Archive

Weekly Email: Week of January 9

I. Conference Call Information (January 18, 2006; January 19, 2006)

II. In the News
     Federal Mental Health Parity Law Extended
     States Respond to Part D Drug Access Problems for Duals
     Colorado expands SCHIP to 200 percent of poverty
     North Carolina Expands Medicaid-funded Mental Health Services
     Two States Approve UnitedHealth Acquisition of PacifiCare

III. Helpful Information
     CMS Resources for Part D Transition
     CMS Tip Sheet for Duals who Have Employer or Union Drug Coverage
     Informed Decisions/Gold Standard Update
     Kaiser Foundation Releases Drug Plan Information Chart

IV. HAP Resources
     HAP's First Aid Kit for Part D Implementation
     HAP Documentation Form for Part D Implementation Issues
     Helping Health Care Consumers in an Ever-Changing World: The HAP Conference Track

I. Conference Call Information

The next HAP MMA call is scheduled for Wednesday, January 18, at 3:00 p.m. EST. We will offer an update on Part D implementation issues and discuss systemic barriers to accessing needed medications, including transition policies, utilization management protocols, coverage determinations, exceptions and appeals.

If you have questions about the call, 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. A guest speaker will join us from National Women's Law Project.

II. In the News

Federal Mental Health Parity Law Extended
Congress extended the federal Mental Health Parity Act, originally approved in 1996, through 2006. This law requires group health plans with mental health benefits to set the same annual and lifetime caps on mental health coverage as for other medical and surgical services.

States Respond to Part D Drug Access Problems for Duals
A few states, including Maine, Massachusetts, New Hampshire, North Dakota and Vermont, have taken steps to use state funds to help duals get fill their prescriptions until their Part D plans start working. Massachusetts' law, for example, allows for a one-time 30 day supply and then a subsequent 72-hour emergency supply of prescribed medicines.

Colorado expands SCHIP to 200 percent of poverty
Using funds generated from a tobacco tax, Colorado will expand eligibility for children by raising its income guidelines for SCHIP from 185 percent to 200 percent of the federal poverty line in 2006. CMS has approved the state's plan.

North Carolina Expands Medicaid-funded Mental Health Services
North Carolina will provide a broader range of substance abuse and mental health benefits, especially to teens, starting in March. The state's press release explains that CMS approved new definitions of mental health services that will allow it to cover detox; a number of residential services; mobile crisis teams; community treatment teams that include psychiatrists, nurses, mental health professionals, employment specialists, and substance abuse treatment professionals; and family-based treatment to address serious antisocial behavior in adolescents. The state has posted the new service definitions on its website.

Two States Approve UnitedHealth Acquisition of PacifiCare
At the end of December, insurance regulators in California and Colorado gave their approval to UnitedHealth Group's proposed acquisition of PacifiCare Health Systems, but attached some conditions to improve access to care for underserved populations. In Colorado, for example, UnitedHealth cannot raise premiums. It also must contribute $7.5 million to rural care (including a contribution to a mobile clinic), and must accelerate complaint resolutions. California required UnitedHealth to provide $50 million in charitable contributions, as well as $200 million in investments, to improve services for low-income California residents who have limited access to health care. As 2005 ended, regulators in Washington and Texas were still working to approve and finalize the acquisition. Go to www.kaisernetwork.org to find articles about the acquisition (search for "PacifiCare").

III. Helpful Information

CMS Resources for Part D Transition
On January 9, CMS sent more resources to pharmacists about handling Part D implementation problems. In one document, CMS explained that it has added more staff to its phone lines to answer calls from pharmacists about Medicare entitlement. It also instructed plan sponsors to abide by their transition policies for new enrollees. If pharmacists cannot resolve problems by contacting the plans or CMS's dedicated phone numbers, or by using electronic procedures, they should contact CMS's Regional Offices. If a dual says that he or she has switched plans, pharmacists can use information on the beneficiary's plan acknowledgement letter to bill the correct plan, use an "E1 query," or the dedicated pharmacist phone line to verify enrollment. See the CMS instructions to drug plan customer service representatives (CSR), and FAQ about duals.

If plans know that an enrollee is eligible for a low-income subsidy but do not yet have information about the enrollee's subsidy level, they are to default enrollees to the $2/$5 co-payment levels. A CMS memorandum to the plans about transition processes explains that plans should not deny new enrollees first refills of non-formulary drugs. The memo states, "While transition policies are not intended to cover excluded drugs or to preclude drug utilization review edits for safety, we must stress that delaying or denying the filling of initial prescriptions for new enrollees at point-of-sale because of prior authorization/step edit requirements is not consistent with the intent of CMS' transition policy."

