Episode Summary
Overview
The podcast episode discusses the proposed CMS (Centers for Medicare and Medicaid Services) final rule for 2025 and its potential impact on insurance agencies. The rule aims to prevent "undue influence" over beneficiary plan selection and prevent "steering." The episode features John Green from NAbip and Mike Smith discussing the proposed regulation and its implications for the industry.
FMO Admin Fee and Dispute
The episode highlights the issue of the FMO (Flood and Mail Order) admin fee, which some claim can reach $1,300 per Medicare Advantage enrollment. However, John Green believes the number is exaggerated. The dispute centering around the FMO admin fee is a major concern in the industry, particularly for insurance agencies.
Complexity of Washington's Inner Workings
The episode sheds light on the intricacies of Washington's inner workings, highlighting the temptation to "smear" those in the private sector. John Green, a senior vice president of government affairs, expresses concern that the proposal could lead to the disappearance of FMOs, causing chaos and disruption to the industry. He emphasizes the importance of considering the private sector's role in the Medicare program and the potential impact on the trust fund.
Challenges of Negotiating with Regulators
The episode discusses the challenges of negotiating with regulators, particularly CMS. The speaker notes that CMS is very siloed and that trying to negotiate with them can be difficult. The speaker also mentions the dysfunction in DC, citing the narrow margin in both the Senate and House, which makes it hard to get things done.
Independent Agency Coalition and Fair Market Value
The episode highlights the role of the Independent Agency Coalition (IAC) and the Fair Market Value (FMV) concept. The speaker explains that the FMV concept is based on fair market value, not specific data. The IAC is working with Congress and appropriators to revise the rule and send it back to CMS for corrections.
FMOs and the Industry
The episode emphasizes the importance of Flood and Mail Order (FMO) organizations, highlighting their role in working with carriers, including Dwayne McFerrin. The speaker notes that FMOs are smart people who work together well and share a common purpose. The role of the FMO council and their ability to speak with one voice are also highlighted.
OMB Meeting and Proposed Rule
The episode discusses the OMB (Office of Management and Budget) meeting and its role in the review process. The speaker notes that the OMB could stop the rule and send it back to CMS for corrections.
Actionable Insights
* The CMS final rule for 2025 aims to prevent "undue influence" over beneficiary plan selection and prevent "steering."
* The FMO admin fee is a major concern in the industry, with some claiming it can reach $1,300 per Medicare Advantage enrollment.
* The private sector plays a critical role in the Medicare program, and its disappearance could cause chaos and disruption to the industry.
* Negotiating with regulators, particularly CMS, can be challenging due to their siloed structure and the dysfunction in DC.
* The Independent Agency Coalition (IAC) is working to revise the rule and send it back to CMS for corrections.
* FMOs play a vital role in the industry, working closely with carriers and speaking with one voice through the FMO council.
Key Takeaways
* The CMS final rule for 2025 has significant implications for the insurance industry.
* The industry must be aware of the proposed regulation and its potential impact on insurance agencies.
* Effective communication and negotiation with regulators are essential in the industry.
* Collaboration and cooperation among stakeholders are critical to addressing the complexities of the CMS final rule.
Timestamps
(0:00:00) - This podcast was recorded from a live event
(0:00:44) - John Anderson has been working on Medicare for 25 years
(0:02:00) - FMO admin override rumors started circulating on the West Coast last year
(0:05:20) - CMS is concerned about having undue influence over beneficiary plan selection
(0:10:26) - There is a lot of dysfunction in Washington right now on Medicare reform
(0:11:40) - Duane: FMO council has come a long way since inception
(0:14:23) - FMO doesn't have authority over agent compensation, according to CMS
(0:17:15) - Speaking of the TPMO, third-party marketing organization, definition changes this year
(0:22:36) - You have a long-term relationship with Hill staff members
(0:23:25) - Nabib says some issues have bipartisan support
(0:27:07) - Do you think ship counselors can do it without brokers
(0:28:23) - FMO members will be responsible for their licensing fees under the new rule
(0:34:36) - There was language in the regs that said TPMOs cannot share beneficiary data
(0:36:32) - CMS left themselves open to the possibility of future rulemaking
(0:38:04) - Navip is your insurance lobbyist. So not only support him financially but get to know him today
