Medicare Part D Index

Medicare Part D - Prescription Drug Benefit

With the advent of the Medicare Modernization Act (MMA), a prescription drug benefit was signed into law. The changes, affecting all persons on Medicare, went into effect on January 1, 2006. Information and educational resources for all and the latest on critical program distinctions for nursing home residents will be posted on this site as they become available. Find detailed information and link to relevant sites below.

LTC Workgroup Materials

Education and Training Tools

Press Releases

CMS/HHS Memos and Resources

Links and Other Resources

These tools were developed for the Medicare Part D Long-Term Care Workgroup comprised of representatives of State LTC Ombudsmen, the SHIP network, and Senior Medicare Patrols for their work with long-term care residents on this issue. The materials include a timeline, a checklist for working with partners and beneficiaries, questions for advocates to ask of their Medicaid agencies, contact information, and more. The workgroup is coordinated by the Health Assistance Partnership and NCCNHR.

• Letter from Health Assistance Partnership, July 2005

• Reaching Long-Term Care Residents - Worksheet

• Timeline for low-income subsidies, all eligible beneficiaries, and open enrollment - Summer 2005 - Dec 31, 2005

• Getting Ready for Medicare Part D  - Checklist

• Where to find your State Long Term Care Ombudsman Program (SLTCO), SHIP, or Senior Medicare Patrol (SMP) - List.  Daily updates to SLTCO can be found on the NORC website Ombudsman Locator at www.ltcombudsman.org.

• Questions to Ask Medicaid Agencies - these questions are designed to help advocates clarify the Medicaid agency’s role in providing prescription drug coverage and to help you assist nursing home residents with the transition to Medicare Part D.

 

Education and Training Tools:

A Dear Advocate letter on Part D and nursing homes from the Center for Medicare Advocacy, Inc.

NCCNHR Consumer Fact Sheet Medicare Prescription Drug Coverage- Q & A for Nursing Home Residents, Their Families, and Friends.

Memo to Ombudsmen from Sue Wheaton, Agency on Aging, regarding the MMA Prescription Drug Benefit.  

Medicare Prescription Drug Coverage: Only the Basics for Now (ppt). This PowerPoint presentation on Medicare Part D was created by Kathy Greenlee, KS State Ombudsman for use in training volunteer ombudsmen. It provides a basic overview, is easily adaptable to your state, and may also be useful in other training venues. When using the presentation, please credit the KS SLTCO with its creation. 

 

Press Releases:

 Medicare Part D and its Effect on Long Term Care and Nursing Home Residents.  Released by WI Board on Aging and Long Term Care, August 31, 2005.

 

CMS/HHS Memos and Resources:

HHS Q&A: Getting Drugs After Your Transition Period - a consumer fact sheet.

CMS Memo: Critical Steps for Successful Transition - March 30th memo to Part D sponsors reiterating that plans should provide enrollees who have used a transition benefit with the appropriate assistance to help them successfully transition to a formulary drug or take the necessary action to maintain their current medication. 

Medicare Transition Fact Sheet - released on March 31st by CMS, this is a reminder to providers and plans about continuing transition policy. 

Progress Report issued by Mike Leavitt, Secretary HHS  - 30 day transition coverage extended 60 more days.

A letter from the CMS Physicians' Regulatory Issues Team with valuable information for providers about how to assist beneficiaries with appeals, coverage determinations and exceptions, as well as other general information about Medicare Prescription Drug Coverage, is available here.

Medicare Plan Contacts - Exceptions and Appeals. This CMS website http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/04_Formulary.asp#TopOfPage provides a spreadsheet of contact information for Medicare prescription drug plans, segmented by state. These contacts are to be used solely for the purpose of resolving plan exceptions/appeals issues that cannot be resolved through the plan's normal channels and/or that take place outside of normal business hours, and not for general plan casework inquiries

CMS establishes Medicare Beneficiary Ombudsman Open Door Forum ODF to provide an opportunity for beneficiaries, their caregivers and advocates to publicly interact with the Ombudsman. See CMS press release on the Medicare Ombudsman.

The CMS Point of Sale Facilitated Enrollment Policy solution for pharmacists to assure that no dual eligible beneficiary leaves the pharmacy without their drugs.

Pharmacist Help Letter from CMS: Information to assist pharmacists in completing pharmacy transactions.

Pharmacy Transition Policies: Memo from CMS Center for Beneficiary Choices to all Part D Sponsors (January 6, 2006).

Transition Dual Eligibles - This CMS webpage, contains materials such as fact sheets, guidance papers, model states. The webpage will be updated as more information becomes available.

CMS offers alternate process by which nursing facilities may check the auto-assigned status of their residents who are dually-eligible for Medicare and Medicaid.  In addition to using the web-based Prescription Plan Finder tool at www.Medicare.gov for individual resident inquiries, nursing homes without Internet access, or who need Medicare prescription drug plan enrollment information for multiple residents, can now do so via a special CMS fax-based procedure: Instructions, Fax Cover Sheet, Nursing Home Administrators Fax ID, and  Clarification 1 (questions and answers).

The Centers for Medicare and Medicaid Services (CMS) website at www.cms.hhs.gov  has information regarding the Medicare Modernization Act, Benefits, and Dual Beneficiaries 

 

Links and Other Resources:

Tip sheet to assist pharmacies in servicing people who are dually eligible for Medicaid and Medicare.

WellPoint for CSR-Pharmacist- Document for CSR describing the POS “WellPoint” process to a pharmacy.

Basic information charts to outline plan transition policies for PDP and MA.

This is an important message from AoA about a resource to help Medicare beneficiaries, the SHIPs and all others working with beneficiaries on any Medicare Part D prescription drug implementation issues: CMS’ Regional Office Part D Assistance Centers.

Twenty Things Medicare Beneficiaries Should Know Before Signing up for the Medicare Drug Benefit, prepared by Tom Clark at the American Society of Consultant Pharmacists, November 2005.

Access to Medications Under Medicare Part D, prepared by Tom Clark at the American Society of Consultant Pharmacists, November 2005.

Health Assistance Partnership (HAP) - additional resources such as CMS notices and guidances, and more information on the prescription drug benefit, can be easily accessed from the HAP website within the Medicare Modernization Act section at www.healthassistancepartnership.org.

National Citizens' Coalition for Nursing Home Reform website http://nursinghomeaction.org contains current information and alerts on Medicare issues in the "Action Center."

Administration on Aging, Medicare Partnership Campaign - this section on the AoA website provides basic information about the Medicare prescription drug plan, news releases, updates and links to additional resources - http://www.aoa.gov/medicare/index.asp.

Center for Medicare Advocacy, Inc. website at http://www.medicareadvocacy.org/ provides various resources including Medicare Part D Plans by State: Types and Numbers, links to press releases and other information, and links to sign up for upcoming seminars.

Medicare Rx Drug Outreach and Education Project is funded by the U.S. Administration on Aging and implemented by an n4a-NASUA partnership. For more about this initiative and its outreach campaign, got to http://www.medicarerxoutreach.org/.