Archive
I. Conference Call Information (March 23, March 29, 2006)
II. In the News
Health Insurance Marketplace Modernization Act Moves Out of Committee
Connecticut AG Intervenes in Medicaid Reimbursement Case
Correction
III. Helpful Information
Good News for HAP!
CMS Accelerates Facilitated Enrollment
CMS Releases Home Infusion Therapy Memo
CMS Releases New Tip Sheet on Extra Help Program
IV. HAP Resources
New Patient Assistance Program Database
CHAPS Listserv Available
I. Conference Call Information
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. The background information for this call is posted on our home page.
A private insurance call is set for Wednesday, March 29. Please note a time change! With apologies to people on the west coast, we changed the time of the call to 11:00 a.m. EST to accommodate a speaker’s schedule. 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
Health Insurance Marketplace Modernization Act Moves Out of Committee
S. 1955, a bill that will exempt private insurers in all markets from many state consumer protection laws, was voted out of the Senate Health, Education, Labor and Pensions committee last week. It may soon move to the Senate floor. Families USA will be posting a summary of the bill and related materials in the next few days. Look for links to materials on Senator Enzi's bill on Families' home page. Please contact Cheryl Fish-Parcham, cparcham@familiesusa.org, with any questions.
Connecticut AG Files Intervenes in Medicaid Reimbursement Case
Last December, a Connecticut Freedom of Information Commission ordered Connecticut’s Medicaid managed care organizations (MCO) to reveal their reimbursement rates for physicians. A Yale Professor and New Haven Legal Assistance allege that MCO reimbursement rates are so low that most physicians will not treat Medicaid patients for many illnesses, injuries and conditions. The managed care plans, however, appealed the Freedom of Information Commission’s decision. The Attorney General filed a motion to intervene on behalf of State Health Advocate, Kevin Lembo, and the state Comptroller. “If we demand an itemized restaurant bill for a $100 dinner, shouldn't we get the same for our $650 million healthcare program?” Lembo said. (Kevin Lembo often participates in HAP’s private network calls.)
Correction
An article in last week’s email, captioned “Minnesota Enacts Law to Pay for Duals’ Drug Coverage,” incorrectly reported the end date of the federal waivers that enable states to claim reimbursement for payments made through their Medicaid systems for duals’ Part D drug costs. According to the Centers for Medicare and Medicaid Services (CMS) statement, while many states had stopped using their Medicaid systems to pay for drugs by March 8, “due to circumstances unique to each state, 12 states will continue to use their systems in limited instances for up to several more weeks.” The states continuing in the program are Arkansas, Arizona, California, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Texas, Vermont, and Wisconsin. Specifically, CMS approved an extension of the demonstration until March 15, 2006 for Massachusetts and Wisconsin; until March 17, 2006 for Arkansas; until March 21, 2006 for New Hampshire; and until March 31, 2006 for Arizona, California, Maine, New Jersey, New York, Pennsylvania, Texas, and Vermont. Medicare will continue to pay administrative costs through April 7, 2006 for all other states in the waiver program, including the District of Columbia.
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III. Helpful Information
Good News for HAP!
The Health Assistance Partnership (HAP), a project of Families USA, is pleased to announce that it has been awarded a generous two-year grant from The Atlantic Philanthropies. The grant will allow HAP to work intensively with selected State Health Insurance Assistance Programs (SHIPs) to enhance their efficiency and effectiveness so that they can provide high-quality education and counseling to a greater number of seniors and others about Medicare and related health care coverage. The grant will also enable HAP to work to stabilize and increase federal funding for the SHIP network. The Atlantic Philanthropies grant complements HAP’s current funding from The Harry and Jeanette Weinberg Foundation to provide SHIPs and their aging partners nationwide with the information and tools necessary to educate and counsel Medicare beneficiaries about Medicare Part D and the Low-Income Subsidy program.
CMS Postings
CMS Accelerates Facilitated Enrollment
This week 1.2 million Medicare beneficiaries, who have been approved for Part D Extra Help benefits or are enrolled in the Supplemental Security Income (SSI) and Medicare Savings programs, will begin to receive letters detailing which drug plans they will be enrolled in if they take no action before April 30. Note that the coverage resulting from this first round of facilitated enrollment will start on May 1 and not June 1, as CMS previously stated. CMS is mailing two versions of the notices to beneficiaries. One is for those who qualify for the full low-income subsidy (LIS) and the other for those who qualify for the partial LIS. The notices are also available in Spanish.
Because of the new guidance on the auto-enrollment effective date, CMS sent memos to Medicare Advantage Organizations (MAO) and 1876 cost plans detailing the new deadlines for notifying beneficiaries. Non-full benefit dual members, who are eligible for LIS must receive notice of facilitated enrollment by April 10, 2006. Also important to note, effective this month, the MAO full dual file will only be sent to MAOs and 1876 plans that need to handle auto-enrollment. CMS also sent a similar notice to Medicare prescription drug plans (PDPs). In addition to information about new time frames, CMS included guidance stating that auto-enrollments for full-benefit duals, previously enrolled in a Part D plan, will have a retroactive effective date.
CMS Issues Home Infusion Therapy Memo
Gary Bailey, the Deputy Director for CMS’s Center for Beneficiary Choices, has sent a memo to Part D plan sponsors detailing guidelines for covering home infusion therapies. Part D benefits do not cover equipment, supplies, and professional services associated with home infusion therapy, however, ingredient costs and dispensing fees linked to infused Part D drugs (currently not covered by Medicare A or B) are covered. One of the guidelines states that the plans must provide clear and coherent directions in accessing home infusion pharmacies. Drugs must also be received in a time sensitive manner and in pre-mixed and usable formats.
CMS Releases New Tip Sheet on Extra Help Program
The new tip sheet for partners, Helping People with Medicare Apply for Extra Help , updates for 2006 the financial criteria that Social Security uses to determine if a Medicare beneficiary is eligible to receive Extra Help for Part D out-of-pocket costs. The tip sheet gives examples of countable and exempt income and resources, along with instructions on how to apply for Extra Help.
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IV. HAP Resources
New Patient Assistance Program (PAP) Database
HAP has created a database of private pharmaceutical company patient assistance programs (PAPs) and drug discount programs. The database contains information on over 50 programs, including 13 that offer some form of assistance to Medicare beneficiaries. It also gives available program eligibility rules and lists the drugs that each program offers. HAP will continue to update the database as we get more information on these and other programs. Please contact us at shiphelp@healthassistancepartnership.org if you have any questions.
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