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Advocacy Issues |
Index Index
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Medicare Prescription Drug Act Index |
With the advent of the Medicare Modernization Act (MMA 2003), 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 it becomes available. Find detailed information and link to relevant sites below.
Letter from Alice Hedt, NCCNHR Executive Director, February 1, 2005.
Final Regulations:
The American Society of Consultant Pharmacists presented an audio conference during the week of February 1, 2005 on the final regulations for Medicare Part D, with special emphasis on long-term care considerations. The slides and audio are archived on the Internet. The program is free and available at: http://www.scoup.net
Transition Policies:
 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.
Letter from CMS Physicians' Regulatory Issues Team to providers: How to assist beneficiaries with appeals, coverage determinations and exceptions, as well as other general information about Medicare Prescription Drug Coverage, is available here.
Memo from CMS, Center for Beneficiary Choices - Reminder to all Part D Sponsors about Pharmacy Transition Policies (January 6, 2006).
Regional Assistance Centers - Oversight of Medicare Part D implementation is being carried out through CMS regional offices. A list of the Centers with their contact information, and a reminder to report problems to them was provided in a message from AoA (January 5, 2006).
NCCNHR signs and sends letter to McClellan expressing concerns about Medicare Part D and long-term care residents in Assisted Living facilities (April 6, 2006).
Letter from FRIA to NY Nursing Home Administrators (December 27, 2005). Can be easily adapted to send to administrators in your state.
Dear Advocate letter on Part D and nursing homes from the Center for Medicare Advocacy, Inc. This letter is intended to provide advocates with information about what to expect, what CMS is saying facilities must or may do, what residents’ rights are, and where you can go for additional information.
Transition to prescription drug coverage (text). See issues affecting nursing home residents and advocates pdf file (2/10/05)
Comments on MMA Guidance Documents (filed 4/8/05). In a letter to Mark McClellan, the Center for Medicare Advocacy and the National Citizens' Coalition for Nursing Home Reform urge CMS to issue new guidance that protects beneficiaries and reflects the requirements of the Nursing Home Reform Law.
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.
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Letter from Health Assistance Partnership, July 2005
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Reaching Long-Term Care Residents - Worksheet
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Timeline for low-income subsidies, all eligible beneficiaries, and open enrollment - Summer 2005 - Dec 31, 2005
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Getting Ready for Medicare Part D - Checklist
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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.
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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.
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Education and Training Tools: |
NCCNHR Consumer Fact Sheet, “Medicare Prescription Drug Coverage- Q & A for Nursing Home Residents, Their Families, and Friends.”
CMS "Quick Facts" for nursing home residents
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.
Tools for checking auto-assigned status of dually-eligible residents:
Prescription Plan Finder tool at www.Medicare.gov
CMS fax-based procedure - for individual resident inquiries, nursing homes without internet access, or who need Medicare prescription drug plan enrollment information for multiple residents - Instructions; Fax Cover Sheet; Nursing Home Administrators Fax ID; and Q&A Clarification 1- follow-up questions and their answers regarding the fax-based procedure.
Transition Dual Eligibles, contains materials such as fact sheets, guidance papers, and model states. This webpage will be updated as more information becomes available.
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.
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.
| Relevant Websites and other Resources: |
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.
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
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/.
Last update: 4/10/06
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