Pennsylvania will require low-income seniors currently enrolled in the PACE prescription drug assistance program to enroll in Medicare Part D. (Medical News Today) PACE covers drug costs not covered by Medicare. The state sent letters to Pace enrollees to inform them about their new Medicare plans. Beneficiaries will have 10 days to object to the state's recommendations. After 10 days, the state will enroll beneficiaries in the recommended plans automatically. Apparently, PACE participants … [Read more...] about Pennsylvania to Require PACE Seniors to Enroll in Medicare Drug Plans
Provider Letter: More Licensure and Medicare Certification Delays
In a letter that replaces PL #06-08, the Texas Department of Aging and Disability Services (DADS) alerted Home and Community Support Services Agencies (HCSSA) to expect more delays for initial licensure and Medicare certification. Region 6 (Houston Regional Office) and Region 3 (Arlington Regional Office) could see delays of up to a year. In the updated letter, DADS added or changed information about the process. For example, providers must request initial licensure at least six months … [Read more...] about Provider Letter: More Licensure and Medicare Certification Delays
CMS Revises Guidance for Coverage Determinations
In an effort to help make sure patients are getting appropriate care, the Centers for Medicare and Medicaid Services (CMS) revised guidance for national coverage determinations (NCDs), according to the news release. As a condition of payment, providers must develop and capture additional patient information to supplement standard claims. CMS Administrator Mark B. McClellan said, "Our goal is to speed access to valuable new technologies, and to promote the effective use of those technologies … [Read more...] about CMS Revises Guidance for Coverage Determinations
Medicare Part D Costly and Burdensome for Nursing Home Providers
Pharmaceutical representatives testified before Congress earlier this month about the administrative burden placed on long term care providers, particularly nursing homes, by Medicare Part D, the new prescription drug program. They also said providers are losing money because of the program. The new drug program was created to give seniors more choices, but it seems to be offering conflicting and confusing choices. For example, Long Term Care Pharmacy Alliance executive director Paul Baldwin … [Read more...] about Medicare Part D Costly and Burdensome for Nursing Home Providers
Survey: Pharmaceutical Companies Should Help Educate on Medicare Part D
Verispan, a health care research company, has issued the results of a spring 2006 survey of long term care providers. According to the survey, 94 percent of long term care providers expect pharmaceutical companies to help educate prescribers about Medicare's new prescription drug plan, and 54 percent said they expect companies to help educate patients. (Source) Long term care providers suggested several ways pharmaceutical companies can educate them about the plan, including webcasts, online … [Read more...] about Survey: Pharmaceutical Companies Should Help Educate on Medicare Part D
Provider Letter: Special Enrollment; New Dual Eligibles
The Centers for Medicare and Medicaid Services (CMS) is extending the Medicare Part D prescription drug program enrollment period for Hurricane Katrina victims, according to a June 20 DADS provider letter to community services providers. Beneficiaries who lived in "designated parishes and counties" when the hurricane hit will have until December 31, 2006, to enroll. CMS also released information for new dual eligible beneficiaries. You may download PDF copies all related letters and documents … [Read more...] about Provider Letter: Special Enrollment; New Dual Eligibles
Congress and Medicare
Congress probably won't act on Medicare legislation until after the August recess and may end up waiting until after the elections, according to The Hill. One of the pending Medicare bills is a proposal to eliminate late fees for beneficiaries who didn't sign up for the Medicare prescription drug plan before the May 15 deadline, which I blogged about here. Medical News Today has a round up of news links. In other Medicare news, an "independent expert panel" concluded that enrollment of … [Read more...] about Congress and Medicare
States Take on Medicaid Reform
Last month I blogged about West Virginia's proposal to implement "personal responsibility contracts" for Medicaid recipients. In essence, beneficiaries will be required to take some responsibility for their health, and those who don't will be penalized with reduced benefits and coverage. As controversial as they may sound, the federal government approved the state's plan. Medicaid serves about 55 million people, and states should do all they can to prevent fraud and waste and help the most … [Read more...] about States Take on Medicaid Reform
Groups Oppose Changes to Medical Device Reimbursements
In April, the Centers for Medicare and Medicaid Services proposed a rule that would cut reimbursements for implanted cardiac devices by up to 30 percent in an effort to close loopholes used by specialty hospitals. (Kaiser Network) Since the proposed rule changes, several groups have come out publicly against it. A group called AdvaMed, which represents medical device makers, says the proposal should be delayed for one year so "interested parties" can review and assess the changes. Scott Ward … [Read more...] about Groups Oppose Changes to Medical Device Reimbursements
Long Term Care Providers Join Coalition to Eliminate Co-Payments
A group of long term care providers is calling for the elimination of Medicare Part D co-payments for patients "in certain homes" who are eligible for both Medicare and Medicaid. The National Center For Assisted Living and the American Health Care Association, which represent long term care providers, believe that beneficiaries receiving care in certain assisted living facilities and group homes who can't afford co-payments are adversely affected. From the Senior Journal: Under Part D, … [Read more...] about Long Term Care Providers Join Coalition to Eliminate Co-Payments
