SETTLEMENT TO SPEED PART D EXTRA HELP

A federal district court judge has conditionally approved a settlement reached between the Centers for Medicare and Medicaid Services (CMS) and plaintiffs in a class action lawsuit filed in 2006. The National Senior Citizens Law Center (NSCLC) and the Center for Medicare Advocacy (CMA) filed a class action lawsuit on behalf of more than 6 million low-income people with Medicare and Medicaid – dual-eligibles – who are entitled to the Medicare Part D Low-Income Subsidy (Extra Help), but had difficulty accessing the benefits because of CMS’ failure to process enrollments in a timely manner.

In the settlement, CMS agreed to make changes to the enrollment process, allowing people with Medicare to benefit from the Extra Help program sooner. Extra Help assists people with the cost of prescription drug plan premiums, deductibles, and copayments. Currently, CMS processes the information provided by states only once a month. As a result of the settlement, CMS will process the information provided by states within one business day of receiving the information. This will allow people to access their Part D and Extra Help benefits more quickly.

In instances when CMS has not notified a prescription drug plan that an enrollee qualifies for Extra Help, the plan must accept evidence – such as a Medicaid card – that shows the person is eligible for Extra Help. Once the plan receives evidence of eligibility, the plan must update its system to show that the enrollee is enrolled in Extra Help.

Under the current system, it is up to the person with Medicare to prove that he or she qualifies for Extra Help. Under the settlement, when an enrollee cannot provide evidence of eligibility, the plan or CMS must contact the state Medicaid office to confirm if the enrollee is eligible for Extra Help. 

CMS has also agreed to educate pharmacists about the changes to the enrollment process. This is an important part of the agreement, since pharmacists will play a central role in ensuring that people are able to receive the benefits of the Extra Help program. 

Members of the plaintiff class will receive notice of the terms of the settlement within the next few weeks. Anyone who objects to the terms may appear at the fairness hearing scheduled for October 6, 2008. Once the settlement is approved, NSCLC and CMA will work with CMS to monitor the new enrollment process to make sure that people who qualify for Extra Help receive this coverage in a timely manner.  

-Adapted from: “ Settlement Makes it Easier to Get Part D Extra Help”, MEDICARE WATCH , a biweekly electronic newsletter of the Medicare Rights Center, Vol. 11, No. 15: July 22, 2008.

 

07/08