Archive
Weekly Email: Week of February 13
I. Conference Call Information (February 22, 2006)
Follow Up on February 8th Medicaid Call
II. In the News
CMS Administrator McClellan Testifies on Part D Implementation
III. Helpful Information
CMS Official Commends SHIPs
2006 NCOA-ASA Joint Conference: Pre-Conference Special Program on Outreach and Enrollment
Scholarships Available to Attend NALC
CMS Asks Part D Plans to Extend 30 day Billing Limits
CMS Details Drug Plan Call Center Contact Requirements
CMS Issues Model Coverage Determination Request Form
IV. HAP Resources
HAP Conference Materials Posted
Medicare Drug Coverage Charts
Program Locator Updates
I. Conference Call Information
HAP’s next Medicare conference call will be on Wednesday, February 22, 2006, at 3:00 p.m. EST. We are moving it to the fourth Wednesday of this month to avoid a conflict with the Medicare Beneficiary Ombudsman’s Open Door Forum call that took place on February 15. We plan to resume our third Wednesday of the month call schedule in March. HAP’s February Medicare call will continue the discussion of how SHIPs and other advocates can help beneficiaries obtain their prescriptions through their Part D plans. We will provide updates on the emergency procedures that CMS has put in place to help beneficiaries through Part D start-up issues. We also plan to discuss more long-term issues related to coverage determinations, exceptions and appeals. Please send any questions or suggestions to Kelly Brantley, kbrantley@healthassistancepartnership.org, or Hilary Dalin, hdalin@healthassistancepartnership.org.
The next private insurance call is scheduled for Wednesday, February 22 at 1:00 p.m. EST. We have several requests to discuss how to help consumers in self-insured plans. Since states do not actually have regulatory authority over these plans, some programs report that the plans do not cooperate with their efforts to resolve consumers' problems. If you have had successes in this regard that you would like to share with other programs, please write to Cheryl Fish-Parcham, cparcham@healthassistancepartnership.org. Cheryl will soon join Families USA's health policy team to work on private insurance health policy issues. She hopes to continue to provide some assistance to the private insurance consumer assistance programs in HAP's network.
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Follow-up on February 8th Medicaid Call
During last week’s Medicaid conference call, we talked about the changes that the Deficit Reduction Act of 2005 (DRA) will bring to Medicaid this year. President Bush signed the Act on February 8, 2006, though some disputes linger regarding needed technical amendments and a question about the law’s validity, due to an error that left a difference between the versions of the conference report passed by the House and Senate.
Nonetheless, the law requires some changes in asset rules for long-term care residents seeking Medicaid to take effect immediately. They are described in the background materials for last week's call. One participant asked us to clarify the rules regarding homes. Generally, Medicaid follows the Supplemental Security Income (SSI) rules, so an individual's home is not counted in evaluating an individual's financial eligibility for Medicaid. Under the DRA, the home remains an exempt asset for Medicaid eligibility purposes if an individual's equity interest in it is under $500,000. However, if the individual has equity in the home exceeding $500,000, he or she can now be disqualified from Medicaid-funded long-term care unless a spouse, a child under age 21, or a blind or disabled child resides in the home. States can raise this $500,000 limit to $750,000 and the Secretary of Health and Human Services (HHS) can also establish a process to waive this limit for hardship. Individuals can also use reverse mortgages to reduce their home equity. See the full text by searching the Thomas website by bill number for S1932. Then go to section 6014 for the provision on home equity.
Another immediate and major change in asset rules for long-term care residents involves the “look-back period.” A person who would otherwise be eligible for Medicaid-funded institutional-level long-term care may now be ineligible for a period of time if he or she transferred assets for less than fair market value during the past five years. This compares with a three year look-back under prior law. The DRA apparently requires states to apply this new rule to long-term care residents and home and community-based care waiver participants. States also have the option to penalize other non-institutionalized individuals who transfer assets for less than fair market value, making them ineligible for home-health, personal care, or other home and community-based care for a period of time. HAP will update you as more clarifications about the mandatory and optional provisions become available.
The DRA also made changes in the penalty period, that is, the length of time that a person is ineligible for Medicaid-covered long-term care. States calculate the penalty period by dividing the uncompensated amount of transferred assets by the average monthly cost of nursing facility care. The result is the number of months the person is ineligible for Medicaid-funded long-term care. Formerly, the penalty period ran from the date of the asset transfer. Under the DRA, it will start on the date the person would otherwise be eligible for and receive Medicaid-funded long-term care, typically the date of application. If a person who already has Medicaid-funded long-term care later transfers assets for less than fair market value, he or she may be subject to a penalty period at that time. States must provide for hardship waivers. You can find more details by looking at section 6011 of Bill S1932 on the Thomas website and in a memorandum from National Senior Citizens Law Center.
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We also talked about a change for most Medicaid applicants that will go into effect in July. People who apply for Medicaid as permanent residents or as US citizens will then need to submit documentary evidence of their status, such as a birth certificate, passport, certificate of naturalization, or driver’s license. The Secretary of HHS can issue regulations concerning other acceptable means of identification. Participants in the call voiced concern about potential problems for homeless clients, those with dementia, and others. If you have comments on what should be in regulations concerning this provision, please share them with Rachel Klein at Families USA, rklein@familiesusa.org.
