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MEDICARE PART D – UPDATE
Starting
January 1, 2006, Medicare will offer prescription drug plans to
help pay for prescriptions. If eligible people don’t join a
Medicare prescription drug plan by May 15, 2006, the individual
will pay a higher premium. Notifications will go out in the fall
that will notify people about their coverage. Most everyone knows
someone that receives Medicare. Inform yourselves to help them
with this complex process.
For the dual
eligible, persons with both Medicare and Medicaid, there will be a
different scenario, as you know from past News and Views. Dual
eligible, (there are 40,000 in New York State), will be
auto-enrolled in a Medicare prescription drug plan in the fall of
2005 since their Medicaid drug benefits will end on January
1, 2006. CMS will randomly assign dual eligibles to a
plan (there will be around 20 plans in New York State that are not
identified yet). An individual can opt to change to another plan
and has the option to change every month, with the newly chosen
plan becoming effective the first of the next month. Currently,
the formularies (the list of medications that a plan covers), of
the plans are not known. When the auto-enrollment notification
arrives the entire formulary will not be listed in the mailing to
the individual. Most plan companies will have a website, as will
CMS, to check the medications of an individual with their plan.
Some of the plans will be benchmark plans –which are those plans
with the average cost. CMS will identify a website that will list
the benchmark plans. There will also be premium plans that will
cost more. New York State has agreed to provide a wraparound for
some drugs that are off a plan. Right now rules are being
developed as well as an appeals process.
For dual
eligibles with income under 100% of the poverty limit, there will
be no premium, no deductible, a $1 co-pay for generic drugs, a $3
co-pay for brand-name drugs, no initial coverage limit, no
doughnut hole (cost that the enrollee must pay 100% of. A regular
Medicare Part D enrollee must pay the cost of drugs between
$2250-$5100), and no cost for catastrophic coverage. No
application is needed to request extra help, dual-eligibles
automatically will receive this. People residing in ICFs that are
dual eligible have the same coverage just noted except they do not
have to pay co-pays.
OMRDD has
convened a work group to share information and plan for the smooth
implementation of Medicare Part D for the people we serve. It
will be very important to compare the plans when they are
announced to determine which plans best suit the individual and
their medication regimen. OMRDD is planning to do a plan
comparison and share it with providers.
New York
State has not passed legislation as yet allowing 90 days of
medication to be obtained when the program begins to ensure that
medications are available to the individual. This is something
allowed by the federal government.
The
following are tasks that can be done now to prepare for the
implementation of Medicare Plan D:
1.
Identify a
“point” person in your agency to be in charge of the information
flow around this new program.
2.
Of those you
serve, determine how many individuals are dual eligible.
3.
Determine if
these individuals received a notification letter in May informing
them of the Medicare Plan D changes (this helps to confirm that
they are listed with CMS, although there were many mistakes in
their mailing such as empty envelopes).
4.
Keep a list
of the medications of each individual to determine the best plan
for them when the auto-enrollment letters come out in October.
5.
Talk to the
pharmacies you do business with to see if they have been
approached to sign an agreement with a plan to participate.
6.
Keep an ear
and an eye out for updates and training from NYSACRA and other
associations. Beware of high-priced consultants that may promise
lots of assistance but who don’t have the information yet to
really help. (Much of the detail is not available from CMS yet).
Continue to inform your self and your staff, especially service
coordinators or staff that work with people in the community that
may have a hard time understanding their options. Check the
following websites for information:
http://www.cms.hhs.gov
http://www.medicare.gov
http://kff.org
http://familiesusa.org
http://www.hiicap.state.ny.us
www.socialsecurity.gov
HUD REOPENS SECTION 811
HUD
understands that many applicants may have had difficulty
submitting their applications. Therefore, HUD has reopened the
Section 811 Program with a new application submission date of
September 6, 2005. This is an electronic application and all
applicants must register at Grants.gov Web site at
http://www.grants.gov.
For
additional information contact Frank Tolliver, HUD Project Manager
at 202-708-3000 or visit
http://www.hud.gov/offices/adm/grants/nofa05/reopenings.cfm |
