Archive
eNewsletter: November 13th
I. Conference Call Information
Next Call on November 15
Follow-Up on October 18th and November 1st HAP/SHIP Conference Calls
II. In the News
CMS Issues Final Rule on Payments for Oxygen Equipment and Capped Rental DME
III. Helpful Information
CMS Issues Transition Policy Reminder to Part D Plan Sponsors
CMS Report Analyzes Potential Part D Savings
CMS Releases Tip Sheets on Formulary Changes, Premium Withholding and Fraud Prevention
LIS Redeeming and Re-assigning Data Available on CMS Website
IV. HAP News and Resources
KFF Updates Part D Fact Sheets
MAPRx Survey of SHIP Counselors’ Part D Experiences with Medicare Beneficiaries
Next Medicare onference Call, “Counsel Through: The 2007 Part D AEP”
November 15, 2006 at 3:00 PM EST
The day has finally arrived! Part D Annual Enrollment is upon us. Please join us to debrief, reflect and predict the next month and a half. Based on discussion during our November 1st HAP/SHIP conference call call, we will also review the decisional factors around choosing Part D plans and what options there are for people who may want to change later. We will discuss the new Part D transitional-fill policies when changing plans, or when your plan changes. Given what we’ve all found in the landscape of plans, we will continue to review counseling tips and tools for beneficiaries considering Private Fee-For-Service and Medicare Savings Accounts. We will open up for discussion about record-keeping strategies that have worked for your counselors in the past and how SHIPs are addressing the need to keep track of beneficiary information for future needs. In preparation for this call, please consider and be ready to share how you successfully implemented keeping track of your hard work in the past year, especially in light of budgetary, time and storage space constraints. Please join us during one of the most important days of the year as we come together to prepare and learn from each other.
For more information or to share your ideas for this call, please contact Kelly Brantley at kbrantley@hapnetwork.org or Rana Suliman at rsuliman@hapnetwork.org.
Follow-Up on October 18th and November 1st HAP/SHIP Conference Calls
Ninety-seven participants joined the October 18th HAP/SHIP Conference Call and 140 participated in our November 1st call. We thank all of you for sharing your ideas, experiences and questions. The discussion was invaluable. HAP is preparing five new tools and tip sheets in response to your suggestions and requests:
1. Tip Sheet on counseling beneficiaries on MSA Medicare Advantage plans
2. Tip Sheet on counseling beneficiaries on PFFS Medicare Advantage plans
3. A flow chart to make it easier to understand and explain the Medicare Advantage Open Enrollment Period (OEP) and how the OEP relates to Part D plan elections.
4. A fact sheet explaining the Medigap guaranteed issue provisions for certain beneficiaries who enroll in – and then disenroll from – Medicare Advantage plans
5. A two-minute conference call satisfaction survey directed to a small sample of participants.
We are delighted that so many of our friends in the SHIP network joined us for these recent calls. But with greater participation has come some unexpected technical problems. The level of background noise has become an acute problem. We appreciate very much when you use the *6 feature to voluntarily mute your phone lines. This reduces the noise to some degree. For upcoming calls, we ask that you try a second strategy that may help cut down the background noise. If more than one person in an office wants to listen, we would ask that you to use one phone to the extent that you have speaker phones available. This will enable us to better serve all of you, and perhaps save some money as well. We have also asked our conference call contractor to pay close attention to dealing with noise problem. Nonetheless, many of you have noted the problems on our last several calls. We would like to get your ideas on how we can address the problem while maintaining the dynamic interactions among and between you on our calls. Our immediate question is whether or not we should we institute Q & A periods on our calls. Please tell us what you think by e-mailing us at shiphelp@hapnetwork.org
II. In the News
CMS Issues Final Rule on Payments for Oxygen Equipment and Capped Rental DME
On November 1, the Centers for Medicare & Medicaid Services (CMS) issued a final rule affecting Medicare Part B payments for oxygen equipment and other durable medical equipment (DME) items. The final rule, published in the November 9 edition of the Federal Register, implements changes that the Deficit Reduction Act (DRA) of 2005 required.
For many years, CMS’s policy has been to make continuous monthly rental payments for oxygen equipment, with no limit on the number of payments. Thus, CMS paid for oxygen equipment differently than it did many other “capped rental” DME items with a limit of fifteen on the number of monthly payments CMS would make. As a result, according to a CMS background paper, a “beneficiary’s coinsurance payment would often exceed the purchase price of the oxygen equipment without the beneficiary acquiring title to the equipment.” The DRA and the final rule now limit Medicare’s rental payments for oxygen equipment, including stationary and portable units, to 36 continuous months. Afterwards, a DME supplier must transfer ownership to the beneficiary.
Similarly, the DRA changed Medicare policy to allow rental payments only for 13 continuous months for capped rental DME items, such as wheelchairs, hospital beds and lifts. CMS’s capped rental category does not include inexpensive DME items, oxygen equipment, and customized DME. The DRA ends Medicare’s past practice of making rental payments for thirteen or fifteen months, depending on whether a beneficiary opts to continue renting or selects instead the “purchase option.” The law now requires suppliers to transfer ownership of these items to beneficiaries after the thirteenth continuous month of rental.
Note that the final rule states that Medicare will continue to pay for oxygen refills and other supplies, and for repairs and maintenance after a beneficiary takes ownership of the equipment (unless a manufacturer’s or supplier’s warranty covers the service). For beneficiaries who were using oxygen equipment at the end of December 2005, CMS and the DMERCs will start counting the 36 month rental period from January 1, 2006. The new rule for capped rental DME applies to items first rented after January 1, 2006.
