RCPA - Rehabilitation and Community Providers Association


CMS Distributes Revised Medicare Transition Notices
April 4, 2006

The Centers for Medicare and Medicaid Services (CMS) has distributed revised provider and beneficiary notices regarding changes established through settlement of Erb v. McClellan to the Medicare Part D transition period for dual eligible individuals passively enrolled in a Medicare Special Needs Plans (SNP). The transition period is extended until June 30.

According to the provider notice the additional time is intended to allow beneficiaries to continue to see their usual providers as they make decisions about whether to remain in the assigned SNP and change to providers who are enrolled in the plan network, to disenroll from the SNP and return to fee-for-service (FFS) Medicare, or to enroll in another Medicare Advantage plan. Providers who are not enrolled in a plan network can continue to provide services and submit claims to the beneficiary’s SNP through June 30. The SNP must pay the non-network provider the Medicare FFS rate or the billed charge, whichever is lower, for services provided through June 30. The notice suggests contacting plans directly for information about enrolling in the plan network or for questions about payment. CMS suggests that questions about transition policies first be addressed to the applicable plans, then to the CMS Philadelphia regional office (215-861-4154) if questions cannot be resolved. Contact information for the SNPs is available in the complete notice, New Information for All Medicare Participating Providers in Pennsylvania, available on the PCPA web site.

The beneficiary notice informs the beneficiary of the plan in which s/he is enrolled and that the transition plan is extended until June 30. It states that beginning July 1, if the beneficiary chooses to remain in the plan, then s/he must use the plan’s providers. It also provides information about how to change plans or return to FFS Medicare.

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