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VOR ACTION ALERT

September 24, 2004

Medicare Part D and ICFs/MR

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Table of Contents

 

1. Action Needed

2. Template Letter

3. VOR Comments

 

[see also attached Word file for template letter and VOR comments].

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1.  Action Needed

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Your help is urgently needed. The Centers for Medicare & Medicaid Services (CMS) is accepting comments UNTIL MONDAY, OCTOBER 4, 2004 on proposed regulations relating to Medicare prescription medication coverage for individuals eligible for both Medicaid and Medicare (“dual eligibles”).

 

VOR’s comments are attached. As you can see, the most critical aspect of this proposed regulation for VOR’s constituency is whether CMS includes ICFs/MR in the definition of “long term care facilities.” Including ICFs/MR would afford dual-eligible residents (and, we argue, all such individuals eligible for ICF/MR placements) an exemption from co-pay requirements for prescription medication coverage.

 

We recognize that this is a complex issue. To make your participation easy, VOR has prepared a template letter for your use (see attached).

 

All comments must be RECEIVED BY MONDAY, OCTOBER 4, 2004. Your submission can be submitted electronically as an attachment (in Word, WordPerfect or Excel) to http://www.cms.hhs.gov/regulations/ecomments. You may also mail your comments (one original and two copies) to the following address:

 

Centers for Medicare & Medicaid Services

Department of Health and Human Services

Attention: CMS-4068-P

P.O. Box 8014

Baltimore, MD 21244-8014

 

THIS IS A CRITICALLY IMPORTANT ISSUE. PLEASE ACT TODAY. THANK YOU FOR YOUR PARTICIPATION!

 

REMEMBER: COMMENTS ARE DUE BEFORE MONDAY, OCTOBER 4, 2004.

 

Sincerely,

 

Tamie Hopp

Executive Director

 

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2. Template Letter

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DATE

 

Centers for Medicare & Medicaid Services

Department of Health and Human Services

Attention: CMS-4068-P

P.O. Box 8014

Baltimore, MD 21244-8014

 

 

RE:  Comments relating to Medicare Part D proposed regulations -  

69 Fed. Reg. 46632 (Aug. 3, 2004).

 

 

I/we support the attached comments submitted by Voice of the Retarded (VOR). We feel strongly

that –

  

ü      The definition of “long term care facility” must include Intermediate Care Facilities for Persons with Mental Retardation (ICFs/MR).

 

ü      “Institutionalized” should include all individuals eligible for ICF/MR placement, including current residents, home and community-based services (HCBS) waiver recipients, and eligible individuals on the waiting list for ICF/MR and HCBS waiver placements.

 

The regulations relating to Medicare Part D must, in all respects, allow for medication decisions based on individual need, not where someone lives.

 

Thank you for your consideration.

 

Sincerely,

 

NAME

TITLE (If representing an organization)

ADDRESS

PHONE/FAX/E-MAIL

 

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3. VOR Comments

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September 22, 2004

 

Centers for Medicare & Medicaid Services

Department of Health and Human Services

Attn:  CMS-4068-P

P.O. Box 8014

Baltimore, MD 21224-8014

 

Sent by regular mail and

electronically (http://www.cms.hhs.gov/regulations/ecomments)

 

On August 3, 2004, the Centers for Medicare & Medicaid Services released proposed regulations relating to section 101 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA). Included within this new law is a shift of payment authority from the states to the federal government for the purpose of providing medication coverage to people eligible for both Medicare and Medicaid (“dual eligibles”). Starting in 2006, this new Medicare prescription medication benefit will replace Medicaid prescription coverage for low income beneficiaries. Although a state may continue to provide “wrap around” prescription medication benefits through its Medicaid plan to compliment the new Medicare coverage, any such supplemental coverage will be at the state’s option.

 

Long term care facilities receive special mention in the new law. Although certain dual eligibles will be subject to Medicare premiums and cost sharing, full dual eligibles, including dual eligibles in “long term care facilities,” are exempt from co-payments. According to the proposed regulations, the definition of “long term care facility” is in question:

 

“We request comments regarding our definition of the term long-term care facility in §422.100, which we have interpreted to mean a skilled nursing facility, as defined in section 1819(a) of the Act, or a nursing facility, as defined in section 1919(a) of the Act. We are particularly interested in whether intermediate care facilities for the mentally retarded or related conditions (ICF/MRs), described in §440.150, should explicitly be included in this definition given Medicare’s special coverage related to mentally retarded individuals. It is our understanding that there may be individuals residing in these facilities who are dually eligible for Medicaid and Medicare. Given that payment for covered Part D drugs formerly covered by Medicaid will shift to Part D of  Medicare, individuals at these facilities will need to be assured access to covered Part D drugs.” [69 Fed. Reg. 46648-49 (Tuesday, August 3, 2004)].

 

VOR strongly agrees. As noted later in the regulations –

 

“It is particularly important to ensure that the drug needs of institutionalized Part D enrolles – most of whom are dually eligible for Medicare and Medicaid – are met. The institutionalized population is generally more sensitive to and less tolerant of many medications.” [69 Fed. Reg. 46661 (Tuesday, August 3, 2004)].