CMS Report Analyzes Potential Part D Savings
Last month, at the same time that CMS announced its new Plan Finder Tools, the agency also highlighted an updated Price Analysis Report for Drugs for Common Health Problems. The report serves as the basis for CMS’s claims that beneficiaries with Part D drug coverage will save an average of 53 percent on their drug costs compared to not having any coverage, with savings as high as 87 percent for beneficiaries who join the lowest-cost plans and switch to generic and preferred drugs in the same drug classes.
The report explains that CMS based its high end savings estimate on the news that more lower-cost substitutes are available in 2007 than in 2006. It calculated the savings estimates based on a set of sixteen drug and beneficiary profiles, using the prices of 100 commonly used medications. The profiles include drugs and combinations of drugs used to treat chronic conditions such as asthma, diabetes in tandem with hypertension and high cholesterol, osteoporosis, heart failure, and several others. To analyze plan savings, CMS ran the 16 profiles in 32 zip-codes around the country to create savings illustrations for 32 beneficiaries. CMS created these profiles in early 2005, and has been using them since to assess Part D costs and savings.
One noteworthy finding is that beneficiaries with chronic conditions who select the lowest cost plan in their area and use its mail order option save an average of 22 percent compared to other mail-order resources, and as much as 33 percent off Costco.com’s mail-order prices and 64 percent off Drugstore.com’s prices. For its analysis, CMS used the price information for PDPs from the Plan Finder. The report does not include MA-PD prices. The report’s charts, detailing the beneficiary and drug combination profiles, may be helpful to those who want more background on how CMS approaches its Part D cost-containment efforts.
III. Helpful Information
CMS Postings
CMS Issues Transition Policy Reminder to Part D Plan Sponsors
On November 1, Cynthia Tudor, Director of CMS’s Medicare Drug Benefit Group, issued a Memo to the Part D plan sponsors to remind them of the agency’s transition policy and expectations for 2007. The memo stressed that “it is vital that enrollees be given clear guidance regarding hot to proceed after any temporary fill is provided so that an appropriate and meaningful transition can be effectuated.” It also directs plan sponsors to select one of two options to effect an appropriate and meaningful transition for current enrollees, including one that involves a temporary 30 day supply of drugs beginning on January 1, 2007, and another that effects a transition by January 1 through a move to alternative formulary drugs or through completion of exception requests. The memo has two attachments that will be helpful as references for SHIPs. The first is a three-page chart that summarizes the 2007 Transition Process. It describes the transition process and CMS’s expectations for various plan enrollees, such as those who received a formulary exception for 2006 and those entering long-term care facilities. The second attachment is a model “general transition notice” that answers--for new and continuing plan members--the question, “What if my current prescription drugs are not on the formulary or are limited on the formulary?”
CMS Updates Plan Finder Model
For the Annual Enrollment Period (AEP) beginning November 15, CMS has released updated version of the Medicare Prescription Drug Plan Finder that incorporates input from consumer testing and partners. CMS also issued a Tip Sheet for Partners that describes some of this year’s enhancements to the web tool.
CMS Releases Tip Sheets on Formulary Changes, Premium Withholding and Fraud Prevention
A new tip sheet, "Information Partners Can Use on: Medicare Part D 2007 Formulary Changes" explains how Part D plan formularies will function and change in 2007.
CMS’s new tip sheet on “Premium Withhold Issues” describes steps the agency is taking to address mistakes in withholding Part D plan premiums. The tip sheet explains both refund and recovery procedures.
CMS has released a tip sheet to SHIPs and other partners detailing steps to take in protecting beneficiaries against potential scams or fraud.
LIS Redeeming and Re-assigning Data Available on CMS Website
On October 13, CMS posted several low income subsidy redetermination and re-assignment tools. These materials may be helpful in targeted outreach efforts as they include background information as well as notices that have been sent to beneficiaries losing their automatic eligibility.
2007 Medicare Advantage Plan Information Now Available
CMS posted state-level Medicare Advantage Plan Information for 2007 on October 13.
2007 Medicare and You Handbook Accessible Online
As of October 16, the 2007 Medicare and You Handbook has been available online. State-specific handbooks are also accessible in the publications portion of the CMS website.
IV. Helpful Resources
KFF Updates Part D Fact Sheets
The Kaiser Family Foundation (KFF) last week issued updated versions of its Medicare Prescription Drug Benefit Fact Sheet and state-level Part D Plan Characteristics, 2007 Fact Sheet. The Plan Characteristics Fact Sheet summarizes information from CMS’s Landscape of Plans and charts for each state the number of plans available, monthly premium ranges, and coverage in the doughnut hole.
MAPRx Survey of SHIP Counselors’ Part D Experiences with Medicare Beneficiaries
Medicare Access for Patients-Rx (MAPRx) is a coalition of patient, family caregiver, and health professional organizations concerned about access to prescription drugs for people with chronic diseases and disabilities through the Medicare Part D drug program. MAPRx is conducting a survey of state and local chapters of patient advocacy organizations and others to gain insights into the problems some beneficiaries face in obtaining prescription drugs.
MAPRx is surveying SHIP counselors as part of its process, to learn what you have heard from Medicare beneficiaries about Medicare Part D. Each SHIP should select the best person to complete the survey. The survey takes approximately 20 minutes to complete. While completing it, you may need to refer to a list of drugs that Part D plans must cover.
Based on the SHIP counselors’ responses, MAPRx will prepare a separate report of the survey responses for the SHIP network. HAP will distribute it to you. We plan to share the survey’s findings with the Department of Health and Human Services (HHS), CMS, and members of Congress. You can find the survey at http://www.zoomerang.com/survey.zgi?p=WEB225SAG76KWT.
If you have any questions about the survey, please contact Tim McLoraine at tmcloraine@hprd.net
