CMS Plans for State Reimbursements for Medicare Drug Costs
The Bush administration plans to announce the details of a system in which states can file claims with the federal government to obtain reimbursements for costs incurred during the launch of the Medicare prescription drug benefit, CMS Administrator Mark McClellan told governors on Monday as part of a meeting of the National Governors Association in Washington, D.C., Reuters/Houston Chronicle reports.
More than 40 states took emergency steps to ensure that dual eligibles -- individuals eligible for both Medicare and Medicaid -- could obtain medications after reports that some beneficiaries experienced problems with access to treatments under the prescription drug benefit, according to Reuters/Chronicle. Most states have sought reimbursements from the federal government for costs related to the emergency steps (Reuters/Houston Chronicle, 2/28).
The federal government has agreed to reimburse states for those costs (California Healthline, 2/27).
On Monday, McClellan said that states will have the ability to file claims with the federal government, which will "send them payments back out within about four weeks of getting clean claims." He added, "The states don't have to interact with the health plans at all" (Reuters/Houston Chronicle, 2/28).
New Jersey Gov. Jon Corzine (D) said that he will "take Dr. McClellan at his word" about the reimbursements. He added, "You can never be satisfied until he puts the number on the check. This is as good as you are going to get in a public forum" (Cohen, Newark Star-Ledger, 2/28).
In related news, Democratic lawmakers have continued "stepping up their attacks" on the Medicare prescription drug benefit, which they consider "an increasingly ripe issue" for the midterm elections in November, the Washington Post reports. On Monday, Senate Democrats heard testimony on the Medicare prescription drug benefit from five health policy experts at a Democratic Policy Committee hearing (Murray/Babington, Washington Post, 2/28).
Committee Chair Byron Dorgan (D-N.D.) said that problems with the Medicare prescription drug benefit could damage the program in the long-term without legislative revisions. "It won't take much more time to elapse until it becomes evident to everyone that if we don't fix this ... the benefit that is so needed by seniors won't work," Dorgan said.
Robert Hayes, president of the Medicare Rights Center, said that Medicare beneficiaries should have the option to purchase prescription drug coverage directly from Medicare.
Thomas Rice, a professor at the School of Public Health at University of California-Los Angeles, said that lawmakers should consider a limit on the number of private plans that can participate in the Medicare prescription drug benefit to simplify options for beneficiaries (CongressDaily, 2/28).
On Tuesday, Democratic lawmakers plan to present concerns raised about the Medicare prescription drug benefit by beneficiaries at the almost 100 town hall meetings they held over President's Day weekend.
House Minority Leader Nancy Pelosi (D-Calif.) said that Democratic lawmakers advocated "a complete overhaul of this disastrous prescription drug plan."
Democratic lawmakers proposed revisions such as a six-month delay of the current May 15 enrollment deadline, the authorization of Medicare to negotiate prescription drug prices directly with pharmaceutical companies and the elimination of subsidies to managed care plans that participate in the program (Washington Post, 2/28).
USA Today on Tuesday examined physician concerns that the "complex tangle of rules, paperwork and telephone delays" related to the Medicare prescription drug benefit is "keeping some patients from drugs they have taken for years."
Physicians said that prior authorization requirements, quantity limits and delays in communications with Medicare prescription drug plans have led to problems with access to medications for some beneficiaries.
Sam Muszynski, director of health care systems at the American Psychiatric Association, added that Medicare prescription drug plans reject most claims submitted for psychiatric medications.
Karen Ignagni, president and CEO of America's Health Insurance Plans, said that health insurers have increased staff at telephone lines and plan to have simplified forms available within two weeks for physicians to request exceptions to Medicare prescription drug plan coverage limits (Appleby, USA Today, 2/28).