CMS Transitions Dual Eligible Beneficiaries to Medicare Part D
Responsibility for the prescription drug coverage for the more than 6 million Medicare beneficiaries who are also enrolled in Medicaid transitioned from state to federal government on January 1. To provide comprehensive coverage for these dual eligible beneficiaries, who often manage several conditions concurrently, the Centers for Medicare and Medicaid Services (CMS) has outlined a number of formulary requirements. According to the requirements, Medicare prescription drug plan formularies must offer benefits that reflect pharmaceutical best practices and treatment standards, must recognize the special needs of certain patients (e.g., those with disabilities, those in long-term care, those with human immunodeficiency virus), and must contain multiple drugs in each class. Each drug plan must also establish a transition process and must provide in-network coverage to all enrollees living in a long-term care setting.
The CMS also is using targeted education and outreach in partnership with federal agencies, faith-based organizations, health care providers, and community groups to raise awareness of the upcoming changes and to ensure continuity of prescription drug coverage and care. Other steps the CMS is taking to prevent any lapse in care include auto-enrollment, targeted assistance, collaboration with states, and point-of-sale protection. More information about the transition plan is available online at http://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_adp.php?p_faqid=6248. Patients seeking guidance can visit the CMS Web site at http://www.medicare.gov or call 800-MEDICARE (800-633-4227).
Campaign to Provide Community Education About Medicare Part D
In an effort to help Medicare beneficiaries understand the changes associated with the introduction of Part D, the National Council on the Aging and the Access to Benefits Coalition have launched an education campaign that will provide counseling and computer-based information to communities in 27 states. The program, “My Medicare Matters,” will have a continuous presence in communities for six months. Trained counselors will visit community centers, churches, and senior housing centers to provide beneficiaries and their families with one-on-one advice and guidance regarding the new coverage. The campaign Web site also features useful information for patients and can be accessed at http://www.mymedicarematters.org.
CDC Proposes Updates to Communicable-Disease Regulations
The Centers for Disease Control and Prevention (CDC) has proposed several changes to communicable-disease regulations that would allow the CDC to act more swiftly to control a potential outbreak of disease introduced into the United States by a passenger aboard a commercial airplane or ship. The proposed updates include expanding reporting of ill passengers on international and interstate flights and ships; requiring international, and certain interstate, flights and ships to maintain passenger and crew lists and to submit these lists electronically to the CDC on request; and explicit due process provisions for persons subject to quarantine (to be used only when a person does not cooperate with a voluntary request). The U.S. Department of Health and Human Services (HHS) is empowered to prevent entrance to the United States of persons believed to have one of nine specific diseases—pandemic influenza, cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers, and severe acute respiratory syndrome (SARS). Existing communicable-disease regulations have not been updated substantially for more than 25 years. The proposed changes were prompted by evaluation of the regulations following the SARS experience in 2003.
AAFP President Supports Family Medicine–Based Health System
In a recent interview, American Academy of Family Physicians (AAFP) President Larry Fields, M.D., Ashland, Ky., emphasized the importance of family medicine in the future of the U.S. health care system. Providing all Americans a medical home in a family physician’s office would automatically give them accessible quality care, Fields said. A family medicine–based health care system tied to liability reform, combining the cost-effectiveness of family medicine with the reduced risk of court action, Fields proposed, would improve health care for the U.S. population while reducing government and employer spending. For the full interview, visit the AAFP Web site at https://www.aafp.org/x40539.xml.
Health IT Bill to Benefit Rural and Underserved Communities
In November, the U.S. Senate passed the Wired for Health Care Quality Act (S. 1418), which supports the adoption of a nationwide, interoperable health information technology system. The bill provides $116 million in individual grants and state loans for physicians and nonprofit health care organizations to establish electronic health records, giving preference for awards to rural, frontier, and other underserved areas. Also specified in the bill is the availability of a toll-free telephone number or Web site through which physicians and patients can learn about federal grants, qualified health information technology, and local networks that provide assistance. To access the full bill online, visit http://thomas.loc.gov then search for “S 1418.”
HHS Agreements Support EHRs in Hurricane-Damaged Gulf Coast
The HHS has made agreements with two organizations—the Southern Governors’ Association and the State of Louisiana Department of Health and Hospitals—that will help establish the use of electronic health records (EHRs) in areas of the Gulf Coast affected by recent hurricanes. Although numerous paper medical records were destroyed by hurricane Katrina, electronic patient information was largely preserved. HHS Secretary Mike Leavitt stated that the hurricanes exposed the vulnerabilities of the U.S. health care system and demonstrated the need for electronic, interoperable health records. The HHS agreements are intended to help health care facilities in the Gulf Coast implement and support EHRs as they rebuild the records that were lost. For more information, visit the HHS Web site at http://www.hhs.gov.
CMS Modifies Vaccine Administration Code Descriptors
The CMS has revised the descriptors for vaccine administration codes G0008, G0009, and G00010, removing payment restrictions of the administration fee for a vaccine not covered by Medicare but administered on the same day as a Medicare-covered vaccine. The change is effective from January 1, 2006, and physicians may refile denied claims from this date. For more information go to http://www.cms.hhs.gov.
NIDA Campaign to Raise Awareness of Drug Abuse–HIV Connection
A new public awareness campaign, “Drug Abuse and HIV: Learn the Link,” has been launched by the National Institutes of Drug Abuse (NIDA) to raise awareness among adolescents and young adults of the links between drug abuse and human immunodeficiency virus (HIV). The number of young persons diagnosed with acquired immunodeficiency syndrome (AIDS) has increased in the past few years, and research shows that for many young people HIV infection is not a concern. Drug abuse may increase risky behaviors that promote the transmission of HIV and may interfere with the effectiveness of antiretroviral therapy. Drug abuse therapy therefore is considered by the NIDA to be an essential part of HIV prevention. The NIDA campaign, supported by many partner organizations, will be broadcasting public service announcements on television stations nationwide. A NIDA research report on the links between drug abuse and HIV is available on the campaign Web site, http://www.hiv.drugabuse.gov.