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Medicare Announces Two
Steps To Ease Enrollment in Card Programs
April 19, 2004 -
Medicare has announced two steps to make enrollment in the Medicare drug
program easier – automatic enrollment by state pharmacy assistance
programs for low-income beneficiaries, and a standard enrollment form
for all card programs.
Medicare has issued
guidance that allows state pharmacy assistance programs, in certain
circumstances, to enroll low-income Medicare beneficiaries automatically
into the transitional assistance benefit of the Medicare Modernization
Act (MMA). States that have the authority to act as an "authorized
representative" of a beneficiary (as defined by state law) would be
permitted to enroll beneficiaries in drug cards on the beneficiary's
behalf. This step will make it easier for low-income beneficiaries in
states with pharmacy assistance programs to get $600 in additional help,
according to Mark B. McClellan, M.D., Ph.D., administrator of the
Centers for Medicare and Medicaid Services.
He said Medicare
will also issue a standard enrollment form that will be accepted by all
Medicare Approved Discount card programs. This standard form will make
it easier for community-based organizations, health professionals, and
consumer groups to assist beneficiaries with the enrollment process.
"The Discount Drug
Card is an important step in the implementation of the Medicare
Modernization Act and an important benefit for seniors. Making it easier
to enroll and receive the benefit is another example of our commitment
to helping seniors lower their drug costs, " said Health and Human
Services Secretary Tommy G. Thompson.
"We intend to make
it as easy as possible for Medicare beneficiaries to get the information
they need and to enroll in the drug card program, so that they can get
the most assistance possible from the new law," McClellan said. "These
two important steps will make it easier for people who want to help
beneficiaries to work with us to achieve this urgent goal."
CMS will soon
provide a standard enrollment form for the Medicare-approved drug
discount card program for use by State Health Insurance Programs
(SHIPs), and other partners and organizations that assist beneficiaries
with their health care decisions.
The standard form
will be made available on www.medicare.gov, and by a variety of
other means, and will include instructions for its use as well as access
to the information needed to complete it, ensuring ease of use and that
existing drug card program activities and responsibilities will be
supported by it.
Approved card
programs will still be able to print their own enrollment forms - which
incorporate standardized elements of the form - but which may have
additional questions on them or personalized elements - such as a crest
or seal. Now, in addition to accepting their own personalized forms, the
card sponsors will also accept the standard form which may be used
across all cards.
The automatic
enrollment policy will help many states coordinate their own drug
benefits for low-income Medicare beneficiaries with the new Medicare
drug benefit by making enrollment easier for the states and the
beneficiaries.
Twenty states have
large programs that already provide drug benefits to these
beneficiaries. Many of the beneficiaries will be eligible for the new
transitional assistance benefit under MMA. Individuals may be enrolled
in both types of programs at the same time.
Beneficiaries who
are signed up for MMA transitional assistance get $600 to pay for drug
costs. Depending upon how the State plan is organized, this could mean
state programs would not have to pay the first $600 for each of these
beneficiaries, thus freeing up money to help states pay for their own
programs.
Medicare-Approved
Drug Discount Card and transitional assistance regulations require a
beneficiary or authorized representative, under penalty of perjury, to
sign an enrollment form in order to apply for the $600 credit.
This signature
ensures that the information the government is receiving is correct and
that the $600 is distributed to those truly qualified for it. However,
many state enrollees may view themselves as already having drug
coverage, and therefore be reluctant to apply for the $600 because they
fear losing their current benefit. The CMS guidance to the states
recognizes that CMS regulations have always permitted an authorized
representative to sign the enrollment form on an individual's behalf. To
the extent a state has the authority to act as the beneficiary's
representative, the state could automatically enroll the beneficiary
into a card.
The CMS guidance
also ensures that beneficiaries are not enrolled against their choice.
For example, states would be required to explain what is happening and
the consequences of the enrollment. Individuals must be given an
opportunity to decline the enrollment.
States that are able
to automatically enroll Medicare beneficiaries into the new program will
be able to identify which card a beneficiary is enrolled in so that the
individual can return to the state program after the $600 is used
without losing any coverage.
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