CMS has given WellPoint back permission to market Medicare Advantage and Medicare Part D plans after a nine-month ban on accepting new enrollments. CMS had imposed the ban in January after receiving lots of complaints about price hikes and denied drug benefits, issues WellPoint blamed on computer problems.
When CMS reviewed the situation, it found WellPoint had "widespread and continued failures" in monitoring the contract, including how it handled enrollments and disenrollments, benefits administration and co-pays, grievances and appeals, marketing claims, processing and customer service.
CMS still isn't completely happy with WellPoint's appeals and grievance processes, so the plan will have to remain under its corrective action plan for these areas. It will also have to remain under its communications CAP, which means that it will have to disclose any major compliance issues to CMS on its own. In addition, it will have to give CMS data from time to time to make sure the deficiencies don't happen again.
To learn more about CMS's decision:
- read this Health Leaders Media piece