Re: Fwd: Issue 8, April 17, 2007

April 18, 2007

Are any of you responsible for getting the PA for Rx after the patients have been discharged or do the transplant nurses do this? Now I make the patient aware of their coverage for the Rx ( or getting them adequate coverage) and verify Par Pharmacies to obtain Rx. I am just curious

-----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of Louis Sent: Wednesday, April 18, 2007 10:42 AMTo: TxFinancialCoordinators Subject: Fwd: Issue 8, April 17, 2007

Welcome to MEDICARE WATCH, a biweekly electronic newsletter of the Medicare Rights CenterVol. 10, No. 8: April 17, 2007Contents:

FAST FACT SENATE PANEL APPROVES DRUG PRICE NEGOTIATIONS BILL DISABILITY ADVOCATES PRESS CONGRESS TO END MEDICARE WAIT SENATORS INTRODUCE BIPARTISAN MEASURES TO IMPROVE PART D NEW: MEDICARE PRIVATE HEALTH PLAN MONITORING PROJECT CASE FLASH: MEDICARE PRIVATE HEALTH PLAN FRAUD

1. FAST FACTMedicare will distribute $30 million to help fund State Health Insurance Assistance Programs (SHIPs), which provide counseling to people with Medicare. Funding will be based on each state’s Medicare population (“ Medicare Gives $30M for Senior Counseling,” United Press International, April 11, 2007).2. SENATE PANEL APPROVES DRUG PRICE NEGOTIATIONS BILLThe Senate Finance Committee approved legislation April 12 that would lift the prohibition on Medicare drug price negotiations. The bill (S. 3) now goes before the full Senate for a vote this week.Under the Medicare Modernization Act of 2003, which created Part D, the federal government is barred from negotiating with drugmakers for lower prescription drug prices, leaving it to private plans to negotiate individually.While the proposed legislation would authorize the health and human services secretary to negotiate on behalf of people with Medicare, it does not require the negotiation. A House bill passed in January goes further, requiring negotiation. The Bush administration has threatened to veto that bill.The Senate bill does include a provision requiring companies sponsoring private drug plans to report price, cost and claims data to agencies that advise Congress. It also gives states access to drug claims data on people with both Medicaid and Medicare, and makes information on drug prices charged by plans available when individuals purchase their medicines. 3. DISABILITY ADVOCATES PRESS CONGRESS TO END MEDICARE WAITIn a letter sent to key members of Congress last week, over 30 patient advocacy groups, including the Medicare Rights Center, United Cerebral Palsy, the National Multiple Sclerosis Society, Easter Seals and Paralyzed Veterans of America, called on legislators to eliminate the two-year waiting period for Medicare for people with disabilities.“The two-year Medicare waiting period affects more than those individuals who are now struggling to survive until their Medicare coverage begins,” stated the letter. “Every American is at risk of a severely disabling illness or accident. For individuals with progressive illnesses that all but guarantee that they will one day have to file for disability, this built-in gap in coverage is a virtual certainty.”The letter was sent to House Speaker Pelosi and Senate Majority Leader Harry Reid, as well as to Democratic and Republican leaders of the Senate Finance Committee, House Ways and Means Committee and the House Energy and Commerce Committee.In the letter, the groups ask the lawmakers to eliminate the two-year waiting period and enable people with disabilities to “receive Medicare coverage as soon as they begin receiving Social Security Disability Insurance benefits.”After individuals are determined by the Social Security Administration to be unable to work due to debilitating health conditions and qualify for disability income, they must wait five months for their first SSDI payment and another two years before they can enroll in Medicare. The two-year wait was written into law when Congress first extended Medicare to people with disabilities in 1972.A new report from the Medicare Rights Center chronicles the experiences of 21 people with disabilities as they endured the two-year wait for Medicare coverage that begins when they first receive Social Security Disability Insurance.During their wait for Medicare, many people are unable to afford the costs of medical care, go into debt and ending up in worse health, according to the report. The 24-month wait for Medicare coverage resulted in serious medical and financial burdens: some individuals spent their savings on private insurance and soon became unable to continue paying high premiums for COBRA coverage; others recounted going without medical checkups and treatments until Medicare began covering them.According to the report, there are about 1.5 million people in the waiting period. Among them, 600,000 are uninsured. Twelve percent of individuals in the waiting period die each year while waiting for Medicare coverage.Allowing all people with disabilities to have Medicare coverage at the time they are deemed eligible for disability income by Social Security is estimated to cost about $8.7 billion annually. That amount would be partially offset by $4.3 billion in reduced Medicaid spending, since many affected individuals qualify for the low-income health coverage program for some time during the waiting period.The full text of the letter can be found at http://www.medicarerights.org/Waiting_period_letter_Finance.pdf (version sent to the Senate Finance Committee). The full report is available at http://www.medicarerights.org/Too_Sick_To_Work_Too_Soon_For_Medicare.pdf .4. SENATORS INTRODUCE BIPARTISAN MEASURES TO IMPROVE PART DLegislation proposed in the Senate would make it easier