I. HAP HAPpenings

• COME VISIT: HAP's New Web site
• UPCOMING OPPORTUNITY: 2008-2009 Collaborative State Projects
• LAST CHANCE: Health Action 2008, January 24-26 

II. Highlights from CMS

• CMS Resources on Prescription Coverage Issues
• CMS Reiterates Marketing Guidance for Limited English Proficient Beneficiaries
• Vaccine Administration Coverage Changes

III. Items of Interest

• SHIP Funding Increases
• GAO Report Shows Waste in CMS Spending
• Medicare Appeals: Adjustments to the Amount in Controversy (AIC) Threshold for 2008
• Report Faults Part D Plan Tracking of Out-of-Pocket Drug Costs in 2006
• U.S. Ruling Backs Benefit Cut at 65 in Retiree Plans
• Kaiser Family Foundation Part D Resources

I. HAP HAPpenings
COME VISIT: HAP’s New Web Site
The new year brings a new face to HAP with resource centers created through partnerships with SHIPs. Our new Web site features a variety of capacity-building tools and resources that focus on program development and Medicare education. Discover HAP’s new Web site.

UPCOMING PARTNERSHIP OPPORTUNITY: 2008-2009 Collaborative State Projects 
On Tuesday, January 15, 2008, HAP will distribute a Request for Proposal to SHIP Network seeking applicants for the 2008-2009 Collaborative State Projects (CSPs). CSPs are capacity-building partnerships in which HAP provides customized assistance for 12 months to strengthen and expand upon existing programs implemented by SHIPs. This year's projects will focus on volunteer program development and training.

Visit HAP's new Collaborative State Projects area to learn more about how CSPs could work for your SHIP.

LAST CHANCE: Health Action 2008, January 24-26
There is still time to register for the Families USA annual conference, Health Action 2008, in Washington, D.C. Join other grassroots advocates, health care providers, and policymakers from around the country to share strategies and recharge for the year ahead.

For more information, please visit Health Action 2008.

II. Highlights from CMS
CMS Resources on Prescription Coverage Issues
CMS has a variety of resources that can be helpful as Medicare beneficiaries try to utilize their prescription drug coverage in 2008.

• Pharmacists can utilize the Point-of-Sale Facilitated Enrollment process for dual eligible and low-income subsidy (LIS) eligible individuals whose records do not reflect a drug plan.
• The Best Available Evidence process can be followed by plans when dual eligibility or LIS information is incorrect and beneficiaries should have lower cost-sharing.
• Formulary Transition policies (pages 24-32) explain the number of pills and timeframes for filling a prescription when changes have been made to a formulary or an individual is a new member of a plan.
• CMS has a Part D Complaint Protocol including email addresses for each CMS regional office.
• An updated Part D Reference Guide for pharmacists compiles useful information and forms on Part D.

CMS Reiterates Marketing Guidance for Limited English Proficient Beneficiaries
A January 2 memo from Cynthia Tudor, Director of the Medicare Drug Benefit Group, and David Lewis, Director, Medicare Advantage Group, highlights the best practices call centers should follow when serving non-English speaking and limited English proficient beneficiaries.

Vaccine Administration Coverage Changes
Beginning on January 1, 2008, the Part D program will cover vaccine administration costs associated with Part D vaccines.

Medicare Part B coverage will continue for the following immunizations: pneumococcal pneumonia vaccine; influenza virus vaccine; hepatitis B vaccine for individuals at high or intermediate risk; and other vaccines (e.g. tetanus toxoid) when directly related to the treatment of an injury or direct exposure to a disease or condition.

III. Items of Interest
SHIP Funding Increases
The last week of December 2007, President Bush signed into law two important pieces of legislation that provide a total of $54.3 million for SHIP funding in 2008. Expansions to Medicare benefits for low-income beneficiaries were not included in the final legislation due to Congress’s inability to find veto-proof sources of funding to pay for the improvements.

Visit HAP's SHIP Funding Resource Center to learn more about the legislation.

GAO Report Shows Waste in CMS Spending
According to a November 2007 Government Accountability Office (GAO) report, 9 percent (close to $90 million) of the $1 billion Congress appropriated to CMS for administrative costs during the implementation of the Medicare Modernization Act (MMA) has been spent on "numerous questionable payments." There are questions regarding contractor oversight, contracting practices, contract terms, and internal control deficiencies and backlogs.

Medicare Appeals: Adjustments to the Amount in Controversy (AIC) Threshold for 2008
The Amount in Controversy (AIC) thresholds under the Medicare appeals process, including Parts A, B, C, and D, increased for 2008. For requests filed on or after January 1, 2008, the AIC threshold amount for an Administrative Law Judge hearing is $120 (compared to $110 in 2007), and the threshold for Judicial Review is $1,180 (compared to $1,130 in 2007). These amounts are increased annually based on the percentage increase in the medical care component of the Consumer Price Index (CPI). For more information, please see the Federal Register  (December 27, 2007).

HAP's resources on the Medicare appeals process have been updated to reflect the increases:

• Original Medicare: The Appeals Process
• Original Medicare: Coverage & Payment Appeals Flowchart
• Medicare Part D: Appeals Process Flowchart
• Medicare Part D Training Manual: Coverage Determinations and Appeals

Report Faults Part D Plan Tracking of Out-of-Pocket Drug Costs in 2006
On December 17, the Office of the Inspector General (OIG) for the Department of Health and Human Services released a report stating that Medicare Part D prescription drug plans did not meet all requirements for tracking out-of-pocket (TrOOP) spending by beneficiaries in 2006. The OIG audit found that neither the Part D plans nor CMS and its contractors were fulfilling their reporting and oversight duties in a consistent manner. The report recommends that CMS ensure that all data for the tracking of TrOOP costs be collected and submitted. CMS commented on a draft of the report and indicated that it will take steps in response to the recommendations but did not say whether or not it concurred with the findings.

Visit HAP's TrOOP page for more information.

U.S. Ruling Backs Benefit Cut at 65 in Retiree Plans
In late December 2007, the Equal Employment Opportunity Commission (EEOC) announced that employers can reduce or eliminate health benefits for retirees when they turn 65 and are eligible for Medicare. Since previous policy required that all retirees be given identical benefits regardless of their age of retirement, many employers opted to provide no coverage since they are not legally required to do so.

Now, because employers can create a two-tier system, advocates are concerned that the people who are Medicare-eligible and have supplemental insurance from their employers will see a reduction in their employer-based insurance. The hope is that this two-tiered system will insure more retirees. It is not clear how this change will ultimately affect retirees' insurance coverage.

Kaiser Family Foundation Part D Resources
The Kaiser Family Foundation has created a series of data spotlights analyzing specialty tiers, benefit design, premiums, and the coverage gap within Medicare’s private drug plans. These short documents identify trends, analyze key policy issues, and detail practical implications for beneficiaries.