CMS suspends enrollment and marketing for two Centene Medicare Advantage plans
Intermediate sanctions, effective on January 12, are due to low Medicare Advantage star ratings.
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The Centers for Medicare and Medicaid Services has terminated two Centene Medicare Advantage plans, in Part C and D enforcement action taken December 27.
CMS has terminated Part D plans by WellCare Health Insurance of North Carolina and WellCare Health Insurance of Arizona, both owned by Centene, citing three consecutive years of low Medicare Advantage star ratings.
CMS also provided notice to WellCare that it had made a determination to impose intermediate sanctions consisting of the suspension of enrollment and all marketing activities for these Medicare Advantage plans.
These intermediate sanctions will be effective on January 12. CMS said it would provide WellCare with detailed instructions regarding the enrollment and marketing suspensions in a separate communication.
"The basis for this action is that CMS has determined that WellCare has substantially failed to carry out its contract with CMS by failing to achieve a Part C summary Star Rating of at least three stars in three consecutive Star Rating periods," the notice read.
CMS said the intermediate sanctions would remain in effect until it was satisfied that the deficiencies had been corrected and were not likely to recur.
CMS also terminated a Part D contract from Zing Health, which offers three Medicare Advantage plans in Illinois, Indiana and Michigan. This was for failing to achieve a Part D summary Star Rating of at least three stars in three consecutive years.
Zing was reportedly founded by Health2047, a venture fund from the American Medical Association.
The health plans may appeal the decision.
WHY THIS MATTERS
In the 2024 Medicare Advantage Star Ratings, four plans received the lowest rating of 2 stars. All were owned by Centene.
THE LARGER TREND
CMS uses star ratings to determine the quality of Medicare Advantage Part C and D plans. The agency may terminate a plan's contract if it achieves a rating of less than three stars for three consecutive contract years.
X: @SusanJMorse
Email the writer: SMorse@himss.org
