Archive
I. Conference Call Information
Next Medicare Conference Call on May 17: “Reflect and Project”
II. In the News
HHS Urges Part D Enrollment by May 15th Deadline
CMS Announces $500,000 in Supplemental Rural Funding for SHIPs
Thirty-Seven Million People Now Have Prescription Drug Coverage
III. Helpful Information
CMS Addresses Part D Plan Disenrollment Problem
CMS Releases Electronic Consumer Rights and Protections Guide
CMS Releases Memo about Duals’ Incorrect Cost Sharing Charges
CMS Sets Guidelines for Implementing Claims Filing Times Frames
IV. HAP Resources
New Tool Explains SEP for Beneficiaries Affected by Katrina
“HAPpy” Hour at the Annual SHIP Director’s Conference
HAP is Hiring!
I. Conference Call Information
Next Medicare Conference Call on May 17: “Reflect and Project”
The next Medicare Network Conference Call, Reflect and Project, is scheduled for Wednesday, May 17, at 3:00 p.m. EDT. The Part D coordinated Annual and Initial Enrollment Periods end on Monday. Now is the time to take a deep breath and think about what we have learned over the past months and how to apply that knowledge to our plans for the future. Join us for our next monthly call where we will discuss our past experiences and strategies for next steps.
II. In the News
HHS Urges Part D Enrollment by May 15th Deadline
The Department of Health & Human Services (HHS) urged Medicare beneficiaries to enroll in the Part D drug benefit before the expected deadline rush. On May 8, Medicare and many of its outreach partners announced that one thousand enrollment events would be taking place before the deadline. Additionally, SHIPs have recruited and trained thousands of volunteers to provide direct one-on-one counseling to beneficiaries in their communities. CMS is also implementing measures to ensure the maximum level of customer service. Six thousand customer service representatives will be available to handle telephone calls, and the agency has enhanced its website support.
CMS Announces $500,000 in Supplemental Rural Funding for SHIPs
On May 5, the Centers for Medicare & Medicaid Services (CMS) announced that the State Health Insurance Assistance Programs (SHIPs) will receive an additional $500,000 to help enroll beneficiaries who live in isolated rural areas. CMS is making these funds available because of challenges many SHIPs face in providing counseling services in rural areas. This funding is specifically for the purpose of conducting outreach about the Part D benefit and enrolling beneficiaries in prescription drug coverage before the 2006 enrollment period ends on May 15th. SHIPs may use the grant to support partner organizations that serve as counseling sites or to provide internet access to counselors, which may help connect them to geographically isolated beneficiaries. SHIPs may also use the funds for counseling in rural areas during the next annual open enrollment period.
Thirty-Seven Million People Now Have Prescription Drug Coverage
On May 10, CMS announced that nearly one million beneficiaries have enrolled in the Part D drug benefit in late April and early May, bringing total enrollment for the program to thirty-seven million. Among this number, nine million individuals are enrolled in "stand alone" prescription drug plans (PDPs) and one million new enrollees have joined Medicare Advantage (MA-PD) plans. For more detailed information on drug coverage enrollment numbers, see the full data files .
(back to the top)
III. Helpful Information
CMS Addresses Part D Plan Disenrollment Problem
In an email to SHIP personnel on May 12, CMS reported that it has taken steps to address a Part D plan disenrollment problem that has confronted many SHIPs and their clients. Some beneficiaries have disenrolled from their first Part D plan while intending to enroll in a second plan. The disenrollment counts as an enrollment choice. When the beneficiaries later tried to enroll in a different plan, they found that they had used up their one chance to switch drug plans.
CMS stated that it has told the drug plans “to process enrollments from people with Medicare in this situation. All people with Medicare should know that if they have disenrolled from their first drug plan, they can still enroll in a different plan before May 15, 2006.
CMS Postings
CMS Releases Electronic Consumer Rights and Protections Guide
On May 8, CMS released a revised version of the "Your Rights and Protections" booklet. This 40 page guide details a Medicare beneficiary’s basic rights in Original Medicare, Medicare Health plans and the Medicare Drug plans. The revisions include information on Original Medicare’s new reconsideration appeal level by a Qualified Independent Contractor (QIC), appeal time frames, Advance Beneficiary Notices (ABN), and fast appeal procedures. This booklet also contains useful information for beneficiaries and advocates about filing complaints and/or appeals, and identifying where to go to get help with questions.
CMS Releases Memo about Duals’ Incorrect Cost Sharing Charges
On May 5, Gary Bailey, Deputy Director of CMS’s Center for Beneficiary Choices, sent a memo to Part D plans addressing the problem of incorrect cost sharing charges that are being billed to dually eligible beneficiaries. The memo describes three steps plans can take to reduce these errors. First, CMS requires plans to use the "best available data" when they are notified that a beneficiary's cost sharing level is incorrect. This means that if a nursing facility or advocate informs the plan that a beneficiary has Medicaid coverage for an institutional stay or if the person is in fact fully dual eligible, the plan should make immediate appropriate changes to their files. Secondly, to address information system lags, plans need to continually update beneficiary information in their systems, especially in regard to institutionalized beneficiaries. CMS is also requiring states to report retroactive changes in beneficiary institutional status on the State monthly MMA file no later than July 2006. Thirdly, CMS is strongly encouraging Part D plans to reimburse long-term care (LTC) pharmacies for co-pays they have covered on a beneficiary’s behalf.
CMS Sets Guidelines for Implementing Claims Filing Times Frames
On May 9, Abby Block, Director of the Center for Beneficiary Choices, sent a memo [http://www.hapnetwork.org/assets/pdfs/MemoClaimsFilingTimeframes_05-09-06.pdf ] to Part D plans describing new requirements to ensure effective synchronization and communications between Part D plans, State Pharmacy Assistance Programs (SPAP), and other organizations providing Part D drug coverage. Plans will be required to adhere to a 180-day claims timeframe for claims incurred between January 1, and June 30, 2006. CMS has determined this timeframe to be the appropriate length to resolve coordination of benefits issues.
(back to the top)
IV. HAP Resources
New Tool Explains SEP for Beneficiaries Affected by Katrina
HAP has created a new tool to explain the Special Enrollment Period (SEP) for Medicare beneficiaries who were affected by Hurricane Katrina. This new SEP allows those in certain affected counties and parishes to enroll in Part D at any time during 2006. This new tool details the affected areas, the new enrollment rules, and the penalties that apply for the different subsections of this population.
“HAPpy” Hour at the Annual SHIP Director’s Conference
HAP is hosting a reception at the Annual SHIP Director’s Conference on Monday, June 26, 2006 from 5:30 to 7:30 pm in the Windows Room. We invite you to stop by to chat with HAP staff and other SHIP personnel from around the country. Light appetizers will be provided and a cash bar will be available. If you have any questions, please contact us at infohap@healthassistancepartnership.org
HAP is Hiring!
HAP is currently seeking to hire a Senior Education and Counseling Associate and a Web Tools Project Manager to work in its DC office. Please see the job announcements on our new “Employment Opportunities” page for more information about these positions.
(back to the top)
