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S. HRG. 110–829 

1–800–MEDICARE: IT’S TIME FOR A CHECK-UP 

HEARING 

BEFORE THE

SPECIAL COMMITTEE ON AGING 

UNITED STATES SENATE 

ONE HUNDRED TENTH CONGRESS 

SECOND SESSION 

WASHINGTON, DC 

SEPTEMBER 11, 2008 

Serial No. 110–35 

Printed for the use of the Special Committee on Aging 

( 

Available via the World Wide Web: http://www.gpoaccess.gov/congress/index.html 

SPECIAL COMMITTEE ON AGING 

HERB KOHL, Wisconsin, Chairman 

RON WYDEN, Oregon 

BLANCHE L. LINCOLN, Arkansas 

EVAN BAYH, Indiana 

THOMAS R. CARPER, Delaware 

BILL NELSON, Florida 

HILLARY RODHAM CLINTON, New York 

KEN SALAZAR, Colorado 

ROBERT P. CASEY, Jr., Pennsylvania 

CLAIRE McCASKILL, Missouri 

SHELDON WHITEHOUSE, Rhode Island 

GORDON H. SMITH, Oregon 

RICHARD SHELBY, Alabama 

SUSAN COLLINS, Maine 

MEL MARTINEZ, Florida 

LARRY E. CRAIG, Idaho 

ELIZABETH DOLE, North Carolina 

NORM COLEMAN, Minnesota 

DAVID VITTER, Louisiana 

BOB CORKER, Tennessee 

ARLEN SPECTER, Pennsylvania 

DEBRA WHITMAN, Majority Staff Director 

CATHERINE FINLEY, Ranking Member Staff Director 

(II) 

(III) 

C O N T E N T S 

Page 

Opening Statement of Senator Gordon H. Smith ................................................. 1 

Opening Statement of Senator Herb Kohl ............................................................. 4 

PANEL I 

Statement of Kerry Weems, Acting Administrator, Center for Medicare and 

Medicaid Services, U.S. Department of Health and Human Services ............. 5 

PANEL II 

Statement of Naomi Sullivan, Medicare Beneficiary, Chico, CA ......................... 24 

Statement of Michealle Carpenter, Deputy Policy Director and Counsel, Medical Rights Center ................................................................................................ 29 

Statement of Tatiana Fassieux, Board of Directors Chair, California Health 

Advocates, Sacramento, CA ................................................................................. 37 

Statement of John Hendrick, Project Attorney, Elder Financial Empowerment 

Project, Coalition of Wisconsin Aging Groups, Madison, WI ............................ 49 

PANEL III 

Statement of John M. Curtis, President and Chief Executive Officer, Vangent, 

Inc., Arlington, VA ............................................................................................... 55 

APPENDIX 

Prepared Statement of Senator Robert P. Casey, Jr. ........................................... 59 

Kerry Weems Responses to Senator Smith’s Questions ....................................... 59 

Michealle Carpenter’s Responses to Senator Smith’s Questions ......................... 62 

Tatiana Fassieux’s Responses to Senator Smith’s Questions .............................. 63 

John Curtis’s Responses to Senator Smith’s Questions ....................................... 63 

Statement by the Health Assistance Partnership ................................................. 65 

Testimony of Jettie Turner, Medicare Beneficiary, Tupelo, MS .......................... 67 

Testimony of Colter McLellan, Medicare Beneficiary, Picayune, MS ................. 77 

Testimony of Dawn V. Crouse, full-time volunteer SMP Counselor, Mississippi 

Senior Medicare Patrol, Columbus, MS ............................................................. 86 

Testimony of Frankie F. Ferguson, Medicare Beneficiary, Oxford, MS .............. 92 

(III) 

(1) 

1–800–MEDICARE: IT’S TIME FOR A CHECK-UP 

THURSDAY, SEPTEMBER 11, 2008 

U.S. SENATE

SPECIAL COMMITTEE ON AGING

Washington, DC. 

The committee met, pursuant to notice, at 10:08 a.m., in room 

SR–325, Dirksen Senate Office Building (Hon. Gordon H. Smith) 

presiding. 

Present: Senators Smith [presiding] and Kohl. 

OPENING STATEMENT OF SENATOR GORDON H. SMITH 

Senator SMITH. Good morning, ladies and gentlemen. We welcome you all to this very important hearing, 1–800–MEDICARE: 

It’s Time for a Check-Up. We’re met in this historic room of the 

Senate Russell Caucus Room. I don’t know that Administrator 

Weems will regard this as anything like the Watergate hearings. 

We don’t intend it to be. But a lot of historic things have happened 

here. 

Certainly one of the more historic things that Congress has done 

in the last several years is the Medicaid reform, the update that 

includes Medicare Part D. Medicare Part D is a massive program 

to provide seniors with prescription drug care as part of their Medicare benefit. 

When we began to put this legislation together to provide this reform and this new benefit, we recognized that it was a monumental 

task. CMS, through Health and Human Services, has certainly had 

an enormous job to do. Our focus here today is on how we can do 

that job even better. This is not designed to call into question anyone’s motive or in any way to question their sincerity, and Kerry 

Weems, who is the Administrator of CMS, has been many times to 

my office. I appreciate that, Kerry, and I appreciate your attention 

to this issue, and we are grateful for your service to our country. 

You’ve spent a lot of time in the Federal Government trying to get 

these programs right, and that is the spirit in which we gather 

here this morning. 

When we began to put 1–800–MEDICARE together as part of it, 

we did this because we heard predicted lots of problems that may 

emerge in terms of customer service as seniors try to navigate this 

very difficult path of getting enrolled and getting the benefit that 

comes with Medicare. 

So today’s hearing is the product of a 31⁄2 year ongoing investigation into the performance of 1–800–MEDICARE. Since I will be 

spending quite a bit of time during today’s hearing talking about 

findings from my investigation, I’m going to take a moment to proVerDate Nov 24 2008 12:02 Jun 04, 2009 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 H:\DOCS\49480.TXT SAG PsN: JOYCE
2 

vide an overview of the committee’s work on this subject. To ensure 

operational readiness for the first Part D open enrollment season, 

we commenced an inquiry into the performance of call centers in 

early 2005. This investigation has entailed the following: 500 test 

calls to 1–800–MEDICARE; annual inspections of 1–800–MEDICARE call centers across the country; interviews with 150 consumer service representatives and management staff who work at 

the 1–800–MEDICARE call centers; monitoring 200 hours of inbound calls; correcting error-ridden scripts related to premium 

withholding errors; reviewing call center performance data; exchanging hundreds of phone calls and emails with CMS, its contractors, beneficiaries, and advocates, subpoena of call center 

records from the administration and Part D plans; exchanging hundreds of—meetings with three separate CMS administrators, including Administrator Weems who is here today, and we appreciate 

his presence, as well as a former Social Security Commissioner. 

I also raised call center performance failures and resource issues 

at prior hearings of this committee and in the Finance Committee 

where I serve. I’ve convened today’s hearing with the indulgence of 

the chairman. I appreciate Senator Kohl very much, whom I thank 

for his support in the committee’s ongoing efforts to improve services at 1–800–MEDICARE. 

To start the hearing on a positive note, I’ll first comment on 

what seems to be working well with 1–800–MEDICARE. See, 

there’s good to report as well, Kerry. My staff have consistently 

had the highest praise for the professionalism and courtesy of the 

customer service representatives and management who work in the 

1–800–MEDICARE call centers. The reports that I have received 

reflect that on the whole the staff at 1–800–MEDICARE are earnest, professional, and courteous and care a great deal about providing the best service possible to beneficiaries. 

I’ll be discussing this in more detail during the hearing, but my 

conclusion is that the problems at 1–800–MEDICARE lie more 

with the training and resources provided to call center staff rather 

than with the staff themselves. 

I have also been quite pleased with CMS’s timely resolution of 

individual beneficiary cases that my office has referred to the agency. A further note. CMS recently implemented a dedicated access 

number for the State Health Insurance and Assistance Program, or 

SHIP, as it’s known, and they did this to streamline SHIP’s access 

to 1–800 services. CMS also recently hired an outside vendor to revise the training curriculum and call scripts used by 1–800–MEDICARE service representatives. 

However, as you might conclude, if all were well we wouldn’t be 

here today. So let’s delve into what needs to be improved and what 

we’re going to spend most of this morning discussing. My investigation has revealed persistent problems at call centers and they include: 

One, confusing interactive voice response menu options, or IVR, 

as it’s called. 

Another is unacceptably long waiting times, up to one hour during peak call periods. I know that when you spread it, Kerry, over 

a 24-hour period it takes the average down. But if you look at the 

3 

8 hours of business calls, that period of time, that’s where it gets 

really, really long, and that’s when people are most likely to call. 

Other problems are disconnected calls, technical and infrastructure failures, inappropriate referrals to SHIP and other entities, 

jargon-filled and error-ridden scripts that are used by customer 

service representatives to respond to caller inquiries, oversight inadequacies, training deficiencies, and incorrect information routinely being dispensed by customer service representatives. 

Many of today’s witnesses will share their firsthand experience 

in trying unsuccessfully to utilize 1–800–MEDICARE. These stories 

reveal much work remains to improve call center services. As we’ll 

hear in testimony today, the problems at 1–800–MEDICARE are 

not mere inconveniences to beneficiaries. When 1–800–MEDICARE 

provides incorrect information, the result can be devastating to 

beneficiaries. 

An Oregon transplant patient in California nearly died because 

1–800–MEDICARE provided incorrect information about coverage 

of anti-rejection medications. A senior in Florida ended up in the 

emergency room after foregoing necessary oxygen treatments because 1–800–MEDICARE provided her with incorrect information 

about the durable medical equipment program. 

Earlier this year I assisted beneficiaries who received incorrect 

information about the Part D enrollment process. These beneficiaries had been turned over to collection agencies for past due 

premiums for a plan in which they were no longer supposed to be 

enrolled. A cancer patient nearly died because he could not receive 

assistance in locating a facility for chemotherapy. 

Hundreds of stories like these have been shared with my office 

by tearful beneficiaries and advocates who are completely exasperated by their experiences with 1–800–MEDICARE. I’ve previously related to Administrator Weems my belief that there are 

failures in the system that we need to fix. That conclusion is informed by these test calls that we have made and also by the Government Accounting Office and the Department’s own Office of Inspector General, as well as information provided by the agency 

itself regarding call center performance. 

The population served by 1–800-MEDICARE is comprised of our 

country’s most vulnerable citizens. It is unacceptable to subject the 

sick, frail, and elderly to long waits, hour-long waits, disconnected 

calls, endless loops of referrals and call transfers, and erroneous information about benefits and services. It’s imperative that we deliver this in a timely and accurate way. 

I want to just say as an aside that I was contacted by Good 

Morning America on this hearing today and I basically told them 

what I just said in this statement, Kerry. You didn’t say it, but I 

understand someone at CMS said that our investigations were outdated. I don’t believe they’re outdated. My staff placed 50 test calls 

over the past 4 weeks. On August 28 of this year I received call 

center performance data current through July 2008. 

In June of this year my staff traveled with yours to the Richmond Call Center. At that time your staff and mine made test calls 

collaboratively onsite. During every single one of these test calls— 

let me repeat that during every single one of those test calls, CRS 

provided incorrect information. When asked to assign a letter grade 

4 

to those test calls, the call center management assigned grades 

ranging from B-minus to F. 

