Recent CMS Guidance Impacts Humana’s Payment Process

The following information is from Humana. If you have any questions, please contact AMAC Broker Services at 1-888-776-6565 or via email at [email protected]

Or contact Humana at [email protected].    

Amendments to contracts containing information about The Centers for Medicare & Medicaid Services’ (CMS) recently issued updated guidance regarding when an agent should be paid full or pro-rated initial year compensation were sent in November 2015 to Humana’s contracted agencies. For your reference, we’ve included the updated CMS guidance below: 

There are three scenarios affecting how an organization may pay full or pro-rated initial compensation.

1. For a beneficiary’s first year of enrollment in a plan, in which the MARx report lists the prior plan type as “none,” organizations may pay full or pro-rated initial compensation.
2. When a beneficiary moves from an employer group to a non-employer group plan, in which the MARx report lists the prior plan type as “none,” organizations may pay full or pro-rated initial compensation for a beneficiary’s first year of enrollment in a plan.
3. For unlike plan changes (e.g., MA-PD to PDP or PDP to Cost Plan), occurring after January 1 in which the MARx report indicates the beneficiary had prior plan history (regardless of plan type), organizations must pay pro-rated initial compensation according to the number of months in the plan. For example, a change from a PDP to an MA-PD effective May 1 is an unlike plan change resulting in a pro-rated initial compensation of 8/12 (May thru December) of the MA-PD initial compensation rate.

For further clarification, the chart below is a brief summary of how the new CMS guidance will affect payments: