RCPA - Rehabilitation and Community Providers Association


MR Update #05-21: Medicare Part D Resources and Lawsuits, Venture Program, Strattera Warning, and SSI Increases
November 30, 2005

Medicare Part D
Ensuring Continuity of Care for Dual Eligibles: A Guide to Transition from Medicaid to Medicare’s Prescription Drug Coverage is now available at www.theDesk.info/PartD. This guide will assist dual eligibles in the selection of the prescription drug plan which will offer the best coverage based on the individual’s needs. Dual eligibles are individuals who receive both Medicare and Medicaid benefits because they qualify for Social Security Disability Insurance or Supplemental Security Income (SSI). It is estimated nationwide that there are 6.4 million individuals considered dual eligible and approximately 500,000 have developmental disabilities.

Medicare Federal Lawsuit
Eight advocacy groups filed a lawsuit against the federal government alleging that the Centers for Medicare and Medicaid Services (CMS) has failed to enact adequate safeguards to ensure that beneficiaries dually eligible for Medicare and Medicaid will not lose prescription drug coverage when their coverage switches to Medicare on January 1, 2006. CMS is automatically enrolling the 6.1 million dual eligibles and has assigned 5.4 million of them to randomly chosen prescription drug plans. The suit seeks a system under which dual eligibles would be guaranteed their existing Medicaid drug coverage until they are enrolled in a new plan that meets their needs. For additional information from the Kaiser Network press release access www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=33735.

Medicare State Lawsuit
The Pennsylvania Health Law Project and Community Legal Services are planning to file a lawsuit against CMS for permitting certain Medicare Health Management Organizations (HMOs) to disenroll some people without their consent from their regular Medicare coverage and put them into another Medicare HMO. This involuntary disenrollment is happening to persons age 21 and older who are on regular Medicare and also enrolled in AmeriHealth Mercy, Gateway, Keystone Mercy, MedPlus, and UPMC. The issue is due to the practitioners, therapists, providers, hospitals, and suppliers who accept regular Medicare but may not accept the Medicare HMO. The law project is seeking additional plaintiffs to join the lawsuit, especially adults with mental retardation, autism, brain injury, or mental illness. For additional information contact David Gates at dgates@phlp.org or 717-236-6310.

OMR Part D Video
Office of Mental Retardation (OMR) Medical Director Jill Morrow has developed a web cast regarding Medicare Part D Prescription drug coverage. This video will help providers of mental retardation services learn how they can help individuals choose a prescription plan. The web cast will be available for the next 60 days at http://presenter.tiu11.org/MediasiteLive30/LiveViewer/?peid=a6d369d5-afed-4666-b72a4e210a82. For information on accessing this site contact Beth Lawler at blawler@tiu11.org. OMR will be sending a copy of the video to licensed providers.

Venture Program
Bellevue Community College in Bellevue, WA has developed the first Associates in Essential Studies degree program in the US for individuals with learning, cognitive, and intellectual disabilities. Fifty-two courses have been approved for the new degree which requires completion of 90 credits that could take three to four years to complete. The Venture Program combines academics, social skills, and workforce training. The degree program tuition is $12,000 per year. For additional information access http://conted.bcc.ctc.edu/venture/default.asp or contact Cynthia Johnson (cjohnson@bcc.ctc.edu or 425-564-2844).

Strattera Warning
The Food and Drug Administration (FDA) has issued a public health advisory to physicians regarding the attention deficit disorder (ADD) medication, Strattera (Atomoxetine). Physicians and caregivers need to be alerted to the suicidal thinking that may occur in children and adolescents when taking this medication for ADD. Side effects include suicidal thinking or behaviors, worsening of clinical condition, agitation, irritability, or behavior changes. For additional information contact Crystal Rice, FDA (rice@cder.fda.gov).

Social Security Increases
Beginning in January 2006 the Social Security Administration will be giving a cost-of-living adjustment of 4.1 percent in cash benefits. This increases the maximum federal SSI benefit to $603 per month from $570 for an individual. The Substantial Gainful Activity level for people with disabilities will increase to $860 per month from the current $830.

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