During that site visit my staff also conducted side by side monitoring of live inbound calls. The service was less than stellar. My 

staff raised several concerns to yours onsite that day regarding 

what had transpired during those calls. After that site visit and 

after you’d been informed about what transpired during the June 

visit, I’m informed you made an emergency site visit of your own 

to a Phoenix call center to investigate, and I appreciate that. 

Further, throughout this week of investigation my staff have 

interviewed Vangent, Briljent, and other contractors as well as 53 

advocates and beneficiaries. 

In any event, I very much hope that this will be a positive hearing. Part of our responsibility is to bring light and heat to issues 

and problems as we see them, not to denigrate but to build. So in 

that spirit, I thank you for being here, Administrator Weems, and 

I turn the mike over to my colleague Senator Kohl, the chairman 

of the committee. 

OPENING STATEMENT OF SENATOR HERB KOHL 

The CHAIRMAN. Thank you very much and good morning to all. 

I thank Senator Smith for holding this hearing. Senator Smith, 

you and your staff launched an investigation into 1–800–MEDICARE nearly 4 years ago. Considering all your hard work and due 

diligence, I am confident that today’s hearing will lead to improvements in the government’s ability to help seniors get the health 

care they need. 

Consumer service is a critical component of navigating the Medicare system. CMS currently estimates that 1–800–MEDICARE will 

receive 34.5 million phone calls in 2009. Older Americans use the 

help line to differentiate and decipher the overwhelming number of 

plan options available, to ask questions about coverage, to switch 

plans, and to file complaints. 

Senator Smith’s investigation shows that, in addition to lengthy 

wait times and a failure to call participants back when promised, 

much of the information disseminated by Medicare customer service representatives is incorrect and inconsistent. These can be 

grave errors. Misinforming Americans about their Medicare coverage can cause them to pay much more out of pocket than they 

should have to or, worse, leave them without the treatment or 

medications that they require. 

This committee worked side by side with CMS on many issues 

and I appreciate the working relationships that we have. I hope 

that we can all learn lessons from today’s hearing and continue to 

improve Medicare for older Americans. 

I would like to particularly thank the Coalition of Wisconsin 

Aging Groups for offering their expertise this morning. 

Once again I thank you, Senator Smith, for your leadership on 

this very important issue. 

Senator SMITH. Thank you, Chairman Kohl. 

Kerry Weems is the Acting Administrator of the Center for Medicare and Medicaid Services, which administers and oversees 1– 

800–MEDICARE. He’s here to discuss CMS’s efforts to ensure the 

overall success of the program and its working relationship with 

5 

Vangent, the company it contracts with to accept incoming beneficiary calls. Kerry, take it away. 

STATEMENT OF KERRY WEEMS, ACTING ADMINISTRATOR, 

CENTERS FOR MEDICARE AND MEDICAID SERVICES, U.S. 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Mr. WEEMS. Thank you, Senator Smith. Good morning, Chairman Kohl. I’m happy to be here to discuss 1–800–MEDICARE and 

how it serves our 45 million Medicare beneficiaries. 

Just stepping back for a moment, the Medicare program has 

changed significantly since when I began my career in HHS in 

1983. At that time the total number of Medicare claims processed 

was about 325 million and most of that was on paper. I’d just say 

parenthetically, at that time we didn’t have PCs on our desks; we 

had ashtrays. A lot has changed since then. The total number of 

contractors that we had processing those claims was 104. 

So if a beneficiary had a question about a claim or a bill or if 

they had questions about whether nursing home care or home 

health services were covered, they might have to make up to six 

phone calls, six different phone calls, to get answers to those questions. For example, for hospital or nursing home stay questions the 

beneficiary would have to make at least two phone calls to fiscal 

intermediaries to find answers, depending on what State they lived 

in. For physician questions, the beneficiary would have to make at 

least one call to a carrier. Some States, however, had two carriers, 

which would have required an additional call depending on the 

service. For a home health question, the beneficiaries would have 

to call the regional home health intermediary, and if there are 

questions about primary or secondary insurance they’d have to call 

the coordination of benefits contractor. This was not only time-consuming, it was frustrating and probably a poor business model. 

So fast forward to today. Today Medicare processes nearly 1.1 

billion bills, over 99 percent of which are electronic. We have about 

49 contractors handling those bills now. That number continues to 

decline. Most important to note is that beneficiaries can call one 

number today to get the answer to any Medicare-related question, 

and that number is 1–800–MEDICARE. 

By calling 1–800–MEDICARE, beneficiaries can check on claim 

status, find a provider or supplier in their area, and find out about 

primary or secondary coverage. So with few exceptions, a beneficiary can have almost all their Medicare-related questions answered by calling 1–800–MEDICARE, which also refers beneficiaries to plans and to SHIPs for more personalized service. 

But the consolidation to 1–800–MEDICARE didn’t occur overnight. It was an evolution of a vision to simplify Medicare processes 

under one roof, and it took hard work to get the operation that exists today. 

The 1–800–MEDICARE arm of our outreach strategy is a tollfree number that beneficiaries can use to get help on all aspects of 

the Medicare program. Services are available around the clock 24 

hours a day, 7 days a week. In fewer than 10 years we’ve increased 

the operational capacity of 1–800–MEDICARE almost eightfold. 

The phenomenal growth has been the result of significant changes 

6 

in the Medicare program and extensive outreach to beneficiaries to 

teach them to call 1–800–MEDICARE for their inquiries. 

As it’s matured, the number of calls handled by 1–800–MEDICARE has grown dramatically. From 1999 to 2003, yearly calls 

averaged 5 million or less. However, the enactment of the Medicare 

Modernization Act of 2003, which included the creation of a prescription drug benefit, changed forever the way that CMS interacts 

with its beneficiaries. The expansion of choices brought about by 

the drug benefit and by Medicare Advantage meant that CMS and 

our partners would have to respond to many more inquiries about 

a much greater range of topics. 

As you can see from this chart on my left, with the implementation of the Part D program the call volume to 1–800–MEDICARE 

skyrocketed. In 2004 and 2005, call volumes were 20.2 million and 

28.2 respectively. In 2004 the call volume was due to the issuance 

of the Medicare approved drug discount card. In 2005 the annual 

election period for the Part D prescription drug program significantly increased call volumes. 

In 2006, the Part D program resulted in a dramatic spike in call 

volume, all the way to 37.5 million calls. In 2007 call volumes 

reached 30 million and we’re on track to receive about 29 million 

calls in 2008. 

As Medicare expanded and changed, so did our 1–800–MEDICARE operations. In September 2007 all beneficiary call services 

were consolidated into the beneficiary contact center, which encompasses all of 1–800–MEDICARE operations. 1–800–MEDICARE 

has existed in its current form for only one year. 

Senator Smith, your review of the 1–800–MEDICARE operations 

has led to changes in the system that will enhance callers’ experiences and ensure that callers receive accurate and up to date information. CMS is committed to decreasing caller wait times. Due to 

recent procedural and technological changes, the average monthly 

speed of answer for this coming year, the remainder of the year, 

will be 5 minutes or less. 

As you can see from the next chart, we had contracted using the 

old technology at about 8 minutes of average speed of answer time. 

The implementation of that technology and those procedural 

changes, at your urging, has made a significant difference in our 

average speed of answer already. That will continue throughout the 

year. In addition, your concerns on the quality of answers callers 

receive have accelerated our review of call scripts and customer 

service representative training. 

As we get ready for the upcoming annual election period for 

2009, we’re reviewing and updating call scripts with the help of a 

third party validator. As a result of this review so far, some of the 

scripts were deactivated and others were consolidated into a new 

Smart Script format. We’ve also made changes to the content and 

the flow of the scripts. Make no mistake, the Medicare program, 

the fee-for-service program, is a complex program and many times 

difficult to explain. The content and the flow are very important. 

We’ve also given our customer service representative training a 

closer look, thanks to your feedback. We’re in the process of expediting changes to the new hire training program to ensure that our 

7 

new customer service representatives are better prepared to assist 

callers. 

In response to feedback from the committee and others, CMS has 

worked hard to improve all aspects of the caller’s experience. By 

employing new technologies, callers are able to self-serve using the 

interactive voice response, or IVR, system. As with virtually all call 

centers, callers to 1–800–MEDICARE are greeted by an IVR. The 

new IVR provides callers the ability to access certain prerecorded 

information to answer basic questions, and it also routes callers 

who need specific information to the right customer service representative. 

The IVR allows beneficiaries to look up claims information and 

hear their current deductible status, as well as last year’s deductible status. In addition, beneficiaries can hear messages about a description of the various preventive programs Medicare provides, 

how to enroll in a Part D program, how to switch Part D plans, 

and how to apply for financial assistance. 

Customer service representatives are charged with understanding and explaining the Medicare program to beneficiaries. We 

use a scripted content approach to provide beneficiaries with consistent and accurate information. This process assists customer 

service representatives to quickly and efficiently find information 

on a vast array of topics, from claims payment status to Medicare 

policies and procedures. 

Like virtually all of our work, CMS uses contractor staff to answer calls and manage the infrastructure of 1–800–MEDICARE. 

You will hear from our contractor later. This strategy allows CMS 

to be highly responsive to call spikes that often accompany the annual election periods, various Medicare campaigns that require 

rapid shifts of resources or other special circumstances. We have 

the ability to reroute calls from less busy call centers as well as 

shift customer service representatives to phone duty who would 

otherwise be answering the mail. 

Our 1–800 number has planned and announced closing dates on 

some Federal holidays. But, given contractor flexibility, three call 

centers were open this Labor Day in anticipation of greater call volumes due to the impending Hurricane Gustav. In addition, CMS 

had call centers open on July 4 of this year due to the expanded 

increase in call volume from the newly implemented durable medical equipment program. 

Overall quality assurance and monitoring activities help ensure 

quality interactions occur between beneficiaries and their families 

across multiple channels. Our activities focus critical attention on 

customer service representative performance across all channels, 

including telephone, written correspondence, email, web chat. Calls 

are closely monitored and the quality monitoring that is performed 

is then used by the contractor to coach and teach and provide feedback to individual customer service reps. 

In our effort to continue to improve 1–800, CMS is working to 

implement several enhancements to the system in order to better 

serve callers. These will come on line through this year and next. 

We’re simplifying the prescription drug plan enrollment algorithms 

to better identify beneficiary eligibility during special election periods. A new virtual callback option is being deployed which will 

8 

allow callers to call in to our system; if they have to wait, they can 

hang up and the system will call them back while holding their 

place in the queue. That way they can talk to a customer service 

representative and not just hang on the phone. 

An improved learning management system is being implemented 

which will help us to identify the training needs of customer service reps and disseminate information to those CSRs in call centers. 

Finally, as we begin our next release of the IVR we’ll begin playing proactive messages tailored to the beneficiary’s particular plan 

and enrollment, also attuned to the time of the year that the beneficiary is calling. 

We acknowledge that 1–800–MEDICARE is not perfect, but we 

feel that it’s successful in meeting the needs of our beneficiaries 

and with continued attention on the part of CMS and of this committee it will continue to improve. I’m happy to answer any questions you have. Thank you for giving me the opportunity to appear 

today. 

[The prepared statement of Mr. Weems follows:] 

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Senator SMITH. Thank you very much, Kerry. What I heard you 

describe was an acknowledgment that we’re making progress, but 

we’ve got a way to go, and that you and CMS take responsibility 

for that. 

Mr. WEEMS. That’s correct. 

Senator SMITH. I appreciate that, and that’s the point of this 

hearing, is just so the relationship we have between the Legislative 

and Executive Branch is we’re on the same page and we’re going 

the same direction. 

Kerry, as I related in my opening statement, there are some of 

the problems I’d like to get your response to. For example, you’ve 

spoken to it a bit, but I’m worried that the scripts are too technical 

and they presuppose programmatic expertise that a caller won’t 

have. I’m aware that this is contracted out and I want to relate to 

you information that one of the new contractors is providing. 

The beneficiary in this scenario calls 1–800–MEDICARE with a 

question. A tier one representative answers the call and requests 

the beneficiary’s Medicare number. The beneficiary tells the first 

representative that he has lost his card and all his paperwork and 

does not have his Medicare number available. The beneficiary is 

then transferred to a tier two representative, to whom he once 

again has to explain his issue. The beneficiary also states numerous times throughout the exercise that he has lost his paperwork 

and doesn’t have his Medicare number. 

The tier two representative continues to tell the gentleman that 

he needs to locate other documents that might contain his Medicare number, even though he has already stated he does not have 

these documents. 

At the end of the call, the beneficiary never gets his original 

question answered due to the fact that he does not have his Medicare number available. Remarkably, throughout the 50-plus pages 

of this interactive training exercise, not once during the mock call 

does the representative provide the beneficiary with instructions on 

how to obtain a new Medicare card. Instead, the beneficiary is sent 

on a scavenger hunt throughout his house trying to locate documents that he has already told the representative he does not have. 

That scenario to me doesn’t sound like the best response. 

Mr. WEEMS. No, clearly it’s not. Under the circumstances where 

a beneficiary may not have access to their Medicare number, one 

of the things that we are extraordinarily careful about and I think 

you’ll appreciate is disclosure of information to people who are not 

the beneficiary. In fact, that’s one of the primary checks on a customer service representative: Are they in fact talking to a beneficiary? Are they talking to their representative? Has their representative been designated? 

Obviously, the situation that you describe is not ideal. There are 

other ways that a beneficiary can show who they are and receive 

the information that they need. Obviously, an area where we need 

to improve. 

Senator SMITH. Kerry, are you persuaded that there’s a sufficiently robust training program for those on the consumer service 

end? 

Mr. WEEMS. Sufficiency is always in the eye of the beholder, and 

in this case in the eye of the experiencer. 

20 

I think we can do better. Part of the third party validation contract we have is to look at the training program and provide additional training—provide targeted training to customer service representatives. 

One of the things that we’ve discovered with customer service 

representatives, they come in and they get 3 weeks of classroom 

training. Classroom training only works so well for adults. Classroom training works well for other age groups, but for adults you 

need to get them on the phone, you need to get them to where 

they’re starting to handle calls. That is our training model, 3 weeks 

of classroom training, demonstrate competency, move to the 

phones, but be closely monitored and closely supervised until 

they’re able to work on their own. 

Senator SMITH. Kerry, you and I have talked privately about 

whether or not there is sufficient funding for 1–800–MEDICARE. 

I have urged the agency to make the requests to the administration 

to get whatever funding is sufficient to get this job done, because 

my concern is that if seniors aren’t given prompt, decipherable, accurate information it may cost them a lot in terms of late enrollment penalties that stay with them for the rest of their lives. It 

may cost them, more importantly, in terms of their health. We’ve 

seen many instances where people were given wrong information 

or no information and they suffered sometimes catastrophic health 

consequences. 

Yet you related to me something I think is important to get on 

the record. You said to me that if we just give you blanket more 

money, this wouldn’t be the first priority. 

Mr. WEEMS. No. 

Senator SMITH. I believe you said the fraud program would be 

first. 

Mr. WEEMS. Yes. 

Senator SMITH. What was the other one? 

Mr. WEEMS. Survey and certification. Senator Kohl every year 

works very closely with us to try and get the survey and certification budget and the nursing home budget to where it should be. 

Over the last 4 years, that budget has fallen $40 million short of 

our request. 

Our total budget for the past 4 years has fallen about 900—this 

is our operational budget—about $928 million short of the dollars 

that we requested, and over half— 

Senator SMITH. Is this because OMB is not asking for it or because we’re cutting it? 

Mr. WEEMS. This is the difference between the President’s budget and what the Congress actually appropriates. 

Senator SMITH. So the President is requesting it? 

Mr. WEEMS. Yes. 

Senator SMITH. But we have not been granting it? 

Mr. WEEMS. That’s correct. 

Senator SMITH. That’s a very important thing. But what I want 

to do, because I’m focused on 1–800–MEDICARE, is to say that 

this shouldn’t be the third priority. What I’m saying is that all of 

those are important and what we need to make sure is that you 

ask for what you need to do the job in a superior way. Then we’ve 

21 

got to get the job done and get the money to you, because again 

this can be literally life and death issues for seniors. 

Mr. WEEMS. Yes. 

Senator SMITH. I appreciate you sharing that publicly for the 

record because I think it’s very, very important. 

Chairman Kohl. 

The CHAIRMAN. Thank you, Senator Smith. 

Mr. Weems, as you know, I have long fought to improve the safety of nursing home residents by requiring criminal background 

checks of the workers who care for them. I was pleased by the success of a recent CMS-sponsored pilot program that enabled States 

to expand their screening programs, which has kept thousands of 

known criminal offenders away from our most vulnerable citizens. 

However, I was disappointed to discover that the findings of the 

report by CMS soon to be issued describing the success of the pilot 

program have been fundamentally altered by your agency. The report’s estimates of the total costs of requiring background checks 

for all current and prospective long-term care workers was inflated 

by a factor of ten. How do you explain such an extreme revision 

of the first report, one that is at odds with the initial views of the 

report’s authors? 

Mr. WEEMS. Thank you for the question. CMS received this draft 

report in May of this year. As is common for reports of this nature 

and of this magnitude, the report is peer reviewed by CMS among 

senior career officials within CMS. One of our components noted 

that the report itself did not fully address the potential costs of the 

background survey, and other components looking at that peer review information agreed and asked the contractor to take another 

look. 

Importantly, CMS did not specify what that other cost algorithm 

should look like. Instead, they said: We think you’ve missed some 

things; take another look. The contractor took another look, provided a methodology that they worked on themselves—it was their 

own original methodology—brought that back to CMS. 

That methodology was again peer reviewed by the same career 

CMS staff in CMS, and agreed to. The contractor then completed 

the estimate using both methods, and both of those methods are in 

the report. I’m satisfied that this is the work of senior career employees using their best intellectual resources and judgment available to them. 

The CHAIRMAN. Well, the version of my background check legislation was passed unanimously out of the Finance Committee, as you 

know, yesterday. It does fall in line with all of the points of consideration made in the soon-to-be-released CMS report. Based on this, 

do you support the bill that was passed yesterday out of the Finance Committee? 

Mr. WEEMS. We certainly support the intent of the bill. We have 

not taken a formal stance on it. The thing that we’re going to have 

to look closely at is how the costs of the background checks would 

be allocated between the Federal Government, State government, 

Medicare, and Medicaid. 

The CHAIRMAN. Mr. Weems, as you’re aware, I have a continuing 

concern about the information conveyed to Medicare recipients by 

Medicare Advantage sales agents. Yesterday in my home State of 

22 

Wisconsin a company was fined for selling products with unlicensed agents. What measures have been taken to specifically address questions about Medicare Advantage marketing practices at 

the call centers? 

Mr. WEEMS. At the call centers, a couple of things happened. 

First of all, we have revised our scripts for the enrollmentdisenrollment process. Previously they had suggested that enrollment would only be prospective. Now we ask a question about, do 

you think that you’d like this to be—I’m not quoting directly from 

the script—do you think you would like this to be retroactive? So 

now a beneficiary has that choice of actually being able to begin 

their disenrollment retroactively. 

Our customer service representatives are also trained to ask 

questions about, did you know what you were getting into, did you 

actually sign the paperwork—anything that might suggest any 

kind of marketing misrepresentation. If they get those answers, 

then the beneficiary can disenroll and enroll in a plan that they 

wish. Further, that complaint is forwarded to our complaints tracking module for follow-up by our regional office. That’s exactly what 

happened in that case. 

I completely share your concern, Senator. As you know, earlier 

in this year CMS proposed a new set of tough regulations to deal 

with fraudulent marketing practices. The Congress took those regulations, put them into law, and I will tell you in the next couple 

of days, not weeks, those laws will be ensconced in a new set of 

regulations that will make it clear that that law and those regulations apply to the coming marketing period. 

Mr. WEEMS. Thank you. 

Thank you, Senator Smith. 

Senator SMITH. Thank you, Senator Kohl. 

Kerry, a couple follow-ups. To the timing on call waits, you indicated CMS is going to reduce wait times to 5 minutes for the remainder of the year. 

Mr. WEEMS. Yes, or better. 

Senator SMITH. Is that 5 minutes calculated on a 24-hour period 

or on the basis of an 8-hour work day? 

Mr. WEEMS. It’s calculated on a 24-hour period. 

Senator SMITH. So if you calculate it on an 8-hour work day, 

what does it mean if somebody’s calling during a work day? 

Mr. WEEMS. I can give you an approximation of that, but one of 

the reasons that you see this reduction here is actually better management of calls during the peak periods. In the June-July period 

we implemented a command center enrichment, which I believe 

your staff had the opportunity to see, and actually I’ve made a visit 

to Richmond subsequently. It’s really quite impressive and it’s able 

to route calls from busy call centers to less busy call centers. It’s 

able to move customer service reps who are doing other things, who 

might be in training, to quickly move them from training to a tier 

one line to start answering that phone call. 

The contractor—and they can talk to you more about this also— 

implemented a real-time compliance with the employees. So we 

know, they know, what employees are doing at any given moment. 

Interesting: One of the things you can see in the command center—and you’ve written me inviting us to go and you and the chairVerDate Nov 24 2008 12:02 Jun 04, 2009 Jkt 000000 PO 00000 Frm 00026 Fmt 6633 Sfmt 6633 H:\DOCS\49480.TXT SAG PsN: JOYCE
23 

man are welcome at any time and I’d love to do that. You can see 

if a customer service rep has been on the phone for an extended 

period of time, so you can go to them: Do you need help? Why is 

this call—and either move the call to somebody that can handle it, 

give them the help they need so that they can shorten that call volume, give them the right answer, and move on to another call. 

Those are the kind of technological changes we’ve implemented. 

Also a new smarter interactive voice unit, so that it does ask you 

to put in your Medicare number, but it will also ask you if it’s a 

doctor claim or a hospital claim. So when you get to the customer 

service rep—and I saw this in Richmond—their name comes up, 

the name of the beneficiary comes up on the screen, even before the 

call begins in the CSR’s ear. They can see the claim and they can 

begin working with them the instant the call begins. 

Senator SMITH. We obviously want to get that wait time as low 

as we can during that 8 hours of the regular work time. 

Mr. WEEMS. Yes. 

Senator SMITH. If you can calculate what I think that would be 

for us, I’d sure appreciate receiving that. 

[The information referred to follows:] 

Mr. WEEMS. The daily average speed of answer (ASA) is calculated by adding up 

the wait times for each individual call and dividing it by the total number of calls. 

When calculating ASA on any timeframe, we county the total wait time spent in 

queue for the time period over the total calls answered by agents for the time period. 

The ASA during the 8-hour workday for the month of August 2008 was 3 minutes, 

58 seconds and for September 2008 was 1 minute, 20 seconds. (We defined the 8- 

hour workday as Monday - Friday, 9:00am ET to 5:00 pm PT.) The overall ASA for 

the month of August 2008 was 3 minutes, 44 seconds and for September 2008 it 

was 1 minute 16 seconds. 

Mr. WEEMS. We can estimate it, and then I would be happy to 

report it as our experience continues. 

Senator SMITH. You have the budget sufficient to get it down to 

an average of 5 minutes in a 24-hour period? 

Mr. WEEMS. Yes. 

Senator SMITH. OK. Obviously, you’re dealing with Vangent as 

the prime contractor on this. My understanding is that below them 

there are a myriad of subcontractors. 

Vangent subcontracts to a company named Sensure, and it in 

turn subcontracts to Palmetto. I don’t know how much more complicated it gets beyond that. 

But my question to you is, what are you doing to ensure oversight not just of Vangent, but their subcontractors? Are they looped 

into this and do you have confidence that this isn’t so distantly removed in relationships that you’re losing control of it? 

Mr. WEEMS. They are looped into it, and in fact some of those 

arrangements that you mention have been concluded as a matter 

of consolidation. The staff that exerts oversight over this program 

I have not only considerable confidence in, but considerable respect 

for. They speak to the contractor—they will validate this—not just 

daily, but I think hourly. It is an extraordinarily closely supervised 

contract. 

Senator SMITH. Kerry Weems, thank you so much for your time 

and your public service. I do appreciate your acknowledgment, the 

acknowledgment of CMS, that there are real problems. The agency 

understands they need to come forward with real solutions, and 

24 

we’re just here to encourage that, because we’re accountable as 

well. 

I think I’ve heard your commitment today that you’ll work with 

us, with me, my staff, Senator Kohl and his, the entire Aging Committee. We want to work with you, not at you, and that’s the spirit 

in which we need to get this right if we’re going to get it done for 

America’s seniors. 

So thank you very much. 

Mr. WEEMS. Thank you for the opportunity to appear, sir. Thank 

you, Senator. Good to see you. 

Senator SMITH. We’ll now call up our second panel. We welcome 

Naomi Sullivan, a dual-eligible Medicare beneficiary from Chico, 

CA, who will offer her on-the-ground perspective and experiences 

calling 1–800–MEDICARE. Then we’ll have Michealle Carpenter, 

the Deputy Policy Director and Counsel of the Medicare Rights 

Center, who will discuss her experience offering information and 

assistance with health care rights to Medicare beneficiaries. Then 

Tatiana Fassieux, who will testify in her capacity as the Board 

Chair for California Health Advocates, also a program manager for 

the California Health Insurance Counseling and Advocacy Program. Tatiana will share with us her experiences in helping beneficiaries to navigate 1–800–MEDICARE. 

Would you like to introduce your Wisconsin witness? 

The CHAIRMAN. John Hendrick is a Staff Attorney at the Coalition of Wisconsin Aging Groups, where he directs the Elder Financial Empowerment Project and also works with the Wisconsin Prescription Drug Help Line in the Elderly Benefits Specialist Program. 

Prior to joining the coalition, he was a managing attorney for 16 

years of a statewide legal education agency, teaching thousands of 

non-lawyers about their legal rights. He has given numerous presentations throughout Wisconsin relating to elder rights and Medicare and presented at the 2004 and 2006 National Aging and Law 

Conference. 

We’re very happy to have you with us this morning, Mr. 

Hendrick. 

Senator SMITH. Well, thank you. Why don’t we start with Naomi 

and we’ll just go in that order. We’ll be informal. We may even 

break in and ask a question or two. But you’ve all obviously heard 

Administrator Weems discuss recent changes at the call centers 

and I’m hoping to hear if you’ve actually seen those improvements 

and what you think of the testimony you’ve heard. 

Take it away, Naomi. 

STATEMENT OF NAOMI SULLIVAN, MEDICARE BENEFICIARY, 

CHICO, CA 

Ms. SULLIVAN. I’d like to thank you, Senator Smith and Senator 

Kohl, for allowing me to come before the Senate and explain my 

experience with Medicare. My name is Naomi Sullivan. I’m 57 

years old. I live in Chico, CA. I’m on disability and am what is 

called a dual-eligible beneficiary. I am here today to share my 

story, to give voice to those who don’t know how to speak for themselves. My hope is that the government will understand that there 

are beneficiaries like me all over the country who lack resources, 

25 

are in dire straits, have turned to 1–800–MEDICARE for help, and 

aren’t getting the assistance they so desperately need. A few years ago I was making over $60,000 per year salary. I now live on less than $700 per month social security disability and 

have had to make choices whether to eat or pay my premiums and 

medications. A while back I went on what I call a refugee diet because I couldn’t afford to buy groceries and pay all of my bills. 

I am here today because in 2007 I decided to switch my Medicare 

D plan from Humana to Blue Cross. I received an information card 

in the mail from Blue Cross, returned it, and shortly after received 

an application in the mail. I filled out the paperwork to enroll in 

a Part D plan and thought I was good to go. Little did I know what 

I was in store for. 

It turns out that somewhere along the way I was inappropriately 

enrolled in a PPO—you call it a Medicare Advantage plan—instead 

of a Part D plan. I found out about that the hard way when my 

doctor started to ask me for copays. I never had to pay copays because I also had MediCal. Then I started to get premium notices 

and billings, and throughout the year I also got many bills from my 

doctors. I couldn’t understand why Medicare and MediCal weren’t 

paying my medical expenses the way they used to. But I knew I 

had to get this straightened out as quickly as possible. 

So I called 1–800–MEDICARE to get some answers and to try to 

get out of the PPO, into a Part D plan I had enrolled with in the 

first place. I called 1–800–MEDICARE over a dozen times. I can’t 

afford both a home phone and cell phone, so I have just a cell 

phone. When I would call 1–800–MEDICARE, I was sometimes on 

hold for up to 45 minutes at a time, and then I’d get transferred 

and disconnected and have to start all over again. 

Meanwhile, I was going over my cell phone plan minutes and 

having to pay for minutes that I couldn’t afford. Eventually it got 

to the point where I simply could not afford to make one more call 

to 1–800–MEDICARE. 

All I can say is thank goodness I found Tatiana at HICAP because honestly I do not know what I would have done. I just wanted to give up. I felt like less than nothing. I felt like the people at 

1–800–MEDICARE did not have any interest in helping me. I told 

them my story, that I was on disability and barely making it on 

less than $700 per month and could not afford the premiums for 

the plan that I had been inappropriately enrolled it. One Medicare 

representative suggested that I get a part-time job to help pay the 

premiums, but they didn’t offer any help. They didn’t tell me about 

any resources and they didn’t tell me because of my situation I can 

switch plans at any time. They just kept telling me to call my plan 

and work it out. 

I just needed a little help and some direction on how to get 

things sorted out. I didn’t get that from Medicare. So many bills 

got turned over to collections, I subsisted on my refugee diet and 

I couldn’t get anyone to help me. 

At last I went to my local Social Security office. They referred me 

to Tatiana. She’s helping me to get things straightened out. I’m 

now enrolled in a Part D plan. I don’t have a clue how I’m going 

to pay for all the bills that mounted up while I was on the wrong 

plan. I know that Tatiana is working on that. But at least hopeVerDate Nov 24 2008 12:02 Jun 04, 2009 Jkt 000000 PO 00000 Frm 00029 Fmt 6633 Sfmt 6633 H:\DOCS\49480.TXT SAG PsN: JOYCE
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fully now I won’t have to worry about going to my doctor or getting 

my medications. 

I feel that 1–800–MEDICARE should have an easier way for people to live—I’m sorry. I feel that 1–800–MEDICARE should have 

an easier way for people to get a live person, that they should have 

proper training so that they can provide accurate information, or 

at least refer callers to their local HICAP, because I know they 

have the ability to help. 

[The prepared statement of Ms. Sullivan follows:] 

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49480.011
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Senator SMITH. Thank you very much, Naomi. That’s firsthand 

experience why we’re having this hearing today, to try to get better 

response. 

Ms. SULLIVAN. Thank you. 

Senator SMITH. Michealle. 

STATEMENT OF MICHEALLE CARPENTER, DEPUTY POLICY 

DIRECTOR AND COUNSEL, MEDICARE RIGHTS CENTER 

Ms. CARPENTER. Good morning, Chairman Kohl and Senator 

Smith. 

Senator SMITH. You want to hit your button there. 

There you go. 

Ms. CARPENTER. Good morning, Chairman Kohl and Senator 

Smith. I thank you for your longstanding and bipartisan commitment to the common good and welfare of people with Medicare. 

The persistent failures of the Medicare consumer hotline, 1–800– 

MEDICARE, cause daily harm to the health and wellbeing of older 

Americans across the Nation. The volunteers and staff of the Medicare Rights Center confront the human hardship caused by these 

breakdowns daily. We appreciate your efforts to shine light on the 

hotline’s failures as a necessary step toward correcting them. 

In recent years Medicare has become a daunting challenge for 

consumers to navigate. Since enactment in 2003 of the Medicare 

Modernization Act, a Wild West marketplace for Medicare coverage 

was launched and a system rich with opportunities to exploit people with Medicare has been established. To no surprise, the older, 

frailer, and most impoverished people with Medicare are most vulnerable to exploitation. Without safety nets, they are the most 

harmed by this exploitation. 

Regrettably, the Centers for Medicare and Medicaid Services has 

failed to provide the most basic tools to protect people from the 

danger of this marketplace. Even as the market became significantly more complex, repeated reorganizations of CMS’s bureaucracy have left CMS with neither a centralized consumer education 

office nor a coordinated approach to consumer education. At times 

CMS has mixed consumer education with ideological propaganda. 

Consumers are harmed by information that is colored by a preference for Medicare Advantage plans and a political imperative to 

paint the prescription drug program in the best light regardless of 

reality. 

In addition to long hold times, callers often spend well over an 

hour while a poorly trained operator tries to find an answer to a 

simple question or resolve a problem. CMS’s customer service representatives lack proper training to answer callers’ questions or assist in resolving problems. The scripts from which representatives 

read often lack meaningful information. Even accurate information 

is often delivered in a way that few people can understand. Representatives provide false, misleading, and inaccurate information. 

While callers often call with complex problems that require the representative to have technical knowledge, representatives are unable to answer even basic questions. 

One area where 1–800–MEDICARE customer service representatives consistently fail to provide accurate information and assistance is when a beneficiary has been a victim of fraudulent or misVerDate Nov 24 2008 12:02 Jun 04, 2009 Jkt 000000 PO 00000 Frm 00033 Fmt 6633 Sfmt 6633 H:\DOCS\49480.TXT SAG PsN: JOYCE
30 

leading marketing by a private Medicare Advantage plan. Because 

this problem is so widespread, CMS has assured us that all customer service representatives are well trained to handle these 

kinds of cases. This is not the case. 

In discussions with CMS last year, we were assured that every 

caller who has been fraudulently enrolled in a private Medicare 

plan will be assessed for retroactive disenrollment. The importance 

of this cannot be overstated as thousands of dollars may be at 

stake for a client who’s left with unpaid medical bills because they 

were enrolled fraudulently in a plan. 

