Here's the excellent PSC update:
November 29, 2021
We hope
you and your families are well. This is an update on retiree health
care. Pending litigation makes the outcome uncertain, but it is
important that you are aware of the latest developments. As you may
know, a group of retirees sued, challenging the City’s implementation of
the Medicare Advantage Plus plan (MA+). The judge who is hearing the
case challenging the implementation of the City’s agreement with the
Alliance, the MA+ provider, has not yet ruled on the City’s plan to cure
the defects in its implementation of the new plan.
Some
important decisions are still not final. The deadline for retirees to
opt out of the MA+ plan has not been clarified. Nor is it clear whether
the judge will allow the City to begin implementing the MA+ plan on
January 1.
However,
today the judge informed the parties that he will not be amending the
injunction he issued on October 21 at this time. The City had asked the
judge to lift his injunction to allow them to transfer the data for
retirees who do not opt out by November 30 to the Center for Medicare
Services, a federal agency, by December 1. Through this action,
the City would have effectively enrolled into the MA+ plan those who
have not yet opted out. Since the judge has declined to modify his
October 21 injunction, the City is unlikely to transfer retiree data by
December 1, as to do so would appear to be a clear violation of the
judge’s order. However, if you wish to opt out by November 30, you can do so by completing this online form: https://nyc-ma-plus.empireblue.com/optout/
Details about litigation
As you
may recall, this past summer the City and the Municipal Labor Committee
(MLC) agreed, over the objections of the PSC and health care unions, to
implement a new, premium-free MA+ plan administered by an “Alliance” of
Emblem and Anthem Health to replace the previous premium-free
combination of traditional Medicare and Senior Care. As agreed to by
the City and the MLC, retirees who wanted to keep their Senior Care
would have had to affirmatively opt out of MA+ by October 31 and would
have to pay a monthly premium starting January 1, 2022.
However,
on October 21, Judge Lyle Frank found that, while the decision to award
the contract to administer the MA+ plan to the “Alliance” complied with
the law, the City’s implementation of the MA+ plan had been arbitrary
and capricious. He issued a temporary restraining order prohibiting the
City from enforcing the October 31 opt-out deadline and ordering the
City to maintain the status quo in plan enrollment until the City cures
deficiencies in the MA+ implementation plan. Further, the judge ordered
the City to send the attorney representing the retirees who brought the
lawsuit the City’s plan for curing the implementation deficiencies, and
to submit that plan to the court within seven days after that, at which
point the court would review and make a determination.
A timeline of events since then:
- November 5: the City sent its plan to cure deficiencies to counsel for the retirees.
- November
12: the City filed their plan with the court and, that evening, counsel
for the retirees filed their objections to the plan.
- November 16 and 22: counsel for the retirees sent letters to the judge, accusing the city of violating the judge’s order.
- November 19 and 22: the City responded.
- November
23: the court held a status conference regarding the plan. The judge
did not rule on the City’s plan to cure the deficiencies in the
MA+ implementation, scheduled another status conference on December
8 and asked the parties to meet to resolve their differences in the
meantime. That same evening, the City modified its proposed plan, asking
the court to (a) dissolve the injunction by December 1 in order to
allow the City to move forward with enrollment to be effective on
January 1 and (b) adjourn the December 8 status conference. Counsel for
the retirees responded the next day.
- November 29: the judge told the parties he does not plan to modify his October 21 order at this time.
The City’s plan
The City is
anxious for the MA+ plan to go into effect by January 1, 2022. However,
given the judge’s notification to the parties today that he does not
plan to amend his order at this time, it is not clear that the MA+ plan
will go into effect on that date. As noted, the City modified its plan
in response to objections from retirees and from the judge at the
November 23 status conference. As best as we can ascertain, this is what
the City is currently offering:
A. Retirees
who opt out by November 30 will remain enrolled in their current plan.
All others will be automatically enrolled in MA+. (The November 30
date was established because December 1 is the last day for the City to
submit participant data to the Center for Medicare Services – a federal
agency – in time for January 1 implementation.)
B. However,
throughout the month of December, any retiree who has not opted out may
still do so and remain in their current plan effective January 1.
C. Although
retires who do not opt out by November 30 will be enrolled
automatically in MA+, they may still change their minds and opt out by
April 30, 2022.
D. Throughout
the month of December, retirees who opted out of MA+ by November 30 may
still change their minds and elect MA+ effective January 1, but they
will not receive their ID cards and welcome kits until January 31.
E. Between
January 1 and April 30, 2022, retirees are permitted to make one change
(in either direction) to their enrollment between MA+ and Senior Care,
with an effective date of the first of the month following the date on
which they notify the Alliance of the change.
F. The Alliance will make a more concerted effort to reach out to providers to secure their participation in MA+.
The City says
it has stopped enrolling people in the MA+ plan, pursuant to the
judge’s order. And, because the judge will not at this point modify his
order, it appears that the City will not be able to enforce a November
30 opt out deadline and may not be able to implement the plan on January
1, 2022. So, it appears that the City’s proposal, as outlined in items A
through F above, will not take effect, at least for the time being.
Keep in
mind that the foregoing is what the City has told the judge it would
like to do, but this plan has not been approved by the judge. Moreover,
given the many problems in the implementation of the MA+ plan to date,
we have no certainty as to whether the City will actually be able to
keep these commitments.
The retirees’ objections
The
retirees suing the City object to the City’s plan, saying it does not
cure the deficiencies in implementation. They say it provides no
certainty about which providers will accept the MA+ plan and imposes a
new, previously undisclosed list of required pre-authorizations.
The City, they claim, has been violating the judge’s order by contacting
retirees to encourage them to enroll in the new MA+ plan and saying the
MA+ plan will take effect January 1.
In
short, the judge has not ruled on whether the City has cured the
deficiencies in its MA+ implementation plan. Given that the judge has
declined to amend his injunction order at this time, we believe it is
highly unlikely the City will transfer retiree data to CMS on December
1, as to do so would likely violate the judge’s order. We still do not know what the new opt out deadline will be, or whether the City will be allowed to implement the MA+ plan on January 1, 2022.
In solidarity,
James Davis, President, PSC
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