Robert M. Hayes, president of the Medicare Rights Center, a national consumer service organization, issued a statement related to Medicare’s new prescription drug program. An excerpt:

Less than five percent of people who could voluntarily choose a prescription drug plan have done so (see calculations below). People with Medicare are frustrated and bewildered about a program that is needlessly complex and unreliable. The reasons for these appalling enrollment numbers are self-evident.

President Bush and Congress refused to enact a Medicare drug plan. Instead, 43 million Americans have been offered a subsidized industry of profit-making insurance plans hawking incomprehensible benefit packages. Any honest appraisal of the drug program’s performance demands an immediate restructuring to enact a drug benefit that would offer nationwide, understandable and affordable drug coverage through Medicare.

You can read the rest of the statement by following this link.

The blogger over at Over! My! Med! Body! is a third year medical student. His blog is very informative about Health Care policies. He recently posted an article that will answer questions you may have about why some medications seem to be missing from the Medicare Drug Calculator. He obtained the following information from a Medicare patient advocate:

In your tutorial, you mention that you have questions with the “Enter My
Medications” section. First, the Federal legislation expressively
prohibited Medicare Part D from providing barbiturates and benzodiazepines,
so they won’t show up. Second, an approved plan is only required to provide
two drugs in each treatment category, so many drugs are not on many of the
formularies, although they are also required to provide “substantially all”
drugs available for the treatment of Cancer, AIDS, and a list of other
conditions.

As all of us who’ve used the Plan Finder know, the prescription information
that the person provides us (even with their prescription bottles in front
of us or a pharmacy printout) doesn’t always match what’s available in the
Plan Finder’s prescription drug drop-down lists. A weird example is that I
have sometimes found a brand name only by going to the name of the generic,
and vice versa.

There is a significant challenge to us who don’t have a medical background.
I can sometimes narrow the specific form of a drug down by going to
http://www.rxlist.com/ and finding how the drug is provided, as I don’t have
a current PDF. As a fictional example: I find in the drop-down list that
there are both an “EX” form of a drug and a “TG” form. Looking at this
website (or PDR, or whatever), I see that the “EX” is available in 2.5, 5,
and 10 mg tablets, whereas the “TG” form is in a 10 ml vial, and the
prescription that the person is taking is 5 mg.

I always tell the person being screened when there is uncertainty as to one
of their prescriptions or when I have to leave a drug off the list. I
recommend that they contact the company(s) directly and find out how those
prescriptions will be handled, before enrolling.

Go over to his post to see lists regarding included and excluded drugs.

Medicare’s new prescription drug plan is causing more headaches.

Many beneficiaries don’t understand it, and doctors say it’s “unrealistic” for them to bear the burden of explaining it. From the Associated Press:

Millions of senior citizens will become eligible for the benefit Jan. 1, but many don’t know whether it will save them money, or which private insurance plan they should choose among the dozens that have bombarded their mailboxes with ads in recent months. Many don’t know how to apply or whether they are even eligible. And many are asking: Will the medications I need be covered?

The clock is ticking. Those who fail to sign up by May 15 may not get coverage until 2007.

Not surprisingly, the people who seem to know the most tend to be the more educated and more affluent — the ones least likely to need the new coverage.

The Long Term Care Pharmacy Alliance has posted a few documents on its web site that may be helpful to providers. Visit the site by following this link.

The Texas Health and Human Services Commission has announced that it has moved to a new pharmacy claims system, effective December 31, 2005.

Information about why the system is changing doesn’t appear on the site, but there are links to frequently asked questions, a pharmacy providers letter, and a quick reference guide for providers.

Texas Association for Home Care will hold a conference on January 25-26, 2006, at the Doubletree Hotel in Dallas, Texas. Providers will have an opportunity to discuss recent trends in home health care and network with other providers. Some session titles:

• The Future of Medicare & Medicaid Reform - What it Means to Texas, the Nation and Home Care
• Tax Reform in Texas - Effects on Your Business
• How to Impact the Politics Affecting Home Care; and
• Remote Electronic Monitoring: The Face of Patient Care in 2011

For more information on the conference, visit the web site.

The Texas legislature recently amended sections of the Local Government Code, which will affect certain long term care providers. The amendments were added to define “International Building Code” and “Commercial.” The letter can be accessed through PDF file by clicking here.

All municipalities must adopt the International Building Code as the standard for commercial buildings for which construction begins on or after January 1, 2006. You can read the text of the bill here.

Texas DADS has published a new provider letter regarding Medicare Rx. as impacts Nursing Homes and ICF-MRs . The letter addresses dual beneficiaries of Medicaid/Medicare:

Effective January 1, 2006, all full-dual Medicare beneficiaries (Medicare beneficiaries who currently receive prescription drug coverage through Medicaid) will be transitioned from Medicaid prescription drug coverage to the new Medicare Rx Prescription Drug coverage (Medicare Rx). We are providing you with information that can help your facility prepare for the implementation of Medicare Rx.

The rest of the letter gives relevant information and can be accessed through PDF file by clicking here

Medicare’s new prescription drug program goes into effect in less that two weeks, and pharmacies and nursing homes are making preparations. About 41 million eligible Medicare beneficiaries will get to select plans that will cover part of the prescription drug costs.

As I’ve written before, long term care providers are concerned that elderly patients, many of whom have cognitive problems, may not have the ability to make informed choices about coverage.

“None of the residents in my facility can make that choice,” Tracie Murray, administrator of Cedar Crest Nursing and Rehabilitation Center in Sunnyvale, told the San Francisco Chronicle. Long term providers face a dilemma. Many of their elderly patients won’t be able to select plans on their own, yet Medicare prohibits staff from assisting, citing potential conflicts of interest.

If patients are “dual eligibles,” the decision has been made for them. Two-thirds of nursing home residents will be eligible for coverage under Medicare and Medicaid. According to Medical News Today, the Centers for Medicare and Medicaid has randomly assigned all dual eligibles to a Medicare drug plan.

The Texas Department of Aging and Disability Services has issued a letter informing Home and Community Support Services Agencies about what they can expect when their agency is surveyed. The letter outlines each stage of the process, including how to begin the informal review of deficiencies, and agency rights and responsibilities.

Download a PDF copy of the five-page letter.

Budget negotiations are getting a lot of press, and for good reason. At issue this week is a 1 percent increase in Medicare reimbursement for doctors, and lawmakers are still trying to reach an agreement on Medicare cuts.

Meanwhile, doctors and beneficiaries have expressed confusion over Medicare’s new prescription drug program, and patients’ rights groups have threatened to sue the federal government. President George Bush, however, says the program is a “good deal.” From USA Today:

The new law offers an array of options, Bush said, and potential recipients who are wary can look to Medicare officials, family members, community centers and the AARP for help and advice.

“People will be able to match a program to their specific needs,” he said during a visit to a retirement center outside Washington. He called the new program “a good deal for our seniors.”

Enrollment began Nov. 15, and benefits begin Jan. 1. Congress created the program in 2003 to cut prescription-drug costs for seniors, but critics say the program is too complex, too costly and a potential liability for Republican congressional candidates.

While Democratic lawmakers claim the drug plan benefits only insurers and drug manufacturers, Republicans contend that the program is too expensive.