In our experience, representatives are aware of the exceptional 

circumstances special enrollment period which allows people with 

Medicare to disenroll from a plan any time during the year under 

certain circumstances. Unfortunately, representatives appear only 

to understand how to help people disenroll from the plan prospectively. On most occasions, callers are not assessed for retroactive 

disenrollment. Even more concerning, a representative recently 

told one of our caseworkers that Medicare does not provide retroactive disenrollment even for marketing fraud cases. 

When our caseworkers attempt to help clients request a retroactive disenrollment through an exceptional circumstances SEP, we 

are transferred from one representative to another and often stay 

on the phone for more than an hour awaiting a resolution. In the 

end we are usually told this issue will be transferred to the regional office for a decision and that the client will receive a call 

within a week. More often than not, that call never comes. 

So what should be done? For starters, CMS must increase oversight of the 1–800–MEDICARE contractor. CMS must reestablish 

an independent office focused on communication with people with 

Medicare that reports directly to the CMS Administrator. This office should have direct oversight over 1–800–MEDICARE and 

should be responsible for developing training materials and scripts 

for 1–800–MEDICARE operators. 

It is our understanding that representatives are not trained on 

Medicare policy, but rather on how to search a database for the 

proper script to read to a caller. Customer service representatives 

must have at a minimum a basic understanding of Medicare. All 

representatives should have regular training on topics callers most 

frequently call about. This is how we train our volunteers and staff 

that answer our hotlines. This training must be reinforced with 

more frequent testing to ensure continued understanding and ability to answer questions accurately. 

In addition to providing better training and scripts to 1–800– 

MEDICARE customer service representatives, CMS needs to make 

a concerted effort to fix the data exchange systems problems that 

plague the privatized sectors of Medicare. Admittedly, these data 

exchange systems are complicated and the solution is not an easy 

one. But it’s been 3 years since Medicare Part D began and 5 years 

since the expansion of Medicare Advantage. 

Simplifying and standardizing Medicare choices is absolutely 

necessary. But 1–800–MEDICARE cannot wait for that day to 

come. People with Medicare must be allowed the helping hand that 

we pay 1–800–MEDICARE to offer. 

Thank you. 

31 

[The prepared statement of Ms. Carpenter follows:] 


49480.013
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Senator SMITH. Michealle, did you take much comfort in what 

you heard the Administrator say this morning? 

Ms. CARPENTER. I think a lot of the changes that are to come will 

be beneficial. They seem to be mostly about the technology and less 

about the training, which is where most of our concern lies. 

Senator SMITH. So yours is technology, not the training? 

Ms. CARPENTER. No, ours—we believe the training. 

Senator SMITH. The training, not the technology. 

Ms. CARPENTER. We are heartened by the technological improvements that will be made and we think they will be helpful to people with Medicare. 

Senator SMITH. Very good. 

Tatiana. 

STATEMENT OF TATIANA FASSIEUX, BOARD OF DIRECTORS 

CHAIR, CALIFORNIA HEALTH ADVOCATES, SACRAMENTO, CA 

Ms. FASSIEUX. Good morning. Good morning, Chairman Kohl, 

Senator Smith, and other distinguished members of the committee. 

My name is Tatiana Fassieux and I am the Board Chair of California Health Advocates and also a Program Manager. I represent 

the boots on the ground of Medicare beneficiaries in California. 

California Health Advocates is a nonprofit organization dedicated 

to education and advocacy on behalf of California Medicare beneficiaries. I’ve been in that role for about 41⁄2 years. But I also represent the 24 HICAPs, the SHIPs, in California serving more than 

4 million Medicare beneficiaries. In my neck of the woods, northern 

California, I serve five counties, rural counties, with about 45,000 

Medicare beneficiaries under our program. 

But I do want to thank the committee for inviting me for the opportunity to speak. I do want to focus on some of the topics discussed, the 1–800–MEDICARE, of course, the myriad of problems 

with the call centers’ performance, the resulting impact on the 

SHIPs, and of course in California in particular, and above all the 

impact on Medicare beneficiaries, and I’ll suggest some recommendations. 

We believe that 1–800–MEDICARE reflects the credibility of the 

agency it represents, that is CMS, and the regulatory process that 

established it. So that credibility must be upheld quite at a very 

high standard. 

The SHIP network has come to rely frequently on the help of 1– 

800–MEDICARE and we have the expectation that our Medicare 

beneficiaries will have accurate and timely information. In many 

instances both clients and SHIP counselors have had good successful contacts. We must agree to that. 

We are also pleased by the recent implementation of the special 

SHIP direct, or I should say back door, number into 1–800–MEDICARE. We still have to go through the protocols and the IVR system, but we have a pseudo-back door way, and California has just 

now implemented that. 

However, as I will illustrate, credibility has been shaken frequently. Medicare beneficiaries and SHIPs have had unreasonable 

wait times, frequent disconnects, misinformation, and what troubles us is the difficulty in resolving hard cases. That lack of faith 

in prompt resolution is what concerns us. 

38 

Beneficiaries continue to complain about the IVR system. They 

say: I wish I could get a live person, because they’re very frustrated 

by that technological feature. We’re still dealing with 1930’s, 1940’s 

seniors, who technology is just frightening to them. On a good day, 

it takes us about 10 to 15 minutes to get to the first level of CSRs. 

The disconnects are particularly egregious, especially when we as 

SHIP counselors are trying to assist clients with the assistance of 

1–800–MEDICARE. Where that first level cannot help, we get 

transferred to the second level, and during that transition we get 

cutoff. 

Misinformation of course can do tremendous harm. Clients have 

told us that, I wish Medicare had told us that I could change plans 

any time, when they discovered that they were in a plan that they 

should not have belonged in. They were locked in, according to the 

Medicare representative, but in reality they were not. 

In an instance where you mentioned, a southern California 

transplant patient was incorrectly told by a CSR that nobody gets 

lifetime anti-rejection medication, and it was because of our persistence we escalated and we were able to assist the client. 

As you heard with Naomi, her case—I am personally handling 

her case—the reason she is on such low income is because she felt 

she had to get a job and Social Security reduced her income, which 

was sort of a double whammy. 

Another counselor had reported that when we were trying to file 

a complaint we were actively discouraged, saying that a complaint 

is serious. 

Now that 1–800–MEDICARE is the single point of entry for all 

issues dealing with Medicare, including our efforts in dealing with 

very complex issues, we may have to contact a subcontractor. It 

just particularly gives us a little more problems in getting to the 

right people. 

So we appreciate that we have been given additional funding, but 

of course in California with the budget that funding hasn’t come 

through yet, and in my neck of the woods it’ll just be a few thousand dollars. $15 million globally sounds like a lot of money, but 

when you break it down to the individual HICAPs it’s just a little 

bit of money. 

So we would like to propose the following actions. Definitely additional training, better scripts. It has been inferred also that they 

get State-specific information. Absolutely better CMS oversight. 

Who knows, a better friendly system in responding. 

It was good to hear from Mr. Weems about that new response 

system. The California CALPERS instituted that and it’s working 

quite well. 

But one more thing I would like to suggest is that we form a task 

force that includes SHIPs, beneficiaries, CMS, and any other advocacy organizations to review those scripts, to review the training, 

because sometimes I think that the SHIP counselors definitely 

know more than the CSRs. 

Thank you for letting me speak. 

[The prepared statement of Ms. Fassieux follows:] 

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Senator SMITH. Thank you very much. That’s excellent. 

John Hendrick. 

STATEMENT OF JOHN HENDRICK, PROJECT ATTORNEY, 

ELDER FINANCIAL EMPOWERMENT PROJECT, COALITION 

OF WISCONSIN AGING GROUPS, MADISON, WI 

Mr. HENDRICK. Thank you, Senator Smith, Chairman Kohl. My 

name is John Hendrick. I’m a staff attorney with the Coalition of 

Wisconsin Aging Groups and it’s my privilege to speak to the committee on behalf of the coalition and share our experiences with 

Medicare’s toll-free consumer service. We supervise a network of 

over 100 trained staff throughout the State of Wisconsin and as 

part of their duties they help older adults with the Medicare program through the State Health Insurance Assistance Program. For 

some reason that’s abbreviated ‘‘SHIP.’’ So we have a lot of experience with 1–800–MEDICARE. 

Based on our experience, we have found that 1–800–MEDICARE 

service has improved since 2006 and we appreciate that. Wait 

times outside the busy annual enrollment period can be as little as 

5 to 10 minutes and there are many knowledgeable and experienced customer service representatives who are able to resolve 

most beneficiary problems in a timely and accurate manner. Many 

are doing a good job. Some are not. Also, in our experience we’ve 

had a high level of success with what I guess they call the tier two 

representatives that are able to deal with the more complex problems, and so we appreciate that success. 

We do have some serious continuing concerns. I would say our 

greatest concern is representatives providing consistently accurate 

information, and we have found that that is not always the case. 

There are a couple recurring problems with specific issues, but our 

biggest concern is that the bad information doesn’t seem to relate 

to the complexity of the issue. It’s just which representative you 

get. So if you get the wrong person you get the wrong answer. That 

makes it hard to predict and it’s very hard for us to deal with. 

The second area of concern would be technological problems. For 

example, at busy times the average waits are over 30 minutes. 

There’s occasional buzzing on the line, which makes it difficult for 

beneficiaries to hear the representative. As has been mentioned repeatedly, senior beneficiaries have difficulty dealing with the telephone prompt system. 

Lastly, the area of programmatic problems, which appear to result either from management decisions or from training. For example, the customer service representatives do not leave a phone 

number when they return a call. They don’t leave any information. 

They just say they’re returning a call. Unless the beneficiary happens to pick up the call at that moment and get that call directly, 

they have to start all over again and go through the wait time and 

explain their situation all over again. 

At times we find as many as one-fourth of the cases have to be 

forwarded to the tier two representatives because the customer 

service representatives can’t resolve the issues. That seems like a 

high percentage to us. Beneficiaries when they file a complaint 

about Part D enrollment or Medicare Advantage enrollment are 

50 

told that they will be called back within 5 days, and that is not the 

case. In our experience those calls never come. 

Senator SMITH. Not later than 5? They just never come? 

Mr. HENDRICK. Never. 

Finally, the customer service representatives frequently don’t 

know that they can talk to the SHIP representative. As everyone 

here has mentioned, a way of resolving problems is for a well-informed SHIP representative to get on the phone with 1–800-MEDICARE and sometimes that’s what works it out. But unfortunately 

the tier one representatives sometimes will refuse to talk to the 

person unless the beneficiary is actually present, and that’s not 

what the rules are. So that’s an important mistake. 

I’d just like to mention a couple of our suggestions for improvement. I think you could increase the number of customer service 

representatives. The increased training which has been mentioned 

would improve the quality of the information. You should continue 

the SHIP-dedicated phone number. That has helped a lot to allow 

the SHIP representatives to get through and to resolve some of 

these problems. 

I believe the General Accounting Office secret shopper program 

was mentioned earlier. That should be continued. That is helping 

to evaluate the quality of the service and the accuracy of the information. 

Our final point, which isn’t actually about 1–800–MEDICARE: 

We believe that all prescription drug and Medicare Advantage 

plans should be required to have their own SHIP-dedicated contacts. With the plans that have a separate contact for SHIP counselors to contact, those plans are resolving problems with their own 

plans in a much more effective way and taking the burden off 1– 

800–MEDICARE. 

In conclusion, we’d like to thank you for this opportunity. We 

hope for further improvements in 1–800–MEDICARE, and I’d be 

happy to answer any questions. 

