June 16, 2008

In this Issue …

1. Senate Fails to Pass Critical Hurdle for Medicare Legislation
2. CMS Provides $15 Million for SHIPs
3. Outreach Effort Helps Beneficiaries Lower Costs for Supplies
4. Learn How to Assist People with Low Health Literacy
5. OIG Examines Part D for Dual-Eligible Nursing Home Residents
6. Medicare Drug Plan Premiums on the Rise
7. Medicare Advantage Grows at Unprecedented Rate
8. New AARP Reports Available

1. Senate Fails to Pass Critical Hurdle for Medicare Legislation

Despite the enthusiastic support of many national aging organizations, the Medicare Improvements for Patients and Providers Act (S. 3101), introduced by Senate Finance Committee Chairman Baucus (D-MT), failed to move forward last week.

The bill would have fixed the physician payment problem that will cause a scheduled 10.6 reduction in Medicare physician payments by July 1, without Congressional action. The bill also included provisions to address serious, long-standing Medicare problems faced by millions of seniors on fixed incomes struggling every day with rapidly rising Medicare, food, and gasoline costs.

To pass a procedural hurdle and move forward, the Baucus bill needed 60 votes. In the 54-39 final tally, the bill had the support of all Democrats present and Sens. Snowe (R-ME) and Smith (R-OR), who were original co-sponsors of the legislation. Joining them were Republican Sens. Coleman (MN), Specter (PA), Collins (ME), Dole (NC), Stevens (AK), Roberts (KS), and Murkowski (AK). If you are from one of these states, NCOA encourages you to thank these senators for their support and to include low-income provisions as the negotiations move forward.

NCOA strongly opposes the alternative bill introduced by Sen. Grassley (R-IA), the Preserving Access to Medicare Act. The Grassley proposal fails to include the provisions in the Baucus bill that would improve low-income protections against rising Medicare costs and enhance access to mental health and preventive services.

Senate leaders now will negotiate on a smaller Medicare package. As this process moves forward, NCOA will continue to urge Senate leaders to retain the modest yet critical improvements for America’s most vulnerable seniors.

2. CMS Provides $15 Million for SHIPs

The Centers for Medicare & Medicaid Services (CMS) announced that an additional $15 million will be distributed to State Health Insurance Assistance Programs (SHIPs) to help people with Medicare get more information about their healthcare choices.

The $15 million is the second of three installments of SHIP funding in 2008 and will be distributed in June. CMS will distribute over $50 million to SHIPs in 2008; of that, $36 million was distributed on April 1 and an additional $1.5 million will be distributed in performance-based awards to SHIPs in September.

CMS expects the SHIPs to use the increased funding to conduct community-based programs targeted at reaching more beneficiaries who are unable to access other sources of information such as Medicare.gov. SHIPs will continue their outreach and assistance to Medicare beneficiaries and their caregivers, as well as to beneficiaries with limited incomes who may be eligible for the Extra Help with their prescription drug costs.

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3. Outreach Effort Helps Beneficiaries Lower Costs of Supplies

Nearly four million Medicare beneficiaries in 10 communities will receive information about a new program set to begin July 1 that will lower their costs for certain medical equipment and supplies by changing where people get the equipment and supplies and how Medicare pays for these items.

CMS will begin mailing letters on the new program to beneficiaries later this month. The mailing also will include a brochure about the new program and a list of Medicare contract suppliers in their area.

CMS is sending similar information to local partner groups and durable medical equipment referral agents, such as hospital discharge planners, physicians’ office staff, and home health agency social workers. The 10 communities include certain ZIP codes in the areas of Charlotte, NC; Cincinnati and Cleveland, OH; Dallas/Fort Worth, TX; Kansas City KS-MO; Miami and Orlando, FL; Pittsburgh, PA; Riverside, CA; and San Juan, PR.

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4. Learn How to Assist People with Low Health Literacy

Marisa Scala-Foley, associate director of the NCOA-led Access to Benefits Coalition, will be a panelist at a free Webinar sponsored by AstraZeneca on health literacy. The event is set for June 24 at 1 p.m. Eastern.

Panelists will provide case studies and statistics, detail one manufacturer’s efforts to successfully revise its patient assistance program application with patient usability in mind, and offer real-world strategies to assist patients with low-literacy levels and cultural barriers.

