This week CMS sent a series of legislative suggestions to Congress including changing how it pays for Part D and how plans are marketed to those eligible for both Medicare and Medicaid.
The ideas were proposed to Congress in its June 18, Medicare-Medicaid Coordination Office Fiscal Year 2017 Report to Congress.
Last year, Dual eligible beneficiaries in Arizona rose 7 percent YOY from 82,188 to 87,769 in 2017.
CMS recommends the following items for legislative actions that were proposed in the President’s FY 2019 budget:
- Permanently Authorize a Successful Pilot on Retroactive Medicare Part D Coverage for Low-Income Beneficiaries;
- Allow for Federal/State Coordinated Review of Dual Eligible Special Needs Plan (D-SNP) Marketing Materials;
- Improve Appeals Notifications for Dually Eligible Individuals in Integrated Health Plans; and
- Clarify the Part D Special Enrollment Period for Dually Eligible Beneficiaries.
The retroactive Medicare Part D pilot for low-income beneficiaries pays plans less because reimbursements are more closely related to actual costs than standard Part D prospective payments.
If Congress agrees, the move would permanently authorize CMS to contract with a single plan to provide Part D coverage to low-income beneficiaries while their Part D eligibility is processed and serve as the single point of contact for beneficiaries seeking reimbursement for retroactive claims.
Coordinated review would allow for joint state and CMS review of marketing materials, alleviating administrative burdens on health plans.
The agency proposed streamlining appeals communication to reduce conflicting instructions received by dual eligibles and improve care coordination.
The SEP recommendation would narrow enrollment perioids for dual beneficiaries by applying the same annual election process for both dually eligible and non-dually eligible beneficiaries. It preserves the ability for dually eligible beneficiaries to use an SEP to opt into integrated care programs or to change plans following auto-assignment. CMS wrote in its report,
Efficient use of the Part D SEP for full-benefit dual eligible beneficiaries reduces aggressive marketing targeted to low-income beneficiaries, improves incentives to make investments in and provide care coordination for high-cost, often vulnerable beneficiaries, and reduces the administrative burden on health plans from beneficiary fluctuations between plans numerous times throughout the year.
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