[The prepared statement of Mr. Hendrick follows:] 

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54 

Senator SMITH. When you heard the Administrator, do you have 

more reason to hope? 

Mr. Hendrick. Certainly some of the things that he described 

sounded promising, and I’m always amazed by what computers can 

do today. The training I think would still be a concern to us. The 

customer service representatives that are taking those calls, if they 

are not correctly trained, are not able to give out the correct information, and I don’t think that what we heard today is going to fix 

that. 

Senator SMITH. Senator Kohl. 

The CHAIRMAN. Thank you, Mr. Hendrick, and we appreciate all 

that you’ve done with the Coalition of Wisconsin Aging Group for 

the people of our State. 

Would you offer the observation if you were asked that, if 1–800– 

MEDICARE were in competition with another organization providing the kind of service that we find in competition in the private 

sector of our country, they’d be out of business? 

Mr. HENDRICK. Well, Senator, I often say in regard to many government programs and people who are complying with regulatory 

requirements: What would you do if you really wanted this to 

work? If your intention was to run a business and to provide good 

customer service so that people would come back, I think you 

would get these problems solved. 

The CHAIRMAN. Mr. Hendrick, your testimony identified a number of problems with Medicare call centers. If you could name one, 

which is the single worst and most persistent problem, and what 

is the most important improvement that CMS could implement to 

enhance the service of the call center for the recipients? 

Mr. Hendrick. I think our biggest concern is the apparently random provision of incorrect information. This happens with the tier 

one customer service representatives. I don’t know the exact solution, but it seems to me that if people knew that they didn’t know 

the answer and they could refer it to someone who could and then 

that call got through without being disconnected during the transfer, I think that would solve a lot of the problems that we see. 

The CHAIRMAN. Thank you so much. 

Senator SMITH. Very good suggestion. 

Thank you all very much. I think that concludes our questions. 

You’ve added human context, put a human face on this problem, 

faceless problem of 1–800–MEDICARE. Naomi, your story will be 

remembered. So thank you all. 

Our third panel and our only panelist is John M. Curtis. He goes 

by ‘‘Mac’’ and Mac is the President and CEO of Vangent, the company contracted by CMS to accept incoming beneficiary calls. He’ll 

discuss his company’s efforts to ensure Medicare recipients are receiving accurate and timely information when calling 1–800–MEDICARE. 

Mr. Curtis, thank you for coming. 

55 

STATEMENT OF JOHN M. CURTIS, PRESIDENT AND CHIEF 

EXECUTIVE OFFICER, VANGENT, INC., ARLINGTON, VA 

Mr. CURTIS. Thank you, Senator, Mr. Chairman. Good morning. 

My name is Mac Curtis and I am President and CEO of Vangent. 

For over 30 years we’ve been a provider of mission-driven systems 

and strategic business process outsourcing services for the Federal 

Government in the U.S., and around the world, Fortune 500 companies, health care organizations, and educational institutions. Our 

company is headquartered in Arlington, VA. 

I was invited here today to talk about Vangent’s role in the 1– 

800–MEDICARE program. I’m not here to say that problems never 

occur or to refute the experiences described here today. But I can 

tell you about our steadfast commitment to quality service for all 

Medicare beneficiaries and offer some context for the issues described by the previous panel. Of the 30 million calls received each 

year, the vast majority work fine. But we’re focused on the small 

minority of calls that don’t. 

First let me explain how the system works. Our job is to manage 

the call center facilities and the workforce that answers the calls 

that come in to 1–800–MEDICARE. Vangent has been working 

with CMS on this program for over 6 years and we’re proud of the 

work we do. 

Callers into the system are prompted by the interactive voice response unit to provide their Medicare number and to select the 

issue they’re calling about. If a customer service representative is 

not immediately available, a call is routed to the queue where, depending on when they call, they may have to wait a few minutes, 

sometimes longer, for the next available CSR qualified to answer 

their question. The caller is then connected to the CSR, who works 

with them to answer their question. 

Our contract with CMS provides that we maintain an average 

speed to answer at or less than 81⁄2 minutes, which we consistently 

meet. Our average speed to answer during the month of August 

was 3 minutes and 40 seconds. Do we always hit the mark? With 

30 million calls a year into the system, not every call is perfect. But 

the hard work to continuously improve and make the system and 

experience better is what we’re dedicated to. 

Our workforce is well trained, closely monitored, and highly motivated to help people. CSRs undergo continuous and rigorous 

training based on industry standards and best practices. Vangent, 

in partnership with CMS, has successfully trained thousands of 

CSRs, who answer millions of beneficiary inquiries using this training program. Instructor-led classroom training is combined with 

multiple forms of recurring on-the-job training to ensure continuous improvement. Every CSR is regularly monitored to identify 

trends and to measure individual performance. Responses are evaluated by multiple checkpoints for quality and accuracy, which 

again are based on industry standards and best practices. 

We also survey our callers to measure their satisfaction with the 

service they receive. What are the results of the monitoring and the 

surveys? Of the thousands of calls evaluated each month, over 90 

percent meet the requirements of our rigorous quality reviews for 

accurate responses and customer interaction. In the customer satisfaction survey, the results we receive show that 85 percent of the 

56 

callers are satisfied with the service, a score that’s above the industry average of about 70 percent for contact centers. 

We’re continuously working to improve the people, the process, 

and the technology that drives the 1–800–MEDICARE program. 

Today we’ve heard from the SHIPs and other advocates about 

concerns they have with the 1–800–MEDICARE system. We appreciate the difficult job the SHIPs have. They assist the neediest 

beneficiaries with very complex problems. We’ve worked with CMS 

to provide the SHIPs with tools such as—and we’ve heard about it 

this morning—a customized IVR and a dedicated 800 number to 

make their jobs a little easier. We want to continue working with 

CMS to find additional ways we can improve our service to the 

SHIPs and their clients. 

We spent a lot of time with your staff in our call centers discussing how the system works and how it can be improved. We applaud the dedication and the zeal, Senator, they have shown toward improving 1–800–MEDICARE. There’s no question about it. 

In summary, the vast majority of the 30 million calls received by 

1–800–MEDICARE are handled well and correctly. But the issues 

identified here today are very important to us. Continuous improvement is a hallmark of this program and we strive to provide 

Medicare beneficiaries the quality of service they deserve. 

Thank you, Senator. I’m happy to answer your questions. 

Senator SMITH. Mac, your surveys show that 85 percent like the 

service they got? 

Mr. CURTIS. Yes, sir. 

Senator SMITH. Eighty-five percent. So we’re really dealing with 

15 percent. Can you tell when you get a call whether it’s a person 

without any agenda just needing help or one of my staff calling and 

testing you? 

Mr. CURTIS. Well, normally—let me answer your question this 

way, Senator. With regard to someone calling with a specific question of the 30 million inquiries that come in a year, 98 percent— 

Senator SMITH. Are we the 15 percent? 

Mr. CURTIS. We’re working on that, Senator. [Laughter.] 

That’s good because we’re trying to improve. There’s no question 

about the value that your staff has provided. 

But back to my answer, Senator, of the 30 million inquiries we 

receive a year that come in to the IVR, 98 percent of those inquiries come with their Medicare number. So as we’ve talked about, 

one of the improvements that CMS has made is the beneficiary 

gets on the line, reaches the IVR, and they’re asked their Medicare 

number. They put their Medicare number in and the record shows 

up on the screen for the CSR. The CSR goes through and they validate the beneficiaries birthday, their Medicare number, and then 

deals with the callers specific issue. 

So that’s really where the balance of the calls come from with regards to a specific issue associated with the Medicare number. So 

what we are dealing with here today is the percentage that have 

very complex calls. I think your staff will attest to this, that the 

typical call is with a Medicare number, and it’s also maybe one 

issue or one question. The reason why we know this, Senator, is 

that when we look at, on an annual basis, the number of scripts 

57 

the CSRs actually go to to provide the scripted response, on an average call it’s 1.2 scripts per call. 

So what we’re really focused on are the multiple question calls, 

where sometimes we’re going to 4 to 12 times the number of scripts 

or the number of questions, and also those calls that don’t have the 

Medicare number. 

Senator SMITH. It is possible that someone has called in not from 

my office without a Medicare number? 

Mr. CURTIS. That happens. Yes, sir, it does happen. That’s 

about—from our record, that’s about 2 percent that call without a 

Medicare number, that’s correct. 

Senator SMITH. So the other 13 percent are my staff? 

Mr. CURTIS. The other 13. Well, one of that percent is probably 

my mother. 

Senator SMITH. But what you’re telling me is if my staff calls 

with a Medicare number they’re going to be completely satisfied? 

Mr. CURTIS. You know, Senator, I’m not going to tell you that out 

of 30 million transactions every one of them is perfect. I’m certainly 

not going to tell you that. But what I will tell you in all sincerity 

is we want all of those 30 million transactions to go well. But no, 

I’m not going to say every one is perfect. I’m not going to say every 

CSR always gives the right answer. We’ve heard situations today 

that, a) are heartbreaking and, b) that’s the percentage that we’ve 

got to get right. Every one of these calls has got to be right. 

But I think what we do focus on is the quality monitoring. When 

we’re at spike we’re talking about close to a little under 4,000 customer service reps, and the quality monitoring we do on a monthly 

basis—we record calls. They’re evaluated in three areas: Are they 

dealing with Privacy Act data correctly, what was the completeness 

and the accuracy of the answer on their call, and what are their 

customer soft skills? 

So it’s thousands of calls a month that are recorded. The calls are 

evaluated and there’s a side by side discussion with each CSR. We 

go through how well they performed. 

Now, the independent TQC contractor that Administrator Weems 

is talking about is also now evaluating additional calls. So we’re 

trying, like the CSRs, to make sure that there’s quality there and 

that they’re answering accurately and completely. 

Not everyone’s perfect and clearly from what we’ve heard today 

there are some issues. We like to get the feedback. By the way, I 

agree, establishing an organization with the SHIPs and the beneficiaries and CMS to support the content review I think is a very 

good idea. 

Senator SMITH. The timing of this hearing, Mac, is intentional 

because we’re coming up to a new enrollment period. That new enrollment period, for any seniors watching that want to enroll, starts 

in November. Are you representing to us that you’re ready for this 

enrollment period? Because if a senior gets trumped up in the enrollment period and they have to start—they start assessing about 

a 1 percent penalty a month, and that could be a 12 percent penalty, and that 12 percent penalty stays with them. It’s not a 1-year 

penalty. It’s just they made a mistake and they live with it the rest 

of their lives. 

58 

Even more important than the money is obviously if they’re 

given the wrong information and that may have a health consequence to them that I know you don’t intend. But we’ve got to 

get it right. 

So you’re representing to us that you’re ready for this next enrollment period? 

Mr. CURTIS. We are getting ready, absolutely, Senator. As you 

know, the enrollment period is November 15 through December 31. 

Your staff has been to our centers. One of the things I do want to 

represent is, in all of our the facilities our CSRs have other opportunities and other places to work. We have a workforce that is passionate about helping people. So I think the attitude is certainly 

one we should all be proud of and reassured by. 

I think you’ve heard about improvements in the training. One of 

the things I think that CMS has indoctrinated into the training 

curriculum is the whole notion of Medicare Advantage and how to 

deal with that. I think we’re always looking at ways to improve 

that training to make sure we have the right answers. 

