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CMS and SSA Roll Out Medicare Drug Benefit with Help from States
May 31, 2005

The Centers for Medicare and Medicaid Services (CMS) has issued information on the Medicare Modernization Act (MMA) relating to prescription drug benefits for Medicare beneficiaries. In late May through June CMS is mailing notices to Medicare beneficiaries who are automatically eligible to receive a low income subsidy to help with paying for a Prescription Drug Plan (PDP). These include persons who receive both Medicare and Medicaid, Supplemental Security Income, and Medicare Savings Program coverage. The notice can be viewed at www.cms.hhs.gov/medicarereform/lir.asp. This site is a repository for information on the Medicare Modernization Act. During the summer, the Social Security Administration (SSA) will mail a letter and an application to those who do not automatically qualify for the low income subsidy, but may potentially be eligible. This letter can be viewed by accessing www.ssa.gov/organizations/medicareoutreach2 and selecting "Application for Help with Medicare Prescription Drug Plan Costs." The application itself should be available online in July. This site contains SSA fact sheets and bulletins related to MMA prescription drug benefits and eligibility.

The Pennsylvania Departments of Public Welfare (DPW) and Aging have been working together on outreach efforts and training. The Office of Income Maintenance (OIM) is preparing county assistance office and central office staff to screen and process low income subsidy applications and to screen them for eligibility for other benefits. OIM will have a centralized unit for processing the applications. OIM officials encourage Medicare beneficiaries to process applications through OIM, even if they believe their income might be too high to qualify for other programs, since there are many deductions that can be made that might lead to eligibility. OIM will receive information from SSA monthly on persons who are eligible for the low income subsidy in order to outreach on eligibility for other assistance programs. OIM has prepared fact sheets for legislators on MMA with contacts for more information. It plans to distribute letters to individuals who receive assistance within the next few weeks.

The DPW policy office is working to coordinate education and outreach throughout the program offices - Medical Assistance, Mental Health and Substance Abuse Services, Mental Retardation, and Social Programs. The Office of Medical Assistance Programs is working on notice to Medicaid recipients that they will no longer receive drug benefits through Medical Assistance beginning on January 1, 2006.

The Apprise Program through the Pennsylvania Department of Aging is training counselors to assist Medicare beneficiaries with selecting PDPs. Counseling on MMA is not limited to persons older than age 60. Educational programs will be available, as well as individual counseling.

Beginning in May, Medicare beneficiaries will receive letters from multiple agencies regarding drug benefits. It is likely to be very confusing to people. Providers are encouraged to learn the basics about MMA and who their local contacts are for referrals for more information. Apprise counselors should be a good source of information. County assistance offices may also be helpful with information as well as processing low income subsidy applications. The Pennsylvania Health Law Project has useful information available on its web site (www.phlp.org/Medicare%20Part%20D.asp). Also, the information available on both the CMS and SSA web sites should be helpful. Over the next months several presentations are planned for PCPA members on MMA, including a presentation by David Gates of the Disabilities Law Project to the Mental Retardation and Mental Health Committees in June and a session by CMS during the annual conference. More information will be made available as implementation in January 2006 approaches. Please contact Betty Simmonds with questions.

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