Kanjorski Cosponsors Bill To Reimburse States for Emergency Medicare Expenses Says Response from Centers for Medicare and Medicaid Services Is ‘Outrageous' WASHINGTON - Congressman Paul E. Kanjorski (PA-11) is helping to introduce a bill that would reimburse states for the emergency actions they are taking to provide medicines to lower-income seniors who are unable to access their Medicare prescription drug coverage. According to media reports, the Centers for Medicare and Medicaid Services (CMS) is refusing to reimburse the states. Medicare Administrator Mark McClellan said CMS "does not have the authority to pay states directly" under the Medicare Prescription Drug Improvement and Modernization Act of 2003. "The Medicare Prescription Drug program is clearly facing major problems and it is the lower-income seniors and disabled who are paying the price when they try to fill their prescriptions. Tens of thousands of elderly people have been improperly charged unaffordable copayments, and many have left their pharmacies without their medications. In some cases, these medications are life-sustaining drugs for heart problems, high blood pressure and diabetes, and missed dosages could prove fatal. It is outrageous that the Centers for Medicare and Medicaid Services refuse to reimburse states when the problems are a result of poor planning and administrative problems on their part," Congressman Kanjorski said. "I commend Governor Ed Rendell's swift response to the problem in Pennsylvania. State governments have generously stepped in to clean up a mess created by the federal government. I urge all Members of Congress to act quickly to heed the example of our fine governors and support this bill to reimburse all of the states that have taken the humanitarian action needed to make sure our most vulnerable elderly citizens get the drugs that are keeping them alive." Many lower-income and disabled seniors are dual-eligible, or eligible for both Medicaid and Medicare. The new prescription drug program was supposed to automatically enroll these dual-eligible beneficiaries in a plan to ensure there was no lapse in coverage. Unfortunately, the complexity of the new program has resulted in great confusion in its implementation. Pharmacists are having difficulty verifying the enrollment of dual-eligibles in a particular Medicare Part D plan. They cannot verify the eligibility of many of those who qualify for Medicare Part D because the beneficiaries are not in the database. Additionally, pharmacists are facing long waits on the telephone or are unable to get through to help lines because of the high volume of calls to CMS. The Centers for Medicare and Medicaid Services (CMS) have reported that they are trying to resolve these issues, but many states, including Pennsylvania, have stepped in to offer immediate help. Gov. Rendell directed Pennsylvania Department of Public Welfare's Medical Assistance program to pay the balance of any copayments that are more than $5 for people who are dual-eligible. On Jan. 1, the federal government began transferring 250,000 eligible Pennsylvanians from the state's medical assistance program to the Medicare Prescription Drug Program. - 30 - Attached below is the press release from Gov. Rendell's office and the letter to Centers for Medicare and Medicaid Services from the Pennsylvania Department of Public Welfare:
FOR IMMEDIATE RELEASE:
STEM MEDICARE CRISIS FOR VULNERABLE CITIZENS HARRISBURG - Governor Edward G. Rendell acted today to provide prescription drug assistance to Pennsylvania's seniors and others who are having difficulty getting their prescriptions filled because of problems with the implementation of the new federal Medicare Part D program. "It is unconscionable that these vulnerable Pennsylvanians can't get their prescriptions filled and we're doing everything we can to fix this during the start of this new federal program," Governor Rendell said. "I have directed the Department of Public Welfare's Medical Assistance program to pay for any required Medicare Part D co-pays of more than $5 for our citizens until the problem is fixed by the federal government. People should continue to go to their pharmacies and get whatever medicine they need." Some poor, disabled and elderly people are reportedly being charged large co-payments because they were misidentified in computer programs as being ineligible for the lower co-payments. In order to ensure that clients receive needed drugs, the Department of Public Welfare will allow pharmacies to bill Medical Assistance for any required co-pays over the low-income subsidy level of $1, $3 or $5.
"While we appreciate the efforts of the regional office of the federal Centers for Medicaid and Medicare to resolve these difficulties, the state also has a responsibility to act so that our citizens will not go without essential medications," the Governor said.
### EDITOR'S NOTE: The text of the letter DPW Secretary Estelle Richman today sent to CMS follows:
Mark B. McClellan, M.D., Ph.D. Dear Dr. McClellan: We appreciate all the efforts of you and your staff to ensure a smooth transition for all individuals who are dually eligible for Medicare and Medicaid into Medicare Part D. As with any new system, there have been challenges and we have been in close contact with your staff to remedy problems as they arise. Since the implementation of Part D on January 1, there is one significant problem that is creating a barrier to dual eligibles receiving essential medications. In many cases, the Medicare system is not yet identifying dual eligibles as low-income subsidy eligible, subject to nominal cost sharing of $1-$5. The pharmacies are therefore charging these individuals amounts up to the standard 25 percent cost sharing, which may be as much as $250, the Part D deductible. In some cases, clients are scraping together the funds to pay these erroneous charges and in other cases, they are leaving the pharmacy with no medications. We know that this problem will be alleviated in the coming days or weeks, but until it is, we in Pennsylvania believe an immediate solution is needed to ensure that our most vulnerable citizens receive their lifesaving medications. Therefore, Pennsylvania will be paying the co-pay overage (the amount individuals are inappropriately charged over the low-income subsidy level co-pay of $1, $3, or $5) for our dual eligibles during the transition period. In contrast to other states, we are not proposing to pay the full drug costs for dual eligibles because these costs are clearly the responsibility of CMS and the plans. We understand that the inappropriate overcharges appear to result from systems glitches, characteristic of bringing up a new program of this magnitude. However, we do expect to fully recoup, from CMS and the plans, the payments Pennsylvania will make to cover the erroneous charges. We cannot let this mistake be an obstacle to ensuring that our citizens receive their critical medications. We expect to spend no more than $2 million on this stopgap measure during the month of January. We look forward to working with your staff on this reconciliation once the initial transition period ends. Your Philadelphia regional staff have been extremely helpful to us in solving individual client problems and we will continue to collaborate with them, monitoring the progress CMS is making towards rectifying this and other Part D issues.
Sincerely,
|
|||