CA

June 16, 2008 Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-4131-P P.O. Box 8016 Baltimore, MD 21244-8016 Re: Docket ID: CMS-2008-0056 Docket/Document Title: Medicare Program; Revisions to the Medicare Advantage and Prescription Drug Benefit Programs Document ID: CMS-2008-0056-0001 Brown & Toland Medical Group is made up of 1,500 doctors – both community- based private practitioners as well as UCSF faculty physicians. Serving over 270,000 patients, including over 11,000 Medicare Advantage (MA) HMO beneficiaries, in San Francisco and surrounding areas, and recognized as a prestigious leader of chronic care programs for conditions such as diabetes, HIV, or asthma, Brown & Toland provides the highest quality of coordinated care to patients. To ensure that our physicians’ patients who are Medicare beneficiaries are aware of the MA options available to them through our physician network, Brown & Toland prepares a comparison of benefits offered by the MA health plans with which we contract. The Medicare Marketing Guidelines permits providers to utilize “objective third-party” benefit comparison. Section 11 of the Medicare Marketing Guidelines, “Specific Guidance About Provider Promotional Activities” in the Marketing Guidelines (p. 125) states: Comparative and Descriptive Plan Information Provided by a Non-Benefit/Service Providing Third-Party – Providers may distribute printed information comparing the benefits of different plans (all or a subset) in a service area when the comparison is done by an objective third party. Accordingly, to ensure that all benefit information is represented accurately and impartially, Brown & Toland uses the services of an “objective third party” to create benefit comparison materials that are made available to our physicians and patients. Brown & Toland and its physicians need to be able to promote contracted MA health plans so that our Medicare patients can determine their best coverage options and at the same time retain relationships with their doctors. As proposed, §422.2268 would prohibit providers from distributing printed information comparing the benefits of different MA health plans unless the materials have been approved by all MA organizations involved. When a medical group contacts its multiple contracted MA health plans, a MA health plan might not support a medical group in that endeavor. Physician organizations such as Brown & Toland need to create a multi-plan benefits comparison that would facilitate the important physician-patient dialog about a physician’s contracted Medicare options. Given this, Brown & Toland requests that CMS formally, in §422.2268 of the proposed regulations, allow providers to continue, as is currently the case under the Medicare Marketing Guidelines, to use an objective third party to create the MA health plan benefit comparisons that are distributed to beneficiaries/patients. Therefore, Brown & Toland requests that CMS consider the following amendment to §422.2268: §422.2268 Standards for MA organization marketing. In conducting marketing activities, MA organizations may not-- (j) (1) Use providers or provider groups to distribute printed information comparing the benefits of different health plans unless the materials have the concurrence of all MA organizations involved. (2) Providers may distribute printed information comparing the benefits of different plans (all or a subset) in a service area when the comparison is done by an objective third party. The proposed regulation needs to be brought in line with the existing Medicare Marketing Guidelines, in regards to allowing providers to use an objective third party to create benefit comparison materials patients. Brown & Toland very much appreciates this opportunity the offer comment to CMS proposed regulations. Sincerely, Keith Pugliese Director, Government Affairs & Compliance