Form CMS-10836 Audits and Letters - Beneficiaries and Caregivers

Medicare Plan Performance Warning Information: Guide 1
Audits and Letters
IDI Discussion Guide (90-minute online interviews)

Interviewer: _________________________
Participant:

_________________________

Date/Time:

_________________________

Objectives
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Gauge reactions to and interest in information on Medicare plan audits.
Understand how beneficiaries may use audit information when making plan
decisions.
Gain insights on best ways to share plan audit information with beneficiaries.
Gauge reactions to appeals letters.
Gauge reactions to checklists for new enrollees/beneficiaries changing plans.

Introduction (3 min)
Thank you for agreeing to speak with me today. My name is ______ and I’ll be leading our
conversation. This is opinion research, which means there are no wrong answers. I am
interested in everything you have to say. Since we are talking about your opinions, you are
the expert.
Before we get started, there are a few things I want to mention. First, I am an independent
researcher. You will not offend me or get me in any trouble. My only goal is to hear your
honest opinions. So please be as open and candid as possible.
We have a number of questions to get through and a few things to look at and read. So, if
at some point I ask that we move on, it’s because I want to make sure that we finish on
time. It’s not because I am not interested in what you have to say.
I am recording our conversation so I don’t miss anything. The recording is confidential and
is not shared outside the research team. There are also other people watching this
interview to help me take notes and to understand what was said. Ultimately, the findings
from this interview will be combined with other interviews we’re conducting, and we’ll write a
report with some recommendations. Your name won’t be used in the report.

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The sponsor of this study is the Centers for Medicare and Medicaid Services, specifically,
the Medicare program, or CMS. I do not work for the Medicare program. Your participation
will not affect any medical services you may be receiving or are eligible to receive.
Do you have any questions before we get started?
Warm-up (7 min)
I like to start by getting to know more about you.
1. Where do you live and how long have you lived there?
2. How long have you had Medicare coverage? [KEEP BRIEF]
3. What are the main things you expect your Medicare plan to do? [PROBE TO
UNDERSTAND ISSUES RELATED TO QUALITY OR PERFORMANCE]
4. In general, how do you know if your Medicare Advantage or prescription drug plan is
“good” or not? By “good,” I don’t mean affordable or if your doctor participates, I
mean if the quality of the plan itself is good, or how well it operates or serves
beneficiaries? We call this “plan quality.”
Audit Information: Introduction (20 min)
Today we are going to talk about how Medicare monitors plans and collects information on
the performance of plans.
5. To begin, how would you expect Medicare to monitor plan performance? What kind
of activities would you expect it to conduct?
a. What would you want to know about this monitoring?
b. What would you expect or hope Medicare would share with beneficiaries?
6. I want to share some information with you about how Medicare monitors plan
performance. [SHARE OVERVIEW TO INCLUDE AUDITS, ENFORCEMENT
ACTIONS, AND OTHER PLAN PERFORMANCE INDICATORS]
a. What is your reaction to this information?
b. What more, if anything, would you like to know about this monitoring?
7. Now I want to share some information with you specifically about plan audits.
[SHARE MORE DETAILED INFORMATION ON AUDITS, INCLUDING THAT NOT
ALL ARE AUDITED, THE FREQUENCY OF AUDITS, COMPONENTS OF AN
AUDIT, AND THAT AUDITS ARE DONE AT THE PARENT ORGANIZATION
LEVEL (AND WHAT THAT MEANS)]
a. What is your reaction to this information?

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8. In general, how interested are you in audit information about the company that runs
your Medicare plan? Please rate your interest on a scale from 1, not at all
interested, to 10, very interested. Please explain your answer.
a. What most interests you about audit information? Why?
b. What least interests you about audit information? Why?
c. How, if at all, would you use this information (e.g., general interest, making
plan decisions, etc.)?
d. When might you use it?
Audit Information: Examples and Details (35 min)
Now we are going to look at some of the information Medicare currently shares about
audits.
9. I want to get your reaction to some high-level information across all audits. I will
share several parts of a national report with you and get your reactions. This is a
real report from [YEAR]. [SHOW MORE RECENT VERSION IF AVAILABLE

https://www.cms.gov/files/document/2021-program-audit-enforcementreport.pdf READ ACCOMPANYING INFORMATION TO DESCRIBE EACH
FIGURE]
a. Figure 1: What is your reaction to this information?
b. Figure 2: What is your reaction to this information?
c. Figure 6: What is your reaction to this information?

