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MEDICARE PART D – REPAIRS MAY BE ON THE WAY?
In an
announcement on Friday, Governor George Pataki provided the
following statement: "Today, I spoke with the Secretary of the
Department of Health and Human Services, Michael Leavitt about
this issue. Secretary Leavitt assured me that the federal
government remains committed to correcting the flaws within its
Medicare system.
"After hearing
from the Secretary about the federal government’s commitment, I
directed the Department of Health to continue its temporary
suspension of related Medicaid rules to ensure that New Yorkers
can receive the prescription drugs they need for another seven
days."
As a result of
Governor George Pataki's action, pharmacists may continue to
temporarily bill Medicaid for pharmacy claims for full benefit
duals when they have made attempts, and failed, to receive
coverage under Part D. This temporary coverage has been extended
another seven days through January 27, 2006.
The pharmacist
is still expected to continue to follow the required CMS
procedures to first attempt to receive payment under Part D.
This temporary
coverage will be provided for an additional seven days, through
January 27th, 2006. Please be reminded that this special coverage
applies only to claims with dates of service between January 13,
2006, and January 27, 2006, and does not apply to retroactive
claims.
In addition,
NYSACRA and our sister associations have sent a letter, (Click
Here for a PDF copy or see the NYSACRA website), to the
Commissioner of the NYS Department of Health, the Governor and
legislative leaders advocating for our members and people with
disabilities on the Medicare Part D issues.
Federal Legislation to correct some of the implementation problems
is expected to be introduced soon. Senators John Rockefeller
(D-WV) and Hillary Clinton (D-NY) plan to introduce the Requiring
Emergency Pharmaceutical Access for Individual Relief (REPAIR)
Act. The REPAIR Act would require a minimum of a 30-day supply of
medications for beneficiaries, improve customer service, reduce
the burden on pharmacies and provide reimbursement to states and
beneficiaries for out of pocket expenses. The legislation would
require that CMS directly provide compensation for any premiums,
deductibles, and coinsurance that was in violation of Part D
limits to beneficiaries and provide full reimbursement to states
that who paid for medications during this time. Currently, under
the Medicare Modernization Act, the federal government cannot
refund the states the out of pocket expenses incurred. Instead the
federal government must pay the insurance providers and they in
turn must pay the states. CMS has, however, offered to assist the
states in compiling and filing claims with the insurance
companies.
NEW YORK STATE BUDGET COMPARISON
As we do each year, NYSACRA compares last year’s budget with the
Governor’s proposed budget for this year 2006-07.
Click Here
for that comparison or view it online at
www.nysacra.org. Call Jim
Kosakoski with any questions at the NYSACRA office. |
