this year. When applying bullet points to EOCs, CMS initiated a false start for like and un-like sections between models, for different plan types. The spectrum of inconsistencies include: Unchanged bullets versus entire sections where bullets have vanished, varied indentations within a grouping, to randomly placed bullets sporting assorted styles. The models arrived with bullets missing in two of the EOCs. In some cases, models have indentations but no bullets. CMS may leave plans to their own devices for determining how to handle. In the event CMS chooses not to provide related corrections, you may choose to reference the 2024 CMS model instructions which clarify formatting preferences are a permissible change.
- Have a gander at the formatting in CMS’ updated models. While we see some improvement in the bullet formatting, it’s not a universal correction throughout a given model, or even between all models.
- Font style observations. We specifically noticed font style changes in the EOC for the PPO MAPD plan type in Chapter 1, and for the COST EOC model in multiple locations.
- In the August model release, we’ve observed a few formatting fixes on the part of CMS. However, the edits by CMS are not consistent. Year-over-year font style edits will still merit a close look.
- Ambulance. This has changed to a paragraph format, omitting the previous bulleted structure. Check for updates to content around non-emergency trips; including the documentation is required to consider a non-emergency trip for coverage.
- Colorectal screening. The content has changed so significantly, modifying last year’s content might not be your best use of time. The age limit was removed, and more details were added outlining the waiting period between screenings for low-risk versus high-risk individuals.
- CMS has made even further changes to this benefit in their corrections memo, so please review thoroughly.
- Dental coverage. CMS indicates 2024 benefits will include dental coverage in limited circumstances.
- CMS’ corrections memo includes further edits to the benefit’s instructional language.
- SHIP content removal. The CMS corrections memo removes options for persons to contact their “State Health Insurance Assistance Program,” offering only the online tool for identifying their state’s SHIP contact information.
Prescription drug coverage updates:
- Onset of IRA’s insulin coverage. We’ve previously mentioned changes to language for insulin coverage due to the passing of the Inflation Reduction Act, and the sunset of the optional Senior Savings Model (SSM) pilot. However, plans that previously did not participate in the SSM pilot will be adding new text, versus replacing, so extra scrutiny of those sections may be worth your time to ensure proper placement of verbiage.
- More language has been added to Section 6 of EOCs regarding the Coverage Gap coinsurance, to clarify coinsurance requirements do not apply to Part D covered insulin products. CMS also added new details about vaccine coverage.
- Biological alternatives. This phrase changed to, “biosimilar alternatives” or “interchangeable biosimilar.”
Sample updates to the ANOCs
- Premium listing. A significant change from previous years, section 2.1 of the ANOC no longer requires listing the plan premium if there are no year-over-year changes.
- CMS-driven benefit changes. Model changes in the EOC which implement new or updated benefit requirements also need to be included in the ANOC. It’s easy to routinely focus on benefit updates initiated by the plan for bid approval, and inadvertently overlook changes implemented by Medicare for placement in the ANOC (such as Medicare-driven updates to colorectal screening).
- DSNP ANOC. In the CMS corrections memo, content was deleted from the Deductible Stage Chart, regarding Low Income Subsidy (LIS), level 4.
- EOC partial hospitalization services. The benefit name has been changed from “Partial hospitalization services” to “Partial hospitalization services and Intensive outpatient services .” Be sure to update the benefit title and include the new additional paragraph shown in the memo.
Prescription drug coverage updates:
- Insulin language. Yes, we’ve mentioned this before. However, it can be confusing whether or not to list this in the ANOC as a year-over-year change, if your plan participated in the SSM pilot program which required similar messaging. As the benefit is now driven by the passing of the IRA, versus an opt-in through a pilot program, you may want to consider listing this in your ANOC, since some of the IRA-related changes occurred mid-year.
- “Initial Coverage” table. This table, which details benefits that occur in the initial coverage stage of a beneficiary’s drug benefits, includes updated content stating that most adult vaccines will be covered at “no cost to you.”
- Review initial model updates provided in our webinar here and further review tips.
Summary of Benefits updates
The recent Final Rule issued by CMS, outlined a change in requirements to the Summary of Benefits. Regulatory changes include the requirement to list all medical benefits first and any applicable drug benefits afterward. Toppan Merrill received further interpretation directly from CMS, which is covered in our June 15 webinar available here
Tips for reviewing your final documents
Selecting your review team and designating a spokesperson for small groups or breakout teams, are critical to supporting communication of edits to those finalizing your documents.
Additional best practices and tips include:
- Confirm timelines for each responsible party to report their findings to ensure version control if multiple sets of findings are provided from large groups
- Build alternate reviewers into your process to relieve “tired eyes” and avoid “error conditioning,” which may occur when the same individual continues to be the only reviewer of a complex document
- Determine a designee to “sign-off” and validate completion prior to uploading your documents to CMS
A number of additional document review tips, process-related best practices and suggestions are covered in the June 15 Toppan Merrill webinar available here.
How Toppan Merrill can help
Toppan Merrill is focused on these, and other CMS requirements, in support of our health plan marketing partners. Using our expertise and insight, we want to partner with you on your marketing and communications materials. From document creation and management, sales enablement, omnichannel communications, printing services, and more, we deliver best-in-class solutions that help you respond quickly to changes in regulations, member needs, and markets.
Learn more about how we can help with your health plans member communications
Summer Beach – Associate Director, Medicare Compliance Solutions, Toppan Merrill
With more than 30 years of insurance industry experience, Summer Beach is an industry thought leader and expert on Medicare-related compliance. Her background includes past roles as Regulatory Compliance Manager and Compliance Director for state, regional and national insurers. Her areas of expertise include CMS-regulated documents and guidelines, agent/broker and sales compliance, designing CMS-approved investigation processes, audits, Corrective Action Plans, and training with re-education formats following CMS disciplines. Summer brings expertise on policies and procedures, auditing compliance programs and has measurably reduced plan member complaints to CMS through remedial initiative.
* This information is intended to serve as a supplemental aid to your professional review and interpretation of year-over-year changes by CMS in its models. It does not include every instance of CMS edits and it should not take the place of guidance by your legal and/or compliance professionals, nor is it intended to replace advisement, manuscript, or guidance by CMS.