[Guidance Overview] CMS’s Medicare Part D Benefit Parameters for 2010

[Guidance Overview] CMS’s Medicare Part D Benefit Parameters for 2010
Excerpt: “EBIA Comment: The new parameters will help group health plan sponsors determine whether their plans’ prescription drug coverage is creditable for 2010. This information is needed for the disclosures that must be made annually and at other specified times to Part D eligible individuals and to CMS [Centers for Medicare & Medicaid Services].” (Employee Benefits Institute of America)
Source: www.ebia.com

[Guidance Overview] Health Plan Insurer Could Not Terminate COBRA Coverage When Qualified Beneficiary Became Covered Under Medicaid
Excerpt: “EBIA Comment: Plan administrators often confuse the rules for Medicare under Title XVIII of the Social Security Act (SSA) (which provides health coverage to individuals on the basis of age, disability, or end-stage renal disease), and Medicaid under Title XIX of the SSA (which generally provides health coverage to low-income individuals) and how they interact with employer-sponsored group health plans. As this case illustrates, ERISA broadly prohibits a health plan from taking into account an individual’s Medicaid eligibility. On the other hand, COBRA coverage may be terminated early if, after electing COBRA, a qualified beneficiary becomes entitled to benefits under Medicare. Although this court did not specifically address this distinction, this case is a good reminder that the COBRA early termination rule for Medicare entitlement does not extend to Medicaid.” (Employee Benefits Institute of America)
Source: www.ebia.com

Walgreens says it met state 2/3rds of the way on Medicaid reimbursements (The Delaware Business Ledger)
Walgreens restarted the war of words with the state of Delaware, claiming it had gone more than halfway in negotiations with the State of Delaware over new Medicaid pharmacy rates by previously agreeing to accept nearly two-thirds of the rate cut proposed by the state.
Source: www.ledgerdelaware.com

Proposed care cuts prompt fight – Raleigh News & Observer
Two distinct narratives are at war in a controversy over whether North Carolina should cut as much as $100 million over two years from in-home care for older and disabled people. Called personal care services, the program cost the state more than …
Source: www.newsobserver.com

Drug deal may be bad trip for Democrats – Politico.com
A Senate-side deal last month with drug manufacturers is coming back to bite House Democrats looking for savings to pay for their own health care reform bill this summer. Having struck a bargain with Senate Finance Committee Chairman Max Baucus (D …
Source: www.politico.com

DELAWARE: Walgreens postpones cut-off for patients on Medicaid (The Daily Times)
DOVER – Delaware and its biggest pharmacy chain have agreed to spend another month trying to work out an agreement on Medicaid reimbursement rates, averting for now a scenario that would have limited the places where thousands of low-income people could fill prescriptions.
Source: www.delmarvanow.com

The Effect of Medicare Part D Coverage on Drug Use and Cost Sharing Among Seniors Without Prior Drug Benefits
Excerpt: “This study evaluates the effect of Medicare Part D among seniors who previously lacked drug coverage, using time-trend analyses of patient-level dispensing data from three pharmacy chains. Of 114,766 seniors without drug benefits, 55 percent initiated drug insurance under Part D. After the penalty-free Part D enrollment period, use of statins, clopidogrel, and proton pump inhibitors stabilized at levels ranging from 11 percent to 37 percent above the trend that would have been expected if Part D had not been implemented.” (Health Affairs)
Source: content.healthaffairs.org

Medicare Secondary Payer User Guide Updated With Guidance for Responsible Reporting Entities and Group Health Plans
Excerpt: “EBIA Comment: [‘Responsible reporting entities’] will likely welcome any assistance to deal with the thorny problem of collecting [Medicare Health Insurance Claim Number]/SSNs. It remains to be seen, of course, whether the new strategy will result in a higher level of cooperation from subscribers and their dependents. Collecting information about dependents is particularly difficult since information about them is harder to obtain and often less accurate than for subscribers. ” (Employee Benefits Institute of America)
Source: www.ebia.com

Medicaid expansion idea turns up heat (St. Louis Post-Dispatch)
WASHINGTON — Medicaid‘s role in health care is emerging as a flash point, exposing policy and political rifts not only between the two parties but also among Democrats themselves. Congressional Democrats are pressing for a major expansion in the state-federal program for the poor and disabled.
Source: www.stltoday.com

[Guidance Overview] CMS Revision of Indexed Medicare Part D Amounts for 2010, Updated April 8, 2009
Excerpt: “In an April 6, 2009 announcement, the Centers for Medicare & Medicaid Services (CMS) revised and made final the indexed Medicare Part D standard benefit and Retiree Drug Subsidy (RDS) amounts for 2010, previously announced in an advance notice. This Capital Checkup features charts comparing the final 2010 numbers and the 2009 numbers.” (The Segal Group, Inc.)
Source: www.sibson.com

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