To receive periodic news and conference call announcements from Families USA, sign up on the Health Action mailing list on www.familiesusa.org.
II. In the News
CMS Administrator McClellan Testifies on Part D Implementation
The Centers for Medicare and Medicaid Services (CMS) Administrator, Dr. Mark McClellan, gave testimony at the Senate Finance Committee's February 8th hearing on the implementation of the new Medicare prescription drug benefit. Dr. McClellan reported on plan enrollment and described some of the steps that CMS is taking to resolve some of the program’s implementation problems. For more details, see Dr. McClellan’s written testimony.
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III. Helpful Information
CMS Official Commends SHIPs
At a February 8 meeting of the Coordinating Committee of CMS's National Medicare Education Program (HAP is a member), Kathleen Harrington, Director of the CMS Office of External Affairs, praised the efforts that SHIPs are making to educate and counsel Medicare beneficiaries about Part D. She stated, "SHIPs have been incredible."
2006 NCOA-ASA Joint Conference: Pre-Conference Special Program on Outreach and Enrollment
The joint conference of the National Council on Aging (NCOA) and the American Society on Aging (ASA), set for March 16-19 in Anaheim, CA, is offering a pre-conference special program on Wednesday, March 15, to highlight strategies and tools to effectively and efficiently enroll people into public and private benefit programs. For more details on this special program, sponsored by the Access to Benefits Coalition, see the description on the joint conference’s website.
Scholarships Available to Attend NALC
The AARP Foundation is funding scholarships to enable several people to attend the 2006 National Aging and Law Conference (NALC). The conference takes place on April 20-23, 2006 in Crystal City, Virginia, just outside Washington, DC. The AARP Foundation will consider all applicants, but will give priority to those who are attending NALC for the first time, who demonstrate financial need, and who provide legal services and advocacy for older people. You can download an application from AARP’s National Legal Training Project’s website, or contact Ana Davis, Project Attorney, at anadavis@aarp.org.
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CMS Postings
CMS Asks Part D Plans to Extend 30 day Billing Limits
Gary Bailey, Deputy Director for Plan Policy and Operations, issued a memo on February 7 in which he asked all Part D plans to extend their billing limits from 30 days to 90 days. Bailey asked the plans to extend their billing deadlines because some plans are rejecting, for lack of timeliness, claims that pharmacists resubmitted after mistaken denials in January. “As they attempt this rebilling,” Bailey wrote, “pharmacists are encountering a 30 day billing limit placed by the Part D plan. That is, the Part D plan is again rejecting the drug claim as “too old” because it exceeds the 30 day limit.” Mr. Bailey added that the plans should relax their billing timelines because beneficiaries will need the extra time to request reimbursement from the plans, and provide documentation, for incorrect payment of deductibles and co-pays.
CMS Details Drug Plan Call Center Contact Requirements
CMS’s Center for Beneficiary Choices issued a memo and accompanying chart on February 3 that details the agency’s policy on the drug plans’ call center coverage. The memo follows up on a memo dated January 27 that CMS sent to some plans that were not fully complying with plan call center requirements for provider and beneficiary service.
CMS Issues Model Coverage Determination Request Form
On February 7, CMS released a model form for requesting a coverage determination from Part D drug plans. The “Request for Medicare Prescription Drug Coverage Determination” form contains check-off boxes for a list eight types of coverage determinations. While the drug plans can encourage plan members to use the companies’ own coverage determination request forms, reportedly they should accept CMS’s model form too.
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IV. HAP Resources
HAP Conference Materials Posted
The materials used in the many sessions that comprised the HAP conference "Helping Consumers in an Everchanging World", a track within the larger Families USA Health Action conference, have been posted on HAP’s website. Materials from the Health Action 2006 workshops and plenary sessions are posted on Families USA’s website. If you have any questions about the materials or the conference, contact Christin Engelhardt at cle@healthassistancepartnership.org.
Medicare Drug Coverage Charts
We have posted three pieces on the HAP website that address prescription drug coverage issues in Original Medicare and Medicare Part D drug. A CMS chart, originally released in July 2005, describes common Part B drug and Part D drug coverage determinations. HAP has written a fact sheet and chart that summarizes the differences in drug coverage under Medicare Parts A, B, and D. We have also posted a new chart, “Part D Drugs/Part D Excluded Drugs” that describes products, drugs, and categories that are and are not covered under the statutory and regulatory requirements for Medicare Part D.
Program Locator Updates
Please take a few moments to review the entry for your consumer health assistance program on our program locator webpage. We are updating the information. Please write to infohap@healthassistancepartnership.org if there are any changes in your program's information or to list other programs in your state that assist consumers with Medicaid, Medicare, and/or private insurance problems. Please note that we can only list nonprofit and government-based consumer health assistance programs. Also, we list the statewide SHIP contact information rather than each local office.
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