So we are getting ready, Senator. We’re doing the recruiting, 

we’re doing the training, and we’ve begun and we’ll be ready for 

the spike. 

Senator SMITH. Well, it’s very important. Obviously, Naomi’s case 

is an example that it isn’t just my staff that’s calling. Those are 

the people who are the focus of this hearing and Naomi puts a 

human face on it. So I want to in the strongest but friendliest 

terms as possible emphasize just how important it is to get systemically right all these things, get the training, get the processes 

worked out in the system, so that those even who are technically 

or high tech challenged—I’d include myself in that number—can 

manage this system. I think that it’s a huge challenge, but you 

took the contract. 

Mr. CURTIS. Yes, sir, we did. Yes, sir, we did. 

Senator SMITH. My admonition is do it, get it right. 

We want to be your cheerleaders, not your critics. 

Mr. CURTIS. We’re committed to doing that, Senator. 

Senator SMITH. Well, thank you all very much. This has been a 

most informative hearing. We hope it helps. We’re not here to pick 

a fight. We’re here to find a solution. 

Thank you, Mac, for your presence, and I hope that you got a 

handle on all your subcontractors, too. 

Mr. CURTIS. One comment. We are the prime contractor we 

would only use the subcontractors if we had to in a spike. 

Senator SMITH. But you feel like you’ve got control of it? 

Mr. CURTIS. Absolutely, there’s no question about it. It’s simpler 

now than it was before CMS consolidated the contract center operations. 

Senator SMITH. So you’re managing them, too? You’re accountable for that? 

Mr. CURTIS. Absolutely, if we use them. 

Senator SMITH. Ladies and gentlemen, thank you. 

We’re adjourned. 

[Whereupon, at 11:35 a.m., the hearing was adjourned.] 

(59) 

A P P E N D I X 

PREPARED STATEMENT OF SENATOR ROBERT P. CASEY, JR. 

I would like to thank Senator Smith for organizing this important hearing on the 

1–800–Medicare number and the service it offers Medicare beneficiaries and their 

families. This hearing is the product of an extensive investigation that Senator 

Smith and his staff began in 2005 into 1–800–Medicare and the concern that our 

older citizens and other Medicare beneficiaries are not receiving accurate information from the customer service representatives who answer these calls. 

1–800–Medicare, the general customer service number all Medicare beneficiaries 

call with questions or problems, is often both the first and last resort for many 

Medicare beneficiaries. Sometimes these calls involve life and death issues. Accordingly, we must ensure that beneficiaries and their families receive accurate and 

timely information. 

There are currently almost 45 million Medicare beneficiaries in this country, including almost 2.2 million in Pennsylvania. Millions more are on Medicaid. Many 

of these individuals are easily confused by the choices Medicare offers and the multiple choices and decisions they must navigate to enroll in various plans and programs. As result, they call 1–800–Medicare looking for simple answers to often complex questions. The results can be far from helpful. 

While 1–800–Medicare is available 24 hours a day, seven days a week, callers can 

experience lengthy wait times before speaking to a customer service representative. 

Once they speak to a person, beneficiaries have reported representatives can be difficult to understand because they are too technical or presume knowledge about the 

Medicare program the caller does not have. At times callers are simply given wrong 

information. 

Hubert Humphrey used to say that one of the things we and society should be 

judged on is how we treat our older citizens. Are we providing them with appropriate help in their time of need? From the evidence before us at this hearing, it 

seems we are not. 

Bottom line, Mr. Chairman, our older citizens, and all Medicare and Medicaid 

beneficiaries who utilize the 1–800–Medicare number need timely answers to their 

questions and they need accurate answers. It is estimated that 1–800–Medicare will 

field 34.5 million calls in 2009. CMS and Congress should strive to make this process better, shorten wait times and provide customer service representatives with the 

tools they need to give accurate and complete information to callers. 

We all know Medicare is a complex program. Our older citizens call this number 

with the expectation that the customer service representative on the other end will 

be able to provide them with correct and helpful information be it explaining the 

difference between traditional Medicare and Medicare Advantage or helping them 

choose which prescription drug plan best meets their needs. It is our job to ensure 

they find the answers they are looking for and that those answers are correct. I look 

forward to hearing the testimony of Administrator Weems and our other witness. 

Thank you, Mr. Chairman. 

KERRY WEEMS RESPONSES TO SENATOR SMITH’S QUESTIONS

Question 1. The New 5 Minute ASA 

It was encouraging to hear the plans that CMS has for reducing wait times at 

the call centers. Will CMS be formally revising the call center contract to require 

a 5 minute average speed of answer (ASA)? 

Answer: CMS modified the contract with Vangent effective October 1, 2008 to 

lower the ASA from 8 minutes down to 5 minutes through the current option year 

which ends May 31, 2009. 

Question 2. Hiring of Briljent 

60 

In December 2007, CMS contracted with Briljent to revise the training curriculum 

and call scripts. Why did CMS remove these responsibilities from Vangent and reassign them to a new contractor? 

Answer: We conducted a full and open competition for the 1–800–MEDICARE 

contract and its support services as the prior contracting vehicle was expiring. As 

part of the competitive bid process, we set aside certain activities for small businesses. The training, quality, and content support services were determined to be 

appropriate for a small business set aside. Therefore, Vangent was not eligible to 

compete for those activities. Briljent, as a small business contractor, was successful 

in its bid for this work. 

Question 3. Taskforce 

I have serious concerns that CMS and its contractors are unable to assess call 

center performance from a beneficiary’s perspective and do not understand the challenges confronting beneficiaries when they try to use 1–800–Medicare. Though I was 

initially encouraged to hear that CMS had contracted with Briljent to revise CSR 

training and scripts, I remain concerned that this contractor’s work product thus far 

does not adequately address the problems identified by my investigation. Therefore, 

to provide better feedback to CMS and its contractors in developing call center 

training curricula and scripts, is CMS willing to implement the advisory taskforce 

recommended by witnesses at the September 11, 2008 hearing? If no, why not? If 

yes, by what date can we expect to have that taskforce in place? 

Answer: CMS does not believe an advisory taskforce is necessary for 1–800– 

MEDICARE training materials and scripts. The quality, scripting and training development contractor works very closely with CMS staff and subject matter experts 

to ensure materials are relevant and up-to-date. We also obtain feedback from our 

CSRs to ensure scripts and training materials provide CSRs with subject matter 

knowledge and address the caller’s need. CMS has consistently made available 1– 

800–MEDICARE Part D scripts to CMS Partners via the www.cms.gov website. 

Additionally, CMS already has two committees that provide feedback on beneficiary education, including 1–800–MEDICARE. The Advisory Panel on Medical 

Education (AMPE) is governed by the Federal Advisory Committee Act and exists 

for the broader purpose of advising CMS on beneficiary education matters. In the 

past the APME has given general suggestions and comments about 1–800–MEDICARE, which have included topics such as wait times and non-English language 

issues. The National Medicare Education Program (NMEP) Coordinating Committee 

has also addressed partner questions and comments regarding 1–800–MEDICARE 

at its meetings. 

We believe that these combined efforts provide sufficient opportunity for feedback 

and forming an advisory taskforce would duplicate our existing efforts. 

Question 4. Other Items that Need to Be Improved at 1–800–Medicare 

Despite CMS’ plans to reduce the ASA from eight minutes to five, I did not hear 

much at the hearing by way of planned improvement that would address other technological issues and adequately address problems with respect to the accuracy of responses provided to callers. Can you please explain CMS’ plans for improving the 

following: 

The interactive voice response system, or IVR as it is called, is challenging for 

seniors to navigate. 

I would ask that CMS revise the IVR to provide an option to go directly to an 

agent. 

Answer: We do not currently offer a prompt that sends a caller directly to an 

agent and have no plans to implement such a change. As it is currently set-up the 

IVR technology improves the efficiency of our operations and enables some callers 

to ‘‘self-serve’’ and receive the information they need without having to speak with 

a CSR. In situations where we cannot serve the caller via the IVR, the caller is 

seamlessly routed to the CSR who is best able to handle the specific topic. 

It also should be easier to reach an agent and obtain service for beneficiaries who 

do not have their Medicare number at hand. 

Further, the IVR should provide choices that better align with callers inquiries. 

Answer: While a Medicare beneficiary does not need to have a Medicare number 

at hand in order to obtain information from 1–800–MEDICARE, having this number 

allows both the IVR and CSRs to quickly access the beneficiary’s specific information and more efficiently serve the caller. Less than 2% of calls coming into 1–800– 

MEDICARE are from callers without a Medicare number. 

The new 5 minute ASA is encouraging. But I still feel strongly that CMS should 

contract for wait times specific to peak call periods. 

By what date can we look for CMS to revise the call center contract to reflect an 

ASA specific to peak call periods? 

What resources will it take (including additional funding) to accomplish this? 

61 

Answer: No, CMS will not be revising the call center contract to mandate an ASA 

specific to peak call periods. 

Scripts still are too technical and presuppose program expertise that most beneficiaries likely do not possess. Scripts also tend to be siloed by issue and do not provide common-sense responses for questions that cut across multiple issues. 

What steps does CMS and its contractors undertake to ensure content is comprehensible by beneficiaries? 

Further, is CMS willing to implement focus group testing on scripts? 

Answer: We recently completed an extensive review and update of all the 1–800– 

MEDICARE Part D scripts. As a result of our review, we have reduced the number 

of Part D scripts from 53 to 25. Notably, we have updated the overview script that 

CSRs use to help triage caller issues and quickly access the most appropriate Part 

D script. We expanded the questions/linkages on that script and incorporated examples to help CSRs assist callers. We have completed a similar review of all of the 

MA scripts and have reduced the number of MA scripts from 28 to 2. In addition, 

we have reduced the previous 10 Low-Income Subsidy (LIS) scripts into one consolidated script to make it easier for CSRs to respond to various LIS questions. All 1– 

800–MEDICARE scripts are scheduled to be reviewed and updated by the end of 

January 2009. 

We have implemented a process by which 1–800–MEDICARE scripts are reviewed 

and focus tested by CSRs before being fully implemented. 

1–800–Medicare customer service representatives (CSRs) have complained to my 

staff that their three week general training does not adequately equip them for the 

scenarios that they encounter on the phone during live calls. What specific improvements can we look for in CSR training and oversight over the next six months? Specifically: 

CMS might consider incorporating a more robust program of test calls in to its 

quality assurance program. 

Answer: As part of the 1–800–MEDICARE quality assurance program, our contractors will continue to conduct test calls to examine readability, content flow and 

logical placement of content. Vangent regularly conducts test calls by topic with its 

CSRs for implementing comprehensive script updates. In addition, both Vangent 

and Briljent perform calls for new or key initiatives such as the Prescription Drug 

program to determine whether the script addresses the caller’s need and provides 

a consistent answer. When making test calls, Briljent and Vangent test callers are 

provided specific call instructions and use pre-written scenarios. As before, CMS 

staff members will continue to listen to actual recorded calls, but will not make test 

calls. 

On the topic of training, customer service representatives currently have four calls 

per month reviewed. Call center management have referred to this review process 

as ‘‘a routine mechanical checklist that lacks common sense and does not provide 

adequate insight in to whether a representative has appropriately identified a caller’s issues, answered those questions and closed the loop for a caller.’’ CMS must 

do a better job ensuring that representatives are appropriately identifying and resolving callers’ issues. 

