June 24, 2008

Center for Medicare and Medicaid Services

Department of Health and Human Services

CMS-4131-P

PO BOX 8016

Baltimore MD 21244-8016

Dear CMS,

The Utah SHIP program would like to make comment on the proposed rule
changes for Medicare Advantage and Prescription Drug Benefit Programs
(CMS-4131-P).

**Section 422.52 *Eligibility to elect an MA plan for Special Needs
Individuals***

Utah SHIP agrees with the request that SNP have an established process
to check eligibility with the State Medicaid office. However, the Utah
SHIP program would like a shorter time frame to accomplish this task
(down to PY 2009). The requirement should force to SNP and State
Medicaid offices to resolve eligibility issues and not refer the
Medicare beneficiary to Medicare or State SHIP offices.

**Section 422.101 *Requirements relating to basic benefits***

Utah agrees with the changes to provide appropriate information to
enrollees under SPN.

**Section 422.103 *Benefits under an MA MSA plan***

MSA plans should be required to provide information on the cost and
quality of services in their service area.

**Section 422.107 *Special Needs Plans and Dual Eligibles: Arrangements
with States***

Utah SHIP strongly agrees with the requirement for SNP plans to have
documented WORKING relationships with State Medicaid Offices. The
requirement should force to SNP and State Medicaid offices to resolve
eligibility issues and not refer the Medicare beneficiary to Medicare or
State SHIP offices. The Utah SHIP program would like a shorter time
frame for this requirement to take effect.

**Section 422.504 *Contract provisions***

The Utah SHIP program agrees with the liability protection for MA
enrollees.

**Section 422.2262 *Review and distribution of marketing materials***

Utah SHIP agrees with the 45-day rule for marketing materials. However,
when CMS enter the realm of the "file and use" forms with marketing
materials. CMS must place proper emphasis on ramifications if the MA
Plan or Prescription Drug Plan violates this certification. Insurance
companies have a bad track record of hurting enrollees when they violate
certification requirements. The Utah SHIP program strongly suggests that
CMS attach the civil monetary penalty (per enrollee effected) as penalty
for violating the certification without exceptions. When Insurance
companies are allowed to use excuses for "misinterpreting rules", " not
properly reviewing documents", and other excuses with no ramifications,
the companies are not held accountable.

**Section 422.2264 *Guidelines for CMS review and notification***

Utah SHIP program agrees with standard rules and wording for marketing
materials.

**Section 422.2268 *Standards for MA organization marketing***

Utah SHIP program agrees with no additional healthcare selling outside
of original purpose of the appointment. CMS should also add wording that
will allow the State Department of Insurance to take action against the
agent/producer violating this standard.

**Section 422.2272 *Licensing of marketing representatives and
confirmation of marketing resources***

Utah SHIP agrees with this requirement.

**Section 422.2274 *Broker and agent commissions and training of sales
agents***

The Utah SHIP program agrees with CMS testing for agents / brokers. We
also support the ability for the State Departments of Insurance to
receive the testing information for the insurance carriers.

**Section 423.34 *Enrollment of full-benefit dual eligible
individuals***

These are great changes to prevent MA plans from hurting dual eligibles.
We suggest that the verification call be after a 72-hour "plan
absorption period".

**Section 423.46 *Late enrollment penalty***

Utah SHIP agrees with this requirement.

**Section 423.505 *Contract provisions***

The Utah SHIP program agrees with CEO / CFO certify report accuracy but
nothing is mentioned in way of non-compliance. This rule is important
but means nothing if not backs with penalties for contract violations.

# Section 423.2262

# Section 423.2264

**Section 423.2272**

**Section 423.2268**

**Section 423.2274**

These sections comments are similar to the MA plan section changes.

Thank you,

Darren Hotton

Utah SHIP Program Manager