Register online using event code AZW520.

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5. OIG Examines Part D for Dual-Eligible Nursing Home Residents

The Department of Health & Human Services Office of the Inspector General (OIG) has issued a final report assessing the availability of Medicare Part D drugs to dual-eligible nursing home residents.

Researchers interviewed nursing home administrators, medical directors, and directors of operations for long-term care pharmacies and found that most dual-eligible nursing home residents are receiving all necessary Part D drugs. However, nursing homes and long-term care pharmacies sometimes pay for Part D drugs that are not covered by plans.

Respondents expressed concerns that formularies, the prior authorization process, and copayments may pose problems for dual-eligible nursing home residents, and that long-term care pharmacies generally do not disclose to physicians the rebates they receive from drug manufacturers. The OIG recommended that CMS address these issues.

A second OIG report found that some nursing homes and long-term care pharmacies are not following CMS rules prohibiting them from requesting, requiring, coaching, or steering residents into certain Part D plans. Nearly 40 percent of nursing home administrators and 26 of the 79 pharmacy directors interviewed reported that their nursing home or long-term care pharmacies identified multiple plans that met dual-eligible residents’ needs or provided a general list of plans that the pharmacy recommended to all residents.

However, about nine percent of nursing home administrators and six of the 79 pharmacy directors reported enrolling most dual-eligible residents in a single plan or recommending one plan to each resident. The remaining respondents reported that they provide only general information about the benefit or no assistance at all.

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6. Medicare Drug Plan Premiums on the Rise

Average monthly premiums for enrollees in the 10 most popular Medicare prescription drug plans (PDPs) increased by 16 percent in 2008, according to a new analysis by Avalere Health.

While seniors faced a 16 percent average premium price increase between June 2007 and April 2008, some of the most popular plans—including Humana PDP Standard, AARP MedicareRx Saver, and WellCare Classic—raised their premiums by more than 50 percent. For example, AARP MedicareRx Saver raised its average premiums from $14.43 in 2007 to $26.56 in 2008—an 84 percent difference, researchers found.

The analysis also discovered that the average premium increase was lower than if Medicare beneficiaries had stayed in the same top 10 plans as last year. If beneficiaries in the top 10 plans for 2007 had stayed in their plans, premiums would have increased by about 21 percent.

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7. Medicare Advantage Grows at Unprecedented Rate

Medicare Advantage (MA) plans enrolled a record 9.8 million beneficiaries, more than one in five of the nation’s 44 million people on Medicare as of April 2008. That represents an increase of more than 800,000 beneficiaries in just four months, according to a new issue brief prepared for the Kaiser Family Foundation by Mathematica Policy Research.

Medicare HMOs account for the largest share of MA enrollment (65 percent), but private fee-for-service plans are driving the increase in market penetration, accounting for 20 percent of total enrollment as of December 2007, up from three percent in 2005.

More than one in five beneficiaries living in urban areas is enrolled in a MA—more than double the enrollment rate among beneficiaries living in rural areas. Rural areas are experiencing the most rapid growth in MA penetration, however, driven largely by the expansion of private fee-for-service plans.

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8. New AARP Reports Available

AARP has several new reports of interest:

• The latest AARP Rx Watchdog Report presents the most recent studies of changes in manufacturers’ prescription drug list prices. They are based on drugs widely used by Medicare beneficiaries and compare price changes with the rate of inflation. The report also presents differences in average price changes by manufacturer and by major therapeutic category.
• Quick Health Facts 2008: A Compilation of Selected State Data provides a snapshot of each state’s healthcare landscape by providing comparable state-level and national data for over 30 indicators. Data are presented for each state and the District of Columbia in regard to demographics, Medicare, Medicaid, and health insurance coverage.
• Energy and Telephone Assistance in the States II: Public Programs that Help Low-Income Households identifies and describes programs that federal and state governments have mandated, funded, or approved to help low-income households initiate and maintain energy and telephone service. The report facilitates comparisons between and among states and across services.

Benefits Alert is published by the National Council on Aging for members of the Access to Benefits Coalition. Jean Van Ryzin, Editor, jean.vanryzin@ncoa.org. Copyright © 2008. All content is copyrighted and must not be reproduced or distributed to others without written permission.

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