for low-income people with Medicare to apply and qualify for Extra Help, the subsidy program for prescription drug coverage.A bill introduced by Senators Jeff Bingaman, Democrat of New Mexico, and Gordon , Republican of Oregon, would increase the amount of financial assets individuals can have and still be eligible for Extra Help, raising the limit from $11,710 to $27,500 for an individual and from $23,410 to $55,000 for a couple. Advocates have argued that the current asset test unfairly hurts people with low incomes but whose savings and other assets are above the current limit and disqualify them from receiving assistance.Senator stated that the increased asset limits proposed in the bill “represent a good, bipartisan solution to the problem,” adding that repealing the asset test entirely this year “may be a difficult feat to accomplish politically and financially.”The bill (S. 1102) also seeks to improve enrollment and simplify the application process. If enacted, it would allow the Social Security Administration to use income information the IRS already possesses to more easily identify and reach out to eligible people with Medicare.Applicants would no longer be required to report the value of life insurance policies, pensions and retirement plans. Currently, individuals must calculate and provide those pieces of information, which critics say deter otherwise eligible low-income people with Medicare from applying.The senators also introduced a separate bill amending what counts toward individuals’ out-of-pocket costs for drug coverage. Under Part D, when drug spending by both the enrolled individual and the plan reaches the initial coverage limit (around $2,400 in 2007), the individual must then pay the full cost of covered drugs through the duration of the “doughnut hole.” After the individual has spent $3,850 out of pocket on medicines, he or she will then qualify for catastrophic drug coverage, where the plan pays for 95 percent of the prescription costs.Under current rules, outside assistance individuals receive paying for medicines from AIDS Drug Assistance Programs, pharmaceutical companies’ patient assistance programs and the Indian Health Service does not count toward the calculation of out-of-pocket spending. The Helping Fill the Medicare Rx Gap Act (S. 1103) proposed by Senators Bingaman and would allow spending by these assistance programs to be included in the amount spent out of pocket on medicines. The bill would allow these programs to cover costs in the doughnut hole and have Medicare resume coverage once the threshold for catastrophic coverage is hit.Also included in the senators’ legislative package are bills eliminating Part D cost-sharing for people with both Medicaid and Medicare (dual eligibles) residing in assisted living facilities and establishing improved outreach efforts and a special enrollment period for low-income people with Medicare.5. NEW: MEDICARE PRIVATE HEALTH PLAN MONITORING PROJECTMedicare Rights Center has launched The Medicare Private Health Plan Monitoring Project to capture the experiences of people who have signed up for a Medicare HMO, PPO, PFFS plan or any of the other types of Medicare Advantage plans. Are you getting the medical care you need? Has your doctor or hospital dropped out of your plan’s network? Is it costing you more than you expected? Were you misled into joining a plan? Are you locked-in to a plan that no longer meets your needs? Please tell your private health plan story so we can bring your story to Capitol Hill.6. CASE FLASH: MEDICARE PRIVATE HEALTH PLAN FRAUDMs. S is enrolled in a Medicare private health plan. Her sister is enrolled in a different plan. When her sister invited her to hear a presentation at her house by a representative from that health plan, Ms. S agreed to attend. At the presentation, however, the sisters realized that the representative was from an entirely different company. Ms. S told the representative that she was fine with her current health plan and did not want to switch. Then Ms. S’ neighbor came to the door to tell her that her house was on fire. As Ms. S ran to the door in a panic, the sales representative put a form in front of her and asked her to quickly sign it before going. Flustered and preoccupied with an urgent situation, Ms. S signed the form without reading it and raced to her house.The next time Ms. S went to her doctor, she learned that she was no longer enrolled in the same Medicare private health plan. She had been switched to a new plan that did not contract with her doctor. The form the sales representative had pushed her to sign as she ran out the door was to enroll her in the Medicare private health plan he represented.Ms. S called her local State Health Insurance Assistance Program (SHIP) for help. A SHIP counselor called Medicare and explained that Ms. S did not understand that she was signing an enrollment form, but was tricked into doing it by the plan representative. Medicare agreed that this was a form of insurance fraud and should not have happened. Ms. S was retroactively reenrolled into her old plan, and she can now see her regular doctor.Note: A drug plan representative cannot force you to sign anything, even if you have invited the representative into your home to give you information about a particular plan. If something like this happens to you, be sure to report this fraudulent activity by calling the Medicare Rights Center hotline at , or write to our Medicare Private Health Plan Monitoring Project by going to http://www.medicarerights.org/americanlives_story_frameset.html.To read more cases by subject, go to "Interesting Cases" on our web site at www.medicarerights.org/interestingcasesframeset.html .

