Archive
I. Conference Call Information
Next Medicare Conference Call on October 18
II. In the News
Federal Appeals Court to Review CMS Efforts to Recover Mistaken Premium Refunds
CMS Announces 2007 Part D PDP Options
III. Helpful Information
NCOA Enhances BenefitsCheckUp with New LIS Screening Tool
CMS Revises Model Annual Notice of Change (ANOC)
IV. HAP News and Resources
HAP Releases New State Specific LIS Charts and Part D Timeline
I. Conference Call Information
Save the Date! The next HAP monthly conference call for the SHIP network and partners will be held on Wednesday, October 18 at 3:00 p.m. EDT. Details will be released soon.
II. In the News
Federal Appeals Court to Review CMS Efforts to Recover Mistaken Premium Refunds
The Court of Appeals for the District of Columbia on October 4 issued a stay of a lower district court ruling that ordered the Centers for Medicare & Medicaid Services (CMS) to stop collecting the premium refunds it mistakenly sent to 230,000 beneficiaries in August (see the September 4 HAP E-Newsletter). On September 27, the district court rejected CMS’s motion to dismiss the case, entitled Action Alliance for Senior Citizens v. Leavitt. Instead, the lower court directed CMS to send a letter to the affected beneficiaries telling them that they have a right to request a waiver of recovery when circumstances, such as hardship, apply.
CMS quickly appealed the ruling to the federal appeals court. The appeals court issued a stay, meaning that the lower court’s order is “on hold” until the court of appeals hears arguments from both sides in early January 2007, and then issues a decision. What should affected beneficiaries do between now and then? This likely means that some of them should wait until early next year before starting, or continuing, to repay the refunded amounts, especially if repayment will cause hardship.
CMS Announces 2007 PDP Options
Department of Health and Human Services (DHHS) Secretary, Mike Leavitt, and CMS Administrator, Dr. Mark McClellan, announced on September 29 the 2007 Part D prescription drug plan (PDP) choices. According to CMS, enrolled beneficiaries who are satisfied with their current drug coverage need not take any steps to switch when the Open Enrollment Period (OEP) begins on November 15. Yet CMS asks SHIPs and other partner organizations to encourage clients to carefully review any possible changes made to their current plans, including formulary and premium changes. Some beneficiaries will indeed see increases in their monthly premiums, including a 500 percent increase (from $1.87 to $10.60 per month) for people in nine Midwestern states who are enrolled in Humana’s standard plan.
Such increases may prompt some beneficiaries to re-evaluate and switch plans. CMS said that those who are not satisfied with their current coverage or who are new to Part D, will have "more plan options that offer enhanced coverage, including zero deductibles and coverage in the gap for both generics and preferred brand name drugs." In many states, the number of PDP choices will increase from about forty to more than fifty plans. It is important to note that there are eight new national organizations offering drug coverage plans, added to nine “returning” national plans. CMS’s recent announcement of plan options did not include the 2007 Medicare Advantage Part D (MA-PD) plans. They will be announced later this, or early next, week. For more information about plans available in individual states, please refer to the CMS state-specific press releases.
HAP has also created state-by-state charts to help place some of the new plan information in context. See HAP News and Resources, below, for more information.
(back to the top)
III. Helpful Information
NCOA Enhances BenefitsCheckUp with New LIS Screening Tool
The National Council on the Aging’s (NCOA) online BenefitsCheckUp tool has a new feature that may interest SHIPs and others who help low-income Medicare beneficiaries apply for the Part D Extra Help, or LIS, program. People with Medicare and those who help them can now use BenefitsCheckUp to submit an application for Extra Help electronically to Social Security and receive immediate confirmation that SSA received the application. The Organizational Edition of BenefitsCheckUp also enables program administrators, whose programs use the tool to submit at least fifty applications, to easily retrieve statistics on submitted and approved LIS applications. Note that the tool is not tied to any state Medicaid agency’s online LIS application system.
Another helpful feature of this BenefitsCheckup enhancement is that, along with its screen for LIS eligibility, the new online tool screens (without additional questions) for eligibility in other federal and state benefit programs including the Medicare Savings Programs (QMB, SLMB and QI), Medicaid, Supplemental Security Income, State Pharmacy Assistance Programs, and Food Stamps. This “shadow screening” function may be helpful for some programs whose volunteer counselors are not well versed in the rules for benefit programs other than Medicare. The tool issues a report with helpful background information on the benefit programs, including instructions on how to apply for them.
HAP staff assessed the reliability of the BenefitsCheckUp shadow screening function with test clients in three states whose eligibility criteria for Medicaid and the Medicare Savings Programs (MSP) depart from national norms. The tool responded appropriately in all three cases. While the tool does not submit MSP applications, it does provide specific instructions for filing an application with the relevant state Medicaid agency.
SHIPs should know that the tool directs those who need help in completing the application to local Access to Benefit Coalition (ABC) contacts, which include some but not all SHIP programs. In states without coalitions, the tool directs users to the Social Security Administration and state SHIP offices. For states with ABC contacts, this may be a good time for SHIP Coordinators to talk with these and other partners about SHIP’s statewide role in LIS assistance and outreach.
CMS Postings
Prescription Drug Manuals Now Available on CMS Website
CMS has created a webpage for the Prescription Drug Manuals. The page, which went live on September 29, also features segment or chapter drafts. Currently drafts of Chapter 5: Benefits and Beneficiary Protections and Chapter 6: Part D Drugs and Formulary Requirements are available for downloading. CMS states that it will update the webpage as it makes revisions to the manuals.
CMS Revises Model Annual Notice of Change (ANOC)
On October 2, Cynthia Tudor, Director of the Drug Benefit Group, released a memo (dated September 13) to Part D plans detailing revisions to the prescription drug plan (PDP) model annual notice of change (ANOC). CMS revised the model ANOC as a result of changes to enrollment policy related to the reassignment of Low-Income Subsidy (LIS) recipients to Part D plans. The revised ANOC tells beneficiaries, who will no longer be auto-enrolled in a plan in 2007 but will still be eligible for extra help, that they may receive notification from Medicare in early November about switching to a plan that will not require them to pay a monthly premium. Plans must provide their contact information for beneficiaries who do not want to switch plans. Plans will not be required to resubmit ANOCs that CMS has already prior to the memo’s release.
(back to the top)
IV. HAP News and Resources
HAP Releases New State Specific LIS Charts and Part D Timeline
In response to CMS’s announcement last week of the 2007 Part D plans, HAP created a set of state charts with information related to LIS outreach and assistance efforts. The charts are designed to complement CMS’s state by state landscapes of plans. The charts provide, for example, the names of the Part D plans with monthly premiums below the Regional Benchmark with which those who qualify for full LIS benefits pay no premium. The charts also show the number of plans that have coverage in the doughnut hole for generics only, generics and preferred drugs, and all formulary drugs. The charts have been sent to state SHIP directors and will soon be available on www.hapnetwork.org.
HAP has also created a Part D and LIS timeline that describes the key dates and events for plan enrollment and LIS deeming and redetermination for 2007. The timeline contains helpful links to relevant documents, including CMS memoranda, guidance and notices.
(back to the top)