10. What questions do you have about this information?
11. Overall, how helpful is this kind of information as you think about your plan? Please
rate how helpful it is on a scale from 1, not at all helpful, to 10, very helpful. Please
explain your answer.
a. What’s most helpful? What’s least helpful?
b. Would having this kind of information change how you thought about your
plan? Why or why not?
c. How, if at all, would you use this information (e.g., general interest, making
plan decisions, etc.)?
d. When would you use it?
12. Now I want to share some audit information in a different format. [SHOW
REFORMATTED INFORMATION INCLUDING NAME OF PLAN, YEAR FORMED,
ENROLLMENT, NAME OF PARENT ORG, DATE OF LAST AUDIT (IF ANY), AND
WHETHER ANY ENFORCEMENT ACTIONS RESULTED FROM MOST RECENT
AUDIT]
a. Example with no recent audit: What is your reaction to this information?
b. Example with recent audit, no findings: What is your reaction?
c. Example with recent audit, with findings: What is your reaction?
13. What questions do you have about this information?

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14. Overall, how helpful is this kind of information as you think about your plan? Please
rate how helpful it is on a scale from 1, not at all helpful, to 10, very helpful. Please
explain your answer.
a. What’s most helpful? What’s least helpful?
b. Would having this kind of information change how you thought about your
plan? Why or why not?
c. How, if at all, would you use this information (e.g., general interest, making
plan decisions, etc.)?
d. When would you use it?
15. Where would you expect to learn about this kind of audit information? Why?
a. IF NOT DISCUSSED: How might you expect to find it?
16. Now I want to share some examples of how the type of information we’ve been
talking about might be shared. [SHOW EXAMPLES OF WAYS TO SHARE
INFORMATION, INCLUDING AN OVERVIEW OF PLAN FINDER WEBSITE FOR
THOSE NOT FAMILIAR; KEEP IN MIND PURPOSE OF PLAN FINDER VS.
OTHER SOURCES LIKE MEDICARE & YOU TO EXPLORE WHAT THE BEST
PLACE IS FOR THIS TYPE OF INFORMATION] What is your reaction to:
a. Language on the Plan Finder website
b. Indicators or icons on the Plan Finder website
c. Links from Plan Finder to a separate website with more information
d. Information hosted on a separate website not directly linked from Plan Finder
e. Others?
17. Which of these options to share information is most helpful? Why?
a. Does it depend on the type of information being shared? How so?
18. Thinking about all the information you consider about a plan: what other things do
you consider?
a. If it was available to you, would you consider the kind of information we’ve
been talking about today?
b. In general, how important is this kind of information to you as you make
decisions about a plan vs. everything else you consider? Please rate how
important it is on a scale from 1, not at all important, to 10, very important.
Please explain your answer.
Appeals Letters and Checklist (20 min)
Thank you. Now I want to get your feedback on some additional information.
19. [SHOW SAMPLE LETTER FOR PART C OR D (DEPENDING ON WHAT KIND OF
PLAN BENEFICIARY HAS), BASED OFF MODEL NOTICES AT
https://www.cms.gov/Medicare/Appeals-andGrievances/MedPrescriptDrugApplGriev/PlanNoticesAndDocuments]
a. In your own words, what is this telling you?
b. What would you do if you got a notice like this?
c. What questions would you have?

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20. [SHOW SAMPLE CHECKLIST WITH PLAN PERFORMANCE INFORMATION
ADDED, BASED OFF https://www.medicare.gov/sites/default/files/202102/12116%201-21-21%20508.pdf OR https://www.medicare.gov/carecompare/en/assets/resources/home-health/Home_Health_Agency_Checklist_2.pdf]
a. Have you ever seen a document like this before?
b. Would it be helpful for you as you were selecting a plan?
c. [DIRECT ATTENTION TO PLAN PERFORMANCE INFORMATION] How
helpful is this specific information?
d. What would you do if you got a checklist like this?
Wrap-up (5 min)
TIME ALLOWING: Before we wrap up, I’m going to check to see if there are any additional
questions for you from anyone else on the team. [CHECK FOR QUESTIONS]
21. This has been really helpful. Thanks so much for participating in this project. Do you
have any other thoughts or comments you’d like to share?
If you have any questions about your Medicare options, please go to Medicare.gov. Thanks
again for participating. We really appreciate your assistance. Have a great day.
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