This message was generated by the Medicare Rights Center list-serve.If you have trouble (un)subscribing or have questions about Medicare Watch, please send an e-mail to medicarewatchmedicarerights (DOT) org.To sign up for additional newsletters, please visit our online registration form at http://www.medicarerights.org/subscribeframeset.html.If you want more information about the Medicare Rights Center, send an e-mail to infomedicarerights (DOT) org.Medicare Rights Center520 Eighth Avenue, North Wing, 3rd FloorNew York, NY 10018Telephone: Fax: Web site: www.medicarerights.orgMedicare Watch is MRC’s fortnightly newsletter, established to strengthen communication with national and community-based organizations and professional agencies about current Medicare policy and consumer issues. Each edition contains news of recent policy developments affecting Medicare and health care generally and a case story from our hotline that illustrates steps professionals can take to get older adults and people with disabilities the health care they need.The Medicare Rights Center (MRC) is the largest independent source of Medicare information and assistance in the United States. Founded in 1989, MRC helps older adults and people with disabilities get good, affordable health care. Unsubscribe from this mailing.Modify your profile and subscription preferences.

The information transmitted in this electronic communication is intended only for the person or entity to whom it is addressed and may contain confidential and/or privileged material. Any review, retransmission, dissemination or other use of or taking of any action in reliance upon this information by persons or entities other than the intended recipient is prohibited. If you received this information in error, please contact the Compliance HelpLine at and properly dispose of this information.

April 18, 2007

I may do this for the discharge but post the nurses handle PA's for meds.

Hartford Hospital

>>> " , " 04/18/07 11:18 AM >>>

Are any of you responsible for getting the PA for Rx after the patients have

been discharged or do the transplant nurses do this? Now I make the patient

aware of their coverage for the Rx ( or getting them adequate coverage) and

verify Par Pharmacies to obtain Rx. I am just curious

Fwd: Issue 8, April 17, 2007

[]

<https://www.kintera.com/accounttempfiles/account10257/images/_181105731552200.g

if>

Welcome to MEDICARE WATCH, a biweekly electronic newsletter of the Medicare

Rights Center

Vol. 10, No. 8: April 17, 2007

Contents:

1. FAST FACT

2. SENATE PANEL APPROVES