Source: http://medicareissimple.blogspot.com/2012/05/
Timestamp: 2017-11-24 13:00:37
Document Index: 301765275

Matched Legal Cases: ['§ 9', '§407', '§423', '§423', '§423', '§1395', '§423', '§407', '§411', '§407', '§1395', '§408', '§408', '§1837', '§406', '§1395', '§1395', '§423', '§4980', '§1161', '§300', '§1161', '§300', '§8905', '§1163', '§1161', '§1167', '§1163']

[1] See § 9.05 (Coordination of COBRA Rights and Medicare) of the "2012 Medicare Handbook," Wolters Kluwer Law & Business, written by the staff of the Center for Medicare Advocacy, Inc. The book is available through www.aspenpublishers.com.[2] 42 C.F.R. §§407.20, 406.24(a)(3). See also the "Medicare & You Handbook for 2012, p. 23. http://www.medicare.gov/publications/pubs/pdf/10050.pdf.[3] See 42 C.F.R. §423.38(c) (special enrollment period) as described in §423.38(c)(8)(ii). See also 42 C.F.R. §§423.46; 423.286(c)(3); 423.286(d)(3). The SEP begins with the month the beneficiary is advised of the loss of creditable drug coverage and ends 60 days from the loss of the coverage or from the date of the notice, whichever is later. See also, "Disclosure of Creditable Coverage to Medicare Part D Eligible Individuals Guidance, OMB 0938-0990 (Feb. 15, 2007), https://www.cms.gov?CreditableCoverage/Downloads?updated_
Guidance_02­­­_15_07.pdf. A Part D eligible individual must pay the late penalty if there is a continuous period of 63 days or longer at any time after the end of the individual's initial enrollment period during which the individual meets all of the following conditions: (1) The individual was eligible to enroll in a Part D plan; (2) The individual was not covered under any creditable prescription drug coverage; and (3) The individual was not enrolled in a Part D plan. 42 U.S.C. §1395W-113(b)(2), 42 C.F.R. §423.46 (Late enrollment penalty).[4] 42 C.F.R. §§407.20(b), (c).[5] 42 C.F.R. §411.104.[6] 42 C.F.R. §§407.15(a), 407.25.[7] 42 U.S.C. §1395(r); 42 C.F.R. §408.22. See also Medicare's late enrollment penalty calculator: http://www.medicare.gov/MedicareEligibility/home.asp?dest=NAV%7CHome%7CResources%7CSurchargeCalcQuestions%
7CResourcesOverview&version.[8] See 42 C.F.R. §§408.24, 408.25. For disabled beneficiaries under age 65, the penalty will end when they turn 65. For persons under age 65 paying the penalty, the penalty goes away at age 65. See §1837(g)(1) of the SSA; POMS HI00805.085(B). Note, for Part A, the 10% penalty extends for twice the number of full 12 months of delay. 42 C.F.R. §406.32(d).[9] See 42 U.S.C. §1395W-113(b)(3).[10] 42 U.S.C. §1395W-113(b)(2), 42 C.F.R. §423.46(Late enrollment penalty).[11] See Pub. L. No. 99-272 (Apr. 7, 1986), 100 Stat. 222, codified at 26 U.S.C. §4980(b), 29 U.S.C. §1161 et seq, 42 U.S.C. §§300bb-1, et seq.[12] See 29 U.S.C. §1161(b). State and local governments employing more than 20 employees also must offer continuation coverage. 42 U.S.C. §300bb-1(a). Federal employees have their own health care continuation coverage. 5 U.S.C. §8905a.[13] See 29 U.S.C. §§1163(2), 1167(2).[14] 29 U.S.C. §1161(a).[15] 29 U.S.C. §1167(2), (3).[16] 29 U.S.C. §1163.
Posted by John Dubas at 8:13 AM No comments:
NASHVILLE, Tenn., May 15, 2012 (BUSINESS WIRE) -- HealthLeaders-InterStudy, the leading provider of managed care market intelligence, finds that the next wave of growth for health plans will come from states looking to them for experience with coordinated care for high-cost dual eligibles, according to the recently published National MCO Analyzer: Medicaid report. Dual-eligibles are high-cost patients who qualify for both Medicaid and Medicare benefits. The report finds that, 38 states are currently preparing dual-eligible coordination programs to begin in late 2012 or early 2013. Other states may follow suit.
"This increased care coordination of the dual-eligible segment, and the contracts' structure and savings requirements will mean that pharma can expect formulary designs to offer broad access to the best medications," said HealthLeaders-InterStudy Analyst Paula Wade.
In addition to the changes in dual-eligible coverage, states are also taking advantage of new federal funding to establish "healthcare homes" for Medicaid enrollees with chronic illnesses, according to the report. Medicaid MCOs are contracting with hospitals and physician practices that are equipped to coordinate care.
"Medicaid enrollees with chronic illnesses and the non-dual-disabled population are the highest utilizers of Medicaid pharmacy," said Ms. Wade. "These health homes may improve members' compliance with drug regimens."
The coordination for duals is not the only major change for Medicaid plans. Cash-strapped states are cutting optional services, raising cost sharing, trimming Medicaid expansion programs and cutting provider reimbursements.
Members of the media are welcome to attend our upcoming Medicaid Analyst Call entitled: Five Things You Need to Know About Medicaid Now. The call will be held on June 14th at 2 p.m. EDT For more information please contact Kristi Guillemette at kguillemette@dresources.com.
The National MCO Analyzer: Medicaid report includes a profile for each state and the District of Columbia to capture each program's unique structure and operation. An abstract of the report can be found here: http://hl-isy.com/Products-and-Services/National-MCO-Analyzer/MCO-Abstracts/2012/National-MCO-Analyzer--Medicaid
HealthLeaders-InterStudy, a Decision Resources Group company, is the authoritative source for managed care data, analysis and news. For more information, please visit www.HL-ISY.com . HealthLeaders-InterStudy is part of the Market Access Business Unit at Decision Resources Group which also includes Fingertip Formulary, Pinsonault and PharmaStrat.
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Posted by John Dubas at 2:50 PM No comments:
Nearly 3.2 million small businesses that employ more than 19 million workers are eligible for $15 billion in tax credits under the health reform law, according to a study released recently by the Small Business Majority and Families USA.
— Melanie Bella, director of the CMS Medicare-Medicaid Coordination Office established by the reform law, told an audience at a recent American Enterprise Institute panel discussion.
Posted by John Dubas at 12:57 PM No comments:
33% … of consumers are using social media for health-related matters, according to a recent survey by PwC’s Health Research Institute.
Posted by John Dubas at 9:03 AM No comments:
The Kaiser Family Foundation (KFF) released two reports this month that discuss the role of competition in Medicare spending under the Medicare prescription drug benefit (Part D), as well as proposals to address areas of limited competition, which could yield federal savings in the Medicare program.
Posted by John Dubas at 1:32 PM No comments:
Insurance Networking News, May 10, 2012
Posted by John Dubas at 11:20 AM No comments:
May 11, 2012 Volume 13 Issue 9
Managed care organizations are increasingly being put in a position of subsidizing consumer copay coupons as pharmaceutical manufacturers attempt to maintain market share of brand-name drugs. And while coupons may be considered beneficial by certain stakeholders outside the pharma industry, there are ways plans can curtail their use without negatively impacting the patient-clinician relationship, suggested two pharmacy benefit experts.