Archive
Beginning April 1, 2006, the mission of HAP is to work with State Health Insurance Assistance Programs (SHIPs) to enhance the efficiency and effectiveness of their programs so they can provide high-quality education and counseling to a greater number of seniors about Medicare and related health care coverage. An additional HAP goal is to stabilize and increase federal funding for the SHIP network. Because HAP will no longer be focused on health insurance issues that affect the non-Medicare population, the weekly emails may not be relevant to your program. We invite you to continue receiving our emails; however, if you prefer not to receive them, please send an email to webmasterga@healthassistancepartnership.org with “UNSUBSCRIBE” in the subject.
I. Conference Call Information
Next Medicare Call on April 19: Part D Latest Developments
II. In the News
CMS Actuary Reports 2007 Part D Cost-sharing Increases
Kaiser Family Foundation Releases Study Assessing Medicare Drug Plans
III. Helpful Information
CMS Reverses Coverage Exclusion for Niaspan and Niocor
Part D Explanation of Benefits (EOB) Update
CMS Releases Roadmaps to Medicaid Reform under the DRA
CMS Releases Multiple Language Resource
IV. HAP Resources
Part D FAQ Resource Center
Updated Stop Gap Chart
CMS 2007 Guidance Resource
I. Conference Call Information
Next Medicare Conference Call on April 19: Part D Latest Developments
The next Medicare Network Conference Call, Part D Latest Developments, is scheduled for Wednesday, April 19 at 3:00 p.m. EDT. The Part D transition period has ended and the conclusion of the Part D 2006 Annual and Initial Enrollment Periods is approaching. CMS has enrolled in Part D plans the Medicare Savings Program beneficiaries, SSI beneficiaries and those who applied and were awarded LIS effective May 1st. Join us for our next monthly call where we will discuss the acceleration of the Part D timeline, enrollment periods and plan elections, especially Special Enrollment Periods, and any consequences of the conclusion of the transition period. We will also invite open and in-depth brainstorming about reaching those who will be most hurt if they fail to enroll in a plan by May 15th. We will also share ideas and practical advice to help beneficiaries gain access to drugs through Part D plans, and if time permits, we will address Parts B and D coverage issues as well.
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II. In the News
CMS Actuary Reports 2007 Part D Cost-sharing Increases
On April 5th, CMS’ Office of the Actuary reported the increased Part D beneficiary cost-sharing amounts for 2007. The Actuary indicated that the annual deductible will increase to $265 in 2007, up from $250. The initial coverage limit, after which beneficiaries enter the coverage gap or “doughnut hole,” will increase from $2,250 to $2,400. The catastrophic limit goes up from $5,100 to $5,451.25 in annual costs, meaning that the out-of-pocket threshold increases to $3,850. Finally, the co-payments for those who qualify for the Extra Help program will, in most cases, increase by ten to thirty-five cents. The co-pay for name brand drugs for non-full benefit dually eligible persons, for example, rises from $5.00 to $5.35. The cost-sharing increases for 2007 will average about seven percent.
Kaiser Family Foundation Releases Study Assessing Medicare Drug Plans
The KFF study, released on April 11, examines 35 prescription drug plans (PDPs) offered by fourteen national or near national plan sponsors. These PDPs represent 1,222 of the 1,429 packages available to Medicare beneficiaries. A sample of 152 commonly and rarely used generic and brand-name drugs was used to compare formularies, drug costs and utilization management tools among these drug plans. The analysis found dramatic variation among plans. Plans covered between 64 and 97 percent of drugs in the sample, with an average of 81 percent. There were also vast disparities in cost-sharing expenses that enrollees paid specific drugs. For instance, an enrollee could pay $15 to $62 per month for Norvasc, a drug for high blood pressure, or $20 to $1,276 per month for Enbrel, a drug used to treat rheumatoid arthritis. The researchers recommended more monitoring and regulation of the drug plans by lawmakers. For more details, see the full report.
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III. Helpful Information
CMS Reverses Coverage Exclusion for Niaspan and Niocor
On April 11, 2006, CMS released a clarification of Part D coverage for prescription niacin products. For certain indications, CMS will consider Niaspan and Niocor to be Part D drugs. This clarification supersedes CMS’ memo on February 3, 2006 which declared these products to be excluded because they were viewed as vitamin supplements.