CMS Tip Sheet for Duals who Have Employer or Union Drug Coverage
Some duals have been auto-enrolled into Medicare Part D plans even though they have prescription drug coverage through an employer or union plan for retirees. Because this could jeopardize some retiree's group medical and prescription drug coverage, as well as that of their spouses and dependents, the Centers for Medicare & Medicaid Services (CMS) issued a tip sheet for employer and union plan sponsors about duals and others who have been automatically enrolled in a Medicare drug plan. It urges employer and union plan sponsors 1) to give those who were automatically enrolled time to correct the problem by disenrolling from their Part D plans if necessary, 2) to allow spouses and dependents to continue in the employer/union plan even if the retiree enrolls in Part D, and/or 3) to allow these retirees to retain supplemental coverage in employer or union plan. The extent to which retiree plan sponsors have responded to the problem is not yet clear. The tip sheet is among the resources available in HAP's new "First Aid Kit for Part D Implementation" in our MMA Resource Center (see HAP Resources, below).

Informed Decisions/Gold Standard Update
After some delays resulting from a lawsuit, Informed Decisions/Gold Standard provided information to duals and providers in several states about the changes in their drug coverage. The company delivered scorecards to duals in Florida, before January 1, describing how the number of covered drugs in their assigned plans compared to other plans. If you are in a state that has used Beneficiary Centered Enrollment and have information to share about how it has gone, please write to Cheryl Fish-Parcham, cparcham@healthassistancepartnership.org.

Kaiser Foundation Releases Drug Plan Information Chart
The Kaiser Family Foundation released on Wednesday a new chart that lists Part D drug plan information by state. Drawing from CMS's "Landscape of Local Plans," Kaiser's chart shows the number of drug plan sponsors, the number of PDPs and MA-PDs, the range of monthly PDP premiums and more, for each state and the District of Columbia.

IV. HAP Resources

HAP's First Aid Kit for Part D Implementation
HAP has added a new "First Aid Kit for Part D Implementation" to our MMA Resource Center. The First Aid Kit contains resources and contact information that you can share with pharmacists, along with CMS's many recent tip sheets, Q&A, and memoranda that address transition and implementation issues. We will be adding CMS Regional Office contact information and other resources in the days ahead. Please contact Kelly Brantley at Kbrantley@healthassistancepartnership.org or Hilary Dalin at Hdalin@healthassistancepartnership.org for more information about the First Aid Kit and its resources.

HAP Documentation Form for Part D Implementation Issues
The HAP Medicare Team would like to remind you to use the Documentation Form to help record any and all issues that you've seen arise in the implementation of Part D. We are interested in capturing new, as well as chronic, issues. Please use the Documentation Form on HAP's website. Thanks for your continuing contributions.

Helping Health Care Consumers in an Ever-Changing World: The HAP Conference Track
The HAP conference is quickly approaching and begins on Wednesday, January 25, two weeks from today. If you have not registered or reserved your hotel room yet, it is not too late! The Renaissance Mayflower Hotel has kindly extended its deadline to Saturday, January 14, so the early-bird conference registration deadline has been extended to January 14 as well. After that date, the hotel's room rate is subject to availability, and the conference registration fee goes up from $275 to $325. To make your room reservation, call the Renaissance Mayflower at 1-800-HOTELS1 or 202-347-3000. Mention that you're with the Health Action 2006 conference to get the special conference rate of $159/night plus tax (for a single or double). To register for the conference, visit the Families' Health Action 2006 web page and, below the picture of the Mayflower Hotel on the right side, check "I'll be there." Then click "Register," and follow the instructions on the registration page. If you are paying by check, you do not have to submit your payment to get the early-bird registration fee, but you must register by Saturday.

If you'd like to meet individually with any HAP staffers during the conference, you can now make an appointment for technical assistance, as noted in the email about the conference sent last Friday. Remember, HAP defines "technical assistance" broadly. You may have questions about how Medicare Part D works with your state's pharmacy assistance program (SPAP), or you may wonder about the best data-collection methods for your program, or you may just want another pair of eyes to review your written materials. We're happy to help in any way we can!

If you are planning to join HAP on Wednesday for the facilitated discussion of issues affecting consumer health assistance programs and/or for the dinner (hosted by HAP) for those who are interested in the HAP track, please complete this brief form. (We have corrected the technical difficulties with the form and apologize for any inconvenience.) In addition, please send any issues that you would like to raise during the discussion to Christin Engelhardt at cle@healthassistancepartnership.org.

Finally, if you have any questions about the conference or about the agenda, please contact Christin Engelhardt at cle@healthassistancepartnership.org.