Answer: Each fall as we near the Annual Enrollment Period, a Readiness Plan 

is developed and implemented. As part of this Readiness Plan, all drug plan scripts 

are reviewed and updated and specific Readiness training is provided to the CSRs. 

We model our scripts and Readiness Plan on how Medicare beneficiaries and their 

caregivers ask questions. Based on prior years experience, we use a combination of 

instructor-led and self-paced refresher training. The complexity of the subject determines whether CSRs receive instructor led or self-paced training. 

As part of our script review, we updated several scripts, which improved the 

CSRs’ ability to navigate within the script. We also updated terminology in the 

script to match the 2009 Medicare & You handbook language. 

CMS also must drastically improve the process by which information is captured 

and recorded by the 1–800 Medicare system. Each time a beneficiary is transferred 

to a new representative, and each time a beneficiary calls to follow up on a prior 

call, they are forced to recount their entire story over and over again to each person 

with whom they speak. Further, customer service representatives rarely seem to be 

able to provide any useful information on the status of complaints and other inquiries. What improvements can we look for regarding the foregoing? 

Answer: CSRs have access to caller activity and history through the CSR desktop 

application. CSRs can also determine what scripts were used during the call. Where 

applicable, CSRs provide additional insight through the use of the CSR comment 

field in the CSR desktop application. 

62 

Additionally, effective September 19, 2008, CMS implemented a more streamlined 

approach for the retro-disenrollment process, minimizing the number of CSR transfers. 

Currently, 1–800–MEDICARE CSRs have the ability to determine whether a Part 

D complaint has been filed, and whether the complaint has been resolved or is pending. We are trying to obtain more information on the status of complaints and have 

made a formal request for additional data. The request is currently being reviewed 

within CMS. 

What additional levels of funding will CMS require to accomplish the foregoing 

improvements? 

Answer: Given CMS’s competing priorities, such as claims payments, program 

oversight, and quality improvement, the FY 2009 requested funding level for 1–800– 

MEDICARE is appropriate within that context. In fact, we’ve ensured that 1–800– 

MEDICARE spending has remained steady despite budget cuts in other areas. In 

addition, we have identified efficiencies in call center operations that have achieved 

savings in the past year. These savings are allowing us to bring down our caller 

wait times. 

MICHEALLE CARPENTER’S RESPONSES TO SENATOR SMITH’S QUESTIONS

Question 1. What Is the Top Priority Fix 

Based on your experience, what is the one item that is the most pressing priority 

that you would ask CMS to first address to ensure seniors get reliable answers and 

prompt service during the 2009 plan enrollment period, which starts in November. 

Answer. 1–800–Medicare Customer Service Representatives (CSRs) hold great responsibility and, in this key role, they are affecting people’s lives significantly. For 

this enrollment period, beginning November 15, 2008, CSRs must be given a standard operating procedure that allows them to assess how callers are currently receiving their coverage and whether they need to make a choice going forward. CSRs 

must be able to determine whether the caller had creditable coverage and whether 

the caller wishes to continue with that coverage. If the caller needs to choose a plan, 

because he or she does not have creditable coverage, is new to Medicare, or needs 

to evaluate whether his or her current MA–PD or PDP plan will continue to meet 

his needs, only then should the CSR begin to research available options. To do this, 

the CSRs must be able to use the plan finder websites to assist callers in selecting 

the most appropriate plan. This will also require the CSR to know how to find important information on the plan finder website. These websites are not often easy 

to use, requiring people with Medicare to look through pages of information before 

they locate which doctors are in a MA plan’s network or which services are excluded 

from an out of pocket maximum. CSRs should also be cautioned against steering 

callers to any particular type of plan, such as a Medicare Advantage plan over original Medicare. This will require that the CSR have a basic understanding of Medicare, the available options, and the benefits and consequences of each. 

Question 2. It has been represented to the Committee that most calls to 1–800– 

Medicare are simple, single-question calls. In your extensive work with seniors, do 

you find that to be the case? 

Answer. The simple answer to the question is no, people almost never call with 

just one simple question. The very nature of the Medicare program makes a single, 

simple questions unlikely. Even if someone does call with what appears to be a simple question, the answer is rarely simple and often requires additional follow up 

questions. But beyond that, we have found that CSRs often are unable to handle 

what should be straight forward questions. 

Question 3. Complaints About 1–800–Medicare 

CMS and Vangent have represented that that they are not aware of significant 

complaints about service at 1–800–Medicare. My office has received numerous complaints regarding difficulties in filing complaints at 1–800–Medicare—either complaints about service at 1–800–Medicare or complaints about plans or other issues. 

In your casework with seniors, have you experienced these problems? Further, in 

your experience, after a bad experience with 1–800–Medicare, are seniors going to 

take the time to call back in to 1–800–Medicare to file a complaint about their service at 1–800–Medicare? 

Answer. Generally, people with Medicare are unaware that they are able to make 

a complaint about 1–800–Medicare or about their plans or other issues. In our experience, by the time a person with Medicare comes to us, they are very frustrated 

with 1–800–Medicare and do not want to call the number again if they do not have 

to. To resolve this problem, 1–800–Medicare should institute a quality improvement 

63 

measure that allows seniors to automatically complete a satisfaction survey after 

the call or to have they survey sent to them via the mail to complete and return. 

TATIANA FASSIEUX’S RESPONSES TO SENATOR SMITH’S QUESTIONS

Question 1. What Is the Top Priority Fix 

Based on your experience, what is the one item that is the most pressing priority 

that you would ask CMS to first address to ensure seniors get reliable answers and 

prompt service during the 2009 plan enrollment period, which starts in November. 

Answer. During the upcoming Annual Coordinated Election Period (AEP), many 

Medicare beneficiaries will be seeking information about their options to change 

Part D and Medicare Advantage plans. One of the most frequently requested types 

of information will be an analysis of Part D options in a given state based upon a 

beneficiary’s drug needs. When a beneficiary calls 1–800–MEDICARE for such information, usually a response is mailed to the caller that includes the ‘‘top three’’ or 

so plans that best meet an individual’s drug needs. Instead of relying upon this information, though, 1–800–MEDICARE customer service representatives (CSRs) 

must be able to explain specific formulary issues, such as when a prescription is 

shown as ‘‘not on formulary.’’ This type of analayis is necessary, as it could give 

beneficiaries the opportunity to choose different plan options. In addition, CSRs 

must be able to explain additional Medigap rights that might be available to callers 

from different states, or, alternatively, affirmatively refer callers to a local SHIP in 

order to obtain such information. 

Question 2. It has been represented to the Committee that most calls to 1–800– 

MEDICARE are simple, single-question calls. In your extensive work with seniors, 

do you find that to be the case? 

Answer. In our work, we find that often the question is simple but the answer 

can be complex. Many questions that we receive require analysis, including a rephrasing of the original question (e.g. ‘‘I want to know if I can change my drug plans 

turns into ‘‘What are my options to change plans, what should I look for when comparing coverage between plans, etc.’’). Medicare beneficiaries regularly seek our assistance with complex issues, and presumably, also call 1–800–MEDICARE with 

similar issues. While we are unable to provide a breakdown of simple vs. complex 

calls that either we or 1–800–MEDICARE receive, we strongly urge CMS to give 

more attention to the calls it deems to be complex. 

Beneficiaries and SHIP counselors alike are frustrated with their inability to get 

back to the same 1–800–MEDICARE CSR, requiring starting the process/explanation all over again each time a call is transferred or dropped—with no assurances 

that all notes are being taken. CSRs do little check of callers’ understanding, and 

there is still an ongoing frustration with the IVR; beneficiaries need to get a live 

person on the phone at the outset. 

Question 3. Complaints About 1–800–Medicare 

CMS and Vangent have represented that that they are not aware of significant 

complaints about service at 1–800–MEDICARE. My office has received numerous 

complaints regarding difficulties in filing complaints at 1–800–MEDICARE—either 

complaints about service at 1–800–MEDICARE or complaints about plans or other 

issues. In your casework with seniors, have you experienced these problems? Further, in your experience, after a bad experience with 1–800–Medicare, are seniors 

going to take the time to call back in to 1–800–Medicare to file a complaint about 

their service at 1–800–MEDICARE? 

Answer. As discussed in our testimony, we are more prone to hearing about problems with 1–800–MEDICARE than successes. In our experience, we have certainly 

encountered many complaints about the difficulties in filing complaints at 1–800– 

MEDICARE—both about the hotline itself and plan or other issues. After a bad experience with 1–800–MEDICARE, we have found that Medicare beneficiaries often 

do not take the time to either call them back or file a complaint. All too often, beneficiaries will reach their local SHIP program after a frustrating experience with 1– 

800–MEDICARE and a subsequent referral from Social Security or a non-Medicare 

related agency. Such contacts often occur after much time has elapsed following a 

caller’s initial attempt to reach 1–800–MEDICARE, which can further exacerbate 

the individual’s problems. 

Thank you for the opportunity to provide these follow-up comments. 

JOHN CURTIS’S RESPONSES TO SENATOR SMITH’S QUESTIONS

Question. What problems have you identified that need immediate attention, and 

what steps do you plan to take to remedy these problems and deliver drastic imVerDate Nov 24 2008 12:02 Jun 04, 2009 Jkt 000000 PO 00000 Frm 00067 Fmt 6601 Sfmt 6601 H:\DOCS\49480.TXT SAG PsN: JOYCE
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provements before the start of the 2009 enrollment period, which starts in November? 

Answer. Vangent takes its responsibility to Medicare beneficiaries seriously, and 

is approaching the 2009 Annual Election Period with a strong emphasis on continuous improvement and quality service. 

Each summer, Vangent develops and implements a readiness plan to ensure that 

we are prepared to meet the increased demand of the Annual Election Period. This 

plan covers all aspects of the BCC operation and is a cornerstone of our approach 

to providing high quality service during the fall ‘‘spike’’ period. 

The following are just a few examples of the steps we are taking to improve service: 

Lowering Wait Times and Supporting Our Infrasture 

We have implemented a number of operational technology improvements to minimize the time required for a beneficiary to reach a CSR trained to answer his or 

her question. In September, we opened an additional call center to accommodate the 

increase in call volume associated with the Annual Election Period. 

We have also implemented a BCC ‘‘Command Center’’ that monitors wait times 

24 hours a day, seven days a week, and shifts workforce as needed to meet incoming 

call volumes. 

The Command Center monitors network and phone systems at each site to quickly identify and address any problems that may arise. 

As stated by Acting Administrator Weems, we are committed to maintaining an 

average monthly speed of answer of 5 minutes or less through the remainder of the 

year. 

Training and Scripting 

In preparation for the Annual Election Period, CMS works with Vangent and the 

Training, Quality and Content contractor to review and update all drug plan scripts, 

and provide specific training to CSRs. 

We are also taking every opportunity to review ‘‘frequently asked questions’’ with 

CSRs to ensure that they are prepared to respond accurately and effectively to these 

questions. 

Finally, CMS has implemented an improved Learning Management System that 

will allow us to better identify training needs of CSRs and disseminate information 

to those CSRs and call centers. 

Quality 

Throughout the Annual Election Period, we will reinforce our commitment to 

quality. We will continue to closely monitor calls and aggressively address any opportunities for improvement identified by our Independent Quality contractor. 

We recognize the important role that 1–800–MEDICARE plays in helping Medicare beneficiaries make informed decisions about their benefits. We take that responsibility seriously, and are committed to providing high quality service not only 

during the Annual Election Period, but throughout the year. 

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