Part D Explanation of Benefits (EOB) Update
CMS sent an email to SHIPs on April 6th containing an attachment with a model Part D EOB, accompanying instructions and two memoranda. In a memorandum dated March 17th from Gary Bailey, Deputy Director of CMS’ Center for Beneficiary Choices, to the Part D drug plans, he notes that CMS permitted the plans to send their first EOBs in March to enrollees who used their benefits in January and February 2006. Mr. Bailey wrote, “We encourage plans to send out the March EOB as soon as possible after the close of the month in order to complete the transfer of gross-drug-spend and TrOOP balances among Part D plans on behalf of beneficiaries who switched plans during the program start-up period.” The memo also states that the EOB serves as a tool through which plans inform enrollees of “upcoming formulary changes.”
CMS Releases Roadmaps to Medicaid Reform under the DRA
CMS issued on March 31st two “Roadmaps to Medicaid Reform” in which the agency outlines its approach to working with states to implement the recently enacted Deficit Reduction Act (DRA) of 2005. In a press release, Health & Human Services Secretary Michael Leavitt reportedly said that the “DRA will provide great opportunities for the states to cover more people at a lower cost, and with greater continuity of coverage.” Leavitt went on to say that the new law will enable states to transform acute care and long-term care Medicaid programs. CMS stressed that, under the DRA, states no longer have to seek “waivers” to establish home and community based care programs. The DRA “allows states to add new designs as part of their basic ‘state plan.’”
The Roadmap to Medicaid Reform for long-term care describes how states can work with CMS under the DRA to 1) expand coverage for individuals with disabilities, 2) increase access to community supports, and 3) promote personal responsibility, independence and choice. With respect to increased community supports, the Roadmap to Reform describes the ability that states will have starting January 1, 2007 to offer home and community based services without waivers, and without an eligibility requirement tied to a person’s need for institutional care, as a “significant step towards ending the ‘institutional bias.’”
The Roadmap to Reform for acute care needs describes strategies by which states can align their Medicaid programs to 1) expand access to affordable mainstream coverage, 2) promote personal responsibility for health and accessing health care, and 3) improve quality and coordination of care. Both Roadmap documents highlight the federal grant programs available to fund states’ DRA implementation efforts including, for example, the “Real Choice Systems Change (RCSC) Grants for Community Living.”
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CMS Postings
CMS Releases Multiple Language Resource
CMS posted a four page compilation of Part D fact sheets, tip sheets, and guides in various languages. The “Multilanguage Medicare Publication” tool has links to more than fifty CMS documents in Spanish, as well as many that are available in Russian, Chinese, Vietnamese, Korean, and Tagalog. These documents cover a range of topics including basic overviews of Medicare Part D, information for caregivers, Katrina enrollment, and facilitated enrollment notices. The materials target beneficiaries and partnering organizations for use in outreach.
IV. HAP Resources
Part D FAQ Resource Center
We invite you to visit HAP’s FAQ Resource Center for answers to questions about a wide range of Medicare Part D topics such as cost-sharing, formularies and penalties for late enrollment. Our FAQ Resource Center is unique in that the answers contain links to helpful reference information, including statutory language, federal regulations and CMS policy statements that give the basis for each response. The questions themselves include many that our colleagues in the SHIP network submitted to HAP via shiphelp@healthassistancepartnership.org. Thank you!! We encourage you to visit this new Resource Center often because HAP staff adds new FAQs regularly.
Updated Stop Gap Chart
The updated Stop Gap Measures chart details which states and municipalities are continuing to provide emergency drug coverage for dual-eligibles and other Medicare beneficiaries who have not yet been able to get drugs through their Part D prescription drug plans. The chart also shows the states that have ended their stop gap measures and the expiration dates for those measures.
CMS 2007 Guidance Resource
CMS began recently to release draft and final versions of Part D Guidances for 2007. HAP has created a resource page to organize the final versions of these guidances as they become available. If you have nay questions about these guidances, please contact Kelly at kbrantley@healthassistancepartnership.org.
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