Archive
Weekly Email: Week of January 2
I. Conference Call Information (January 4, 2006; January 18, 2006; January 19, 2006)
II. In the News
CMS Announces Numbers of Medicare Beneficiaries with Drug Coverage
SSA Releases Final Regulations on Limited Income Subsidy Applications
III. Helpful Information
Information to Help Duals Get Prescriptions Filled
CMS Updates www.cms.hhs.gov Website
Employment Opportunities in the Field
IV. HAP Resources
Prescription Drug Plan Charts for all States
Chart Compares Drug Plan Coverage for Duals
HAP Conference Runs January 25 to 28, 2006
V. Happy New Year!
I. Conference Call Information
The next HAP Medicare MMA Conference Call will be on Wednesday, January 4, 2006 at 3:00 p.m. EST. This MMA conference call, “First Call After D-Day,” will cover new developments regarding the process for point-of-service facilitated enrollment and assisting dually eligible persons (duals) at the pharmacy, unforeseen issues and problems that have arisen since coverage began, and strategies for handling the volume of work. We will host a second MMA call this month on Wednesday, January 18, at 3:00 p.m. EST to ensure that we have ample time for sharing information on new developments as well as ideas, suggestions and commonly experienced issues.
If you have questions about these calls, please contact Kelly Brantley at Kbrantley@healthassistancepartnership.org or Hilary Dalin at Hdalin@healthassistancepartnership.org.
The next Medicaid conference call is scheduled for Thursday, January 19 at 1:00 p.m. EST. The topic is teen health. We'll talk about EPSDT screening for teens, when minors can consent to various types of treatment, access to family planning and mental health services, when minors are "emancipated" and can qualify for Medicaid in households separate from their parents, outreach to teens about their rights, and any other issues for teens that you are facing. Please email Cheryl Fish-Parcham at cparcham@healthassitancepartnership.org with suggestions.
While this call is designed for the Medicaid network, please let us know if you are seeing issues for teens in private insurance as well. If so, we may broaden the call's focus.
The information about participating in the HAP conference calls is limited to staff members (paid or volunteer) of consumer health insurance assistance programs because of HAP's funding restrictions. If you are a staff member of a consumer health insurance assistance program and should be getting the conference call information, please email Avis Hall at ahall@healthassistancepartnership.org with your request and information about your program.
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II. In the News
CMS Announces Numbers of Medicare Beneficiaries with Drug Coverage
On December 22, 2005, the Centers for Medicare & Medicaid Services (CMS) announced that over 21 million Medicare beneficiaries would have prescription drug coverage on January 1, 2006. With a goal of 28 to 30 million enrolled in the first year, this figure seems promising. A closer look at the numbers, however, showed that of this 21 million enrolled, only a million Medicare beneficiaries actually actively enrolled in stand-alone Prescription Drug Plans. The remaining 20 million were divided as follows: 6.2 million Medicare/Medicaid beneficiaries were auto-enrolled, 4.4 million Medicare Advantage participants shuttled into new MA-PDs, 5.9 million Medicare beneficiaries with retiree drug coverage, and 3.1 million TRICARE and FEHB members. Before Congress enacted the Medicare Modernization Act, nearly 13 million non-institutionalized Medicare beneficiaries had no prescription drug coverage. Thus it appears that less than ten percent of them have enrolled in a Part D plan.
SSA Releases Final Regulations on Limited Income Subsidy Applications
The Social Security Administration published its final rules on the Medicare Part D Limited Income Subsidy (LIS) application in the Federal Register for December 30, 2005.
III. Helpful Information
Information to Help Duals Get Prescriptions Filled
CMS has posted guidance for pharmacists to use if a dually eligible person comes into the pharmacy and has not been enrolled in a Medicare drug plan. This system should enable the dual to leave with a filled prescription. Pharmacists also have a special phone number to call to resolve problems. If you need to inform a pharmacist of this process, see CMS's outline detailing these procedures. In addition, CMS has a set of Frequently Asked Questions (FAQ) and answers for pharmacists that explain how to process claims for duals who don’t know which drug plans into which they have been enrolled.
Finally, all Part D plans are to have transition processes for new enrollees. They should allow first refills of drugs that are not on their formularies to give the person time to get in touch with their doctor about a new prescription or to request a formulary exception. See CMS’s state-by-state lists of the Prescription Drug Plans’ transition procedures, revised on December 28, 2005. If you have any trouble getting a plan to use a transition process, contact your regional CMS office to report the problem.
CMS Updates www.cms.hhs.gov Website
CMS recently revamped its website www.cms.hhs.gov, and HAP is working to repair the many broken links from our website to theirs. Please be patient as we update these links. The process is quite tedious. If you find broken links that you need updated immediately, please notify Kelly at kbrantley@healthassistancepartnership.org.
Employment Opportunities in the Field
The Health Rights Hotline in California has an opening for a supervising attorney.
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IV. HAP Resources
Prescription Drug Plan Charts for all States
HAP is pleased to announce the new tool PDP Charts by State. The tool is designed to break down the entire list of Medicare Prescription Drug Plans into easy-to-read charts for each state, territory and DC. They contain the following information: State, PDP Region, Organization Name, Plan Name, Premium, Deductible, No Premium with Full Low-Income Subsidy, Variable Copayments, Extra Coverage in the Gap, Top 100 Drugs on Formulary, Top 100 Drugs Requiring Prior Authorization, Top 100 Drugs with Cost-Sharing Below $20, and Mail Order.
Chart Compares Drug Plan Coverage for Duals
Using the top drugs prescribed for Medicaid beneficiaries in the District of Columbia, HAP has prepared a comparison of coverage among the fourteen Medicare prescription drug plans with $0 premiums for duals in DC, Delaware, and Maryland. Coverage of those drugs varies dramatically from plan to plan, showing the importance of alerting Medicaid providers to the new formularies. The findings include a list of drugs most likely to be off-formulary and information about the plans that covered the most and the fewest commonly prescribed drugs. The chart shows the prices of these drugs for duals. We invite you to use the same list of drugs to compare coverage in your region, or you may want to ask your Medicaid agency for a more customized list of commonly prescribed drugs in your state or community.
HAP Conference Runs January 25 to 28, 2006
Be sure to join your colleagues at Helping Health Care Consumers in an Ever-Changing World, the HAP conference which is now a separate track within Health Action 2006, Families USA’s Annual Grassroots Meeting. We are excited about the agenda as well as the ability to offer so many opportunities for individual technical assistance. (You'll be able to make an appointment for technical assistance shortly.)
The HAP track starts on Wednesday afternoon with a facilitated discussion of issues affecting consumer health assistance programs followed by a dinner for those who are interested in the HAP track. If you plan to join us at the dinner (hosted by HAP) and/or the discussion, please complete this brief form. In addition, please send any issues that you would like to raise during the discussion to Christin Engelhardt at cle@healthassistancepartnership.org.
As a reminder, the early-bird conference registration deadline is Friday, January 6. After that date, the registration fee increases from $275 to $325. The special conference rate of $159/night plus tax (for a single or double) at the Renaissance Mayflower Hotel is now still available as long as you make your room reservations also by Friday, January 6. Call the Renaissance Mayflower at 1-800-HOTELS1 or 202-347-3000, and be sure to mention that you're with the Health Action 2006 conference to get the special conference rate. After Friday, the room rate depends upon availability and is likely to be significantly higher.
If you have any questions about the conference, contact Christin Engelhardt at cle@healthassistancepartnership.org.
V. Happy New Year!
We hope that you enjoyed the holiday season, and we wish you all the best in 2006!
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