Archive
I. Conference Call Information
(March 15, March 23, March 29, 2006)
II. In the News
Senate Committee Continues Private Insurance Bill Mark-up Today
Minnesota Enacts Law to Pay for Duals’ Drug coverage
States File Clawback Lawsuit
III. Helpful Information
Social Security has Processed 4.4 million Extra Help Applications
CMS Grants Hurricane Katrina Evacuees a Special Enrollment Period
CMS Releases Model Coverage Determination Request Form
IV. HAP Resources
Fact Sheets on Deficit Reduction Act and Medicaid
HAP Web Address for SHIP Questions
I. Conference Call Information
The next Medicare Network Conference Call, “Beyond the Theory of Exceptions and Appeals,” will be held today, Wednesday, March 15, at 3:00 p.m. EST. We will discuss strategies to assist beneficiaries with understanding the transition period, and to inform providers about the importance of applying for exceptions during the transition. For more information or to make suggestions for this Conference Call, please contact Kelly at kbrantley@healthassistancepartnership.org or (202) 737-6340.
The next Medicaid Conference Call is scheduled for Thursday, March 23 at 1:30 p.m. EST. We will talk about the new requirements for Medicaid applicants that take effect in July to document citizenship, and also about the Medicaid Commission’s proposals for future Medicaid changes. In preparation for this call, please write to Cheryl Fish-Parcham at cparcham@healthassistancepartnership.org about anything your program is doing to help people gather missing birth certificates, to educate the community about the new documentation requirements, or to assist consumers with the new requirements. Staff from Families USA will join us to talk about the Medicaid commission. We will post background information on our home page before the call.
A private insurance call is set for Wednesday, March 29 at 1:00 p.m. EST. The topic will be high-risk pools. We have invited Bruce Abbe of Communicating for Agriculture and the Self-Employed, and a high-risk pool administrator to join us to describe what some states have done to make high-risk pools more affordable. They will also talk with us about issues that may come up in counseling consumers about enrollment. If you have experiences with risk pools to share, please contact Cheryl Fish-Parcham at cparcham@healthassistancepartnership.org. We will also spend a few minutes talking about S 1955, the private insurance bill that has been in the news the past two weeks.
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II. In the News
Senate Committee Continues Private Insurance Bill Mark-up Today
The Senate Health, Education, Labor and Pensions committee will resume, and probably conclude, mark-up of S 1955, the Health Insurance Marketplace Modernization and Affordability Act of 2006, later today, Wednesday, March 15. The bill would exempt small group insurers from state rate regulation and instead require them to follow 1993 National Association of Insurance Commissioner (NAIC) standards. It would exempt all commercial insurers from state-mandated benefits and instead allow them to offer a choice of benefits, as long as they offered one plan that included the benefits of one of the most populous states’ employee plans. Finally, the bill would create a commission to “harmonize” other state insurance laws including internal appeals procedures. The NAIC and several state insurance commissioners have written letters to the Senate opposing the preemption of state rate regulation and other state authority. Many consumer groups and disease societies oppose the loss of mandated benefits and other consumer protections. For more details, see the most recent version of the bill (which differs from the version originally introduced). The Committee is considering a long list of amendments, but it had made no changes to the posted version as of last Wednesday.
Minnesota Enacts Law to Pay for Duals’ Drug coverage
The federal waiver which allowed the Centers for Medicare & Medicaid Services (CMS) to reimburse states for payments to cover drugs as a last resort for dually eligible Medicare beneficiaries (duals) expired on March 7. Minnesota therefore enacted a law, HF 3015, to extend drug coverage for duals who encounter problems with Medicare Part D. $570,000 are budgeted for costs between March 8 and April 15.
States File Clawback Lawsuit
Kentucky, Maine, Missouri, New Jersey and Texas have sued the Department of Health and Human Services over the provision of Medicare Part D which requires states to pay the federal government a portion of the cost of coverage for duals. The case, Texas v. Leavitt, U.S., Original Action 135, was filed March 3, 2006 in the U.S. Supreme Court.
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III. Helpful Information
Social Security has Processed 4.4 million Extra Help Applications
The Social Security Administration reported last week that more than 4.5 million people have applied for the Part D Extra Help program. The agency has processed almost 4.4 million cases. Of these, nearly 800,000 were deemed eligible or had filed a duplicate application. Of the remaining 3.6 million applicants, SSA found some 41 percent eligible for the extra help. The others were ineligible due to excess income or resources.
CMS Postings
CMS Grants Hurricane Katrina Evacuees a Special Enrollment Period
CMS has given Hurricane Katrina evacuees an extension to change their Medicare prescription drug plan in 2006, regardless of changes in residence. These individuals will now have through December 31, 2006 to switch plans. Not all evacuees who are Medicare beneficiaries, however, will be eligible for this Special Enrollment Period (SEP). Only those residing in certain zip codes, as determined by the Federal Emergency Management Agency (FEMA), will be able to take advantage of this extra time. To determine eligibility, plans must obtain proof that a beneficiary resided in an affected zip code or they must accept the beneficiary's word that this is the case. For more details, see CMS's list of affected zip codes.
CMS Releases Model Coverage Determination Request Form
CMS created the model form to guide enrollees through Part D plans' coverage determination and exception processes. The enrollee, an appointed representative or the prescribing physician can request a coverage determination. Use of this form is completely optional, and may be adjusted or adapted by anyone who uses it. Persons completing the form should keep in mind that the plan may use a different form or format, so it’s a good idea to contact the drug plan before completing a request.
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IV. HAP Resources
Fact Sheets on Deficit Reduction Act and Medicaid
Families USA has prepared a set of fact sheets on the Medicaid provisions of the Deficit Reduction Act, including the new requirements to document citizenship or immigration status.
HAP Web Address for SHIP Questions
We want to mention again that HAP has created a new email address specifically to respond to SHIP questions and needs more efficiently. We encourage SHIPs and their partners to send all inquiries and requests for technical assistance to shiphelp@healthassistancepartnership.org. A HAP staff member will respond to your inquiry within 2 business days. Afterwards, you are entirely welcome to contact the staff person who responds to your request by phone or email. We look forward to continue receiving many wonderful and challenging questions from all of you!
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