Glitches Between CMS, Social Security Ongoing Problem
A glitch last month that caused the government to erroneously reimburse about 230,000 Medicare beneficiaries for their prescription drug benefit premiums is the latest of several mistakes in the "strained, often dysfunctional relationship" between CMS and the Social Security Administration, the New York Times reports. CMS administers the drug benefit and SSA deducts some beneficiaries' premiums from Social Security checks.
According to the Times, CMS and SSA officials for "more than a year ... have struggled to mesh their computer systems so that Medicare premiums are correctly withheld from Social Security checks and low-income people get the extra help to which they are entitled." The task of transferring data between the two agencies is further complicated because the information also is gathered and used by private insurers who sponsor Medicare drug plans, "each with its own procedures and computer systems," the Times reports.
The Times reports that federal officials have identified four categories of problems:
- Beneficiaries who requested that their premiums be deducted from their Social Security checks, but the government has not fulfilled their requests, so they owe several months of premiums;
- Beneficiaries who told the government to stop deducting the premium, but the deductions have continued;
- Beneficiaries whose premiums were correctly deducted, but their insurers have not received the payments from the government; and
- Beneficiaries who changed drug plans but are still having premiums deducted for the original plan.
CMS Administrator Mark McClellan in a recent letter to SSA Commissioner Jo Anne Barnhardt wrote about "the unnecessary complexity" of SSA's computer system, which he said performs "more than 40 edits" each time a Medicare beneficiary requests a transaction. McClellan wrote, "In the past, my staff has felt that significant concerns they have expressed have not been taken into account by Social Security."
For example, he said, SSA officials in 2004 established the "technical details of the data exchange" between the agencies without fully taking into account the mandates of the 2003 Medicare law or concerns raised by Medicare officials. He added, "We have only been allowed to submit data to your system for about 10 business days out of each month. Because of your system design, SSA will not process transactions outside of that window."
Beatrice Disman, chair of the Medicare Planning and Implementation Task Force at SSA, said, "What the public has to understand is that Social Security is at the end of the trail. We rely on information provided by Medicare." In reference to the number of "edits" on beneficiary requests, Disman said, "We may have information that a person is in the ABC [drug] plan. Now Medicare tells us to withhold premiums for the XYZ plan. We have to verify that" (Pear, New York Times, 9/25).
In related news, the Washington Post on Monday examined how "millions" of Medicare beneficiaries are facing prescription drug cost increases under the so-called "doughnut hole" of the Medicare drug benefit. Under the doughnut hole provision, beneficiaries are responsible for 100% of annual prescription drug costs between $2,250 and $5,100.
Medicare covers 95% of drug costs beyond $5,100. Medicare officials estimate than about three million beneficiaries enrolled in the drug benefit will reach the doughnut hole this year.
McClellan said beneficiaries who reach the doughnut hole should continue to use their Medicare drug cards so that they get the prices negotiated by their drug plans. Beneficiaries also can apply for prescription drug assistance programs offered by states and pharmaceutical companies or call Medicare for help, he said.
"There are lots of places to go to get lower-priced drugs, to get additional help with you drug costs," McClellan said.
Chris DeYoung, community outreach coordinator for Iona Senior Services in Washington, D.C., said, "I don't think everyone really appreciates the doughnut hole, or they thought it'd be narrower than it is."
Robert Hayes, president of the Medicare Rights Center, said, "Virtually everyone who calls to say they've been denied coverage, they're shocked. Trying to explain that this is the way the program was created by Congress angers folks who think it makes no sense" (Lee/Levine, Washington Post, 9/25).