Archive
I. Conference Call Information (February 8, February 22, 2006)
II. In the News
Budget Reconciliation Bill Containing Medicaid Changes Goes to Vote
CMS Announces Plan to Reimburse States for Part D Spending
OIG Reports on Part D Plan Formularies and Transition Issues for Duals
CIGNA Fined by New York State Insurance Department
HSA Enrollment Exceeds 3 Million Mark
Maryland Legislature Overrides Governor's Veto; Fair Share Health Care Bill Becomes Law
III. Helpful Information
SHIP Staff Meets with Dr. McClellan
Three More States Add Stop Gap Measures
CMS Guidance on Pharmaceutical Assistance Programs (PAPs)
CMS Issues Letter to Physicians
IV. HAP Resources
New HAP Tools for Counseling and Assistance with Part D Implementation Issues
Tools for Duals
V. Other Resources
MS Society’s Appeal Toolkit
To all the program staff who joined us last week for the HAP track at the Families USA Conference, and to all the speakers who helped to make it a success, THANK YOU! It was a pleasure to see so many of you and to support the important work you do!
I. Conference Call Information
HAP’s next Medicare conference call will be on Wednesday, February 22, 2006, at 3:00 p.m. EST. We are moving it to the fourth Wednesday of the month to avoid a conflict with the first Open Door Forum call with Dan Schreiner, the Medicare Beneficiary Ombudsman, on February 15. We intend to schedule future calls on the third Wednesday of the month, as we have in the past. HAP’s February Medicare call will continue the discussion of how SHIPs and other advocates can help beneficiaries obtain their prescriptions through their Part D plans. We will provide updates on the emergency procedures that CMS has put in place to help beneficiaries through Part D start-up issues. We also plan to discuss more long-term issues related to coverage determinations, exceptions and appeals. Please send any questions or suggestions to Kelly Brantley, kbrantley@healthassistancepartnership.org, or Hilary Dalin, hdalin@healthassistancepartnership.org.
The next Medicaid conference call, "Changes Ahead in Medicaid and the New Direction of HAP," will be held on Wednesday, February 8th at 3:00 p.m. EST. The federal budget reconciliation bill, approved February 1, 2006, includes a number of significant changes to the Medicaid program (see the summary in the "In the News" section, below). Families USA health policy and field staff will join us to talk about the timetable for the changes that lie ahead. We also will discuss how you might prepare for consumer assistance to address these changes. We will post background information on the Health Assistance Partnership's home page and Medicaid conference call page prior to the call.
We will also talk about a change in the direction of HAP. As you may know, HAP was initially created under a generous grant from the Robert Wood Johnson (RWJ) Foundation that allowed us to serve programs that
work on a variety of health coverage and access issues. HAP’s work under the RWJ grant was completed on December 31, 2005. HAP has secured ongoing funding which focuses on SHIPs and their network partners that serve senior Medicare beneficiaries. Nevertheless, our parent organization, Families USA, will continue to meet some of the needs of non-SHIP consumer assistance programs, while seeking additional funds to support that work. The February 8th conference call will discuss the transition of services from HAP to Families USA. We invite consumer assistance programs that focus primarily on Medicaid to talk with some key Families USA staff members about how we can help each other in 2006 and beyond. For more information, contact Cheryl Fish-Parcham, cparcham@healthassistancepartnership.org.
The next private insurance call is tentatively scheduled for Wednesday, February 22 at 1:00 p.m. EST. We have several requests for discussion on how to help consumers in self-insured plans. Since states do not actually have regulatory authority over these plans, some programs report problems in getting the plans to cooperate with their efforts to resolve consumers' problems. If you have had successes in this regard that you would like to share with other programs, please write to Cheryl Fish-Parcham, cparcham@healthassistancepartnership.org. (Cheryl will soon be joining Families USA's health policy team to work on private insurance health policy issues, and she hopes to continue some assistance to the private insurance consumer assistance programs in HAP's network.)
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II. In the News
Budget Reconciliation Bill Containing Medicaid Changes Goes to Vote
The House of Representatives approved the budget reconciliation bill on February 1. The reconciliation bill will make many changes in Medicaid affecting beneficiaries. The bill will allow states to charge significantly higher Medicaid co-payments, to charge premiums, and to alter the Medicaid benefit package. Up to 10 states will be allowed to establish "health opportunity accounts" under which beneficiaries would directly pay providers from personal accounts and would be at risk if their spending went above the amount in their accounts. The bill will also require Medicaid applicants in all states to present a US Passport or birth certificate as proof of citizenship. In addition, people seeking long-term care will be subject to new asset transfer rules. Transfers for less than fair market value, within five years of seeking Medicaid nursing home coverage, will be subject to penalties including ineligibility for a period of time. Under the bill, the penalty period will begin at the time long-term care residents apply for Medicaid rather than from the time of the asset’s transfer.
More information about any changes enacted will be posted on HAP's
website early next week as part of the background materials for the
February 8 conference call.
CMS Announces Plan to Reimburse States for Part D Spending
On Tuesday, January 24, 2006, the Centers for Medicare & Medicaid Services (CMS) announced a plan to reimburse states for money they spend to give dually eligible beneficiaries access to Part D-covered drugs through February 15, 2006. CMS will also pay states for their administrative costs and for any difference between their incurred costs and the amount the plans pay for those drugs. The program may be extended beyond February 15. There is a link to the CMS Fact Sheet on the agency’s state reimbursement plan from HAP’s States with Stop Gap Measures chart (below, in Helpful Information and HAP Resources sections).
OIG Reports on Part D Plan Formularies and Transition Issues for Duals
The HHS Office of the Inspector General released a report Dual Eligibles Transition: Part D Formularies’ Inclusion of Commonly Used Drugs, (January 2006, OIE 05-06-000900) on Wednesday January 25, 2006.
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CIGNA Fined by New York State Insurance Department
On January 24, 2006, the New York State Insurance Department fined CIGNA $150,000 for violating a state law that requires health plans to respond to consumer complaints within 15 days. CIGNA said that it has now taken corrective action. For details, see The Insurance Department's news release announcing the action.
HSA Enrollment Exceeds 3 Million Mark
Last Thursday, January 26, America's Health Insurance Plans announced in a press release that enrollment in high-deductible health care plans paired with Health Savings Accounts (HSAs) has now passed three million. According to AHIP, the number of HSA enrollees has tripled over the past 10 months. Last spring, as reported in HAP's weekly email, AHIP released its study of HSA participation when enrollment hit one million.
Created by the 2003 Medicare Modernization Act, HSAs can be confusing and complicated. To learn more about them, visit the page about consumer-driven health insurance in the private insurance issues section of HAP’s website.
Maryland Legislature Overrides Governor's Veto; Fair Share Health Care Bill Becomes Law
Shortly after its current legislative session began, both the Maryland Senate and House of Delegates on January 12 overrode Governor Ehrlich’s veto of the Fair Share Health Care bill (also known as the Wal-Mart bill because Wal-Mart is the only company thought to be affected by the bill). As noted in HAP’s weekly email of May 22, 2005, the bill establishes a Fair Share Health Care fund into which for-profit employers with 10,000 or more employees that did not spend at least eight percent of their payroll on health insurance would be required to submit payments to Maryland's health program for low-income residents. Supporters of the bill say it is only fair that Wal-Mart make such payments as some Wal-Mart employees are also Medicaid beneficiaries. Governor Ehrlich had vetoed the bill last spring on the grounds that it was "a bad piece of public policy" given its impact on business. The Senate voted 30-17 and the House 88-52-1 to override. The Bill (SB 790, HB 1284) and information about the campaign to enact it is on Maryland Health Care for All! Coalition's website.
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III. Helpful Information
SHIP Staff Meets with Dr. McClellan
Responding to a CMS invitation, 14 SHIP attendees to the Families USA conference met last Thursday with CMS Administrator Dr. Mark McClellan. The five state-level and nine local-level SHIP coordinators from California, Colorado, New Mexico, Massachusetts, Maine, Maryland, Montana, and Virginia persuasively represented the network to the Administrator. They began by thanking Dr. McClellan for supporting and promoting the SHIP mission. They went on to describe the many ways in which SHIPs are working beyond capacity to meet the dramatic growth in beneficiary needs over the last few months. They told Dr. McClellan that SHIPs need more information from CMS about Part D plans. They asked for specific information about all plan formularies, transition policies, exception and appeals procedures and contacts with plans and Regional CMS Offices. They asserted that SHIPs need this information to work quickly to resolve problems and obtain answers to beneficiaries’ questions. They also asked Dr. McClellan to help obtain a sustainable and reliable federal funding stream so that SHIPs can engage in strategic planning and operations for the near and longer term future. In a preliminary meeting with Kathleen Harrington, CMS’s communications director, the SHIPs also asked CMS to move quickly to ensure that duals receive reimbursements for their excess out-of-pocket spending during the Part D implementation process.
Three More States Add Stop Gap Measures
Three more states-- Florida, Montana and Texas--have adopted stopgap measures to ensure that their low-income Medicare beneficiaries can access prescription drugs despite start-up problems with Part D plans. For detailed information about the steps these and 26 other states (and the City of Baltimore, Maryland) have taken to protect Medicare beneficiaries please see “States with Stop Gap Measures” on HAP’s Web site.
CMS Postings
CMS Guidance on Pharmaceutical Assistance Programs (PAPs)
CMS issued guidance on Wednesday January 25, 2006 to describe how manufacturer-sponsored pharmaceutical assistance programs (PAPs) could continue to assist Medicare beneficiaries in light of an Office of the Inspector General (OIG) report issued on November 22, 2005. The guidance emphasizes that it is up to the pharmaceutical manufacturers to decide the future of their programs after Part D implementation. Many PAPs have announced that they will not continue to cover Medicare beneficiaries who join Part D plans.
CMS Issues Letter to Physicians
CMS also issued a letter to physicians on January 25 describing coverage determinations, exceptions and appeals procedures. The letter includes previously issued information, including a link to contact information for Part D plans, a fax form that pharmacists and physicians may use to communicate about formulary issues, and the two web sites with plan formulary information, the CMS Plan Finder tool and Epocrates.
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IV. HAP Resources
New HAP Tools for Counseling and Assistance with Part D Implementation Issues
HAP has posted on its website two important tools that SHIPs and other advocates can use to help beneficiaries obtain their needed prescription medications. The first, entitled Helpful Information for Pharmacists Serving Medicare Beneficiaries, describes all of the procedures that CMS implemented since January 1, 2006 to help pharmacists who encounter problems in filling prescriptions under Part D to assist beneficiaries to obtain their needed drugs. SHIPs can give the tool to pharmacists as a reference guide in their work with Medicare beneficiaries. If you have any questions about this tool, please contact Kelly Brantley, kbrantley@healthassistancepartnership.org.
We also update our other key tool, States with Stop Gap Measures on a daily basis. It contains specific information about the beneficiaries each state is helping, the date on which the state took action, how long the state will continue to help beneficiaries, and how the state adopted the measure (emergency declaration, legislation, etc.). The chart also contains a link to the best state-based resource we could find that details each state’s stop gap measure. If you have new or updated information to add to the tool, please contact Rana Suliman, rsuliman@healthassistancepartnership.org.
Tools for Duals
In the days after the 2006 poverty guidelines were published in the Federal Register on January 24, 2006, HAP created a chart that shows monthly and annual income guidelines at various percentages of poverty as they relate to Medicaid, SCHIP, and Medicare Part D "extra help" eligibility.
We also prepared a tool for Handling Some Common Part D Problems for Duals. It contains a set of instructions that you can adapt for use with your own staff and volunteers. It links to some of the CMS documents that provide further details.
V. Other Resources
MS Society’s Appeal Toolkit
The National Multiple Sclerosis Society has prepared a Health Insurance Appeal Letter Toolkit for Clinicians. The toolkit contains sample appeal letters, quoting medical research, that you can use to challenge denials of drugs and other therapies commonly prescribed for people with MS.
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