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Medicare Drug Program News
Medicare Attacked for Not Telling Dual Eligibles
About Drug Reimbursement
One of several problems that complicated enrollment
of up to seven million dual eligibles
May 8, 2007 – Since the beginning of the Medicare
drug program the "dual eligibles" have been of concern to Medicare
advocacy groups, concerned that these senior citizens once provided
drugs through Medicaid, would be lost in the transition to the new
Medicare program. Now, a report by the Government Accountability Office
says this concern was justified – 400,000 appear to have lost their
coverage on some purchases.
CMS Did Not Tell Some
Beneficiaries Dually Eligible for Medicare, Medicaid About Retroactive
Prescription Drug Reimbursements, According to GAO Report
More than 400,000 low-income seniors might have
lost the opportunity to receive federal subsidies because
CMS failed to notify them of their eligibility for
reimbursements on previous prescription drug purchases when they
enrolled in the Medicare drug benefit, according to a
Government Accountability Office report released Tuesday, the
Los Angeles Times reports.
CMS' failure to notify beneficiaries is one of
several problems that complicated the enrollment of as many as seven
million dual eligibles who qualify for both Medicare and Medicaid,
according to the report (Los Angeles Times, 5/8).
Once a dually eligible beneficiary enrolls in
Medicaid, it can take more than one month to be enrolled in the
prescription drug plan. By law, the beneficiary must receive drug
coverage retroactively to the date they became eligible. The federal
government reimburses beneficiaries for prescription drugs bought during
the retroactive period. However, CMS until March of this year failed to
inform beneficiaries that they were eligible for these retroactive
reimbursements, despite paying insurers $100 million in 2006 for this
purpose.
"Given the vulnerability of the dual-eligible
beneficiary population, it seems unlikely that the majority of these
beneficiaries would have contacted their (plan) for reimbursement if
they were not notified of their right to do so," according to GAO
investigators.
Acting CMS Administrator Leslie Norwalk in a
written statement said she disagreed with the "overwhelmingly negative
tone" of the report. She added that it is difficult to deliver
"real-time" benefits to beneficiaries with retroactive eligibility (Lee,
Washington Post, 5/8).
CMS recently revised the letter it sends to dual
eligibles when they enroll in the drug plan to explain that they qualify
for reimbursements on previous drug purchases (AP/Baltimore
Sun, 5/8). The
Senate Finance Committee on Tuesday will hold a hearing on
issues with the Medicare drug benefit, according to the Post (Washington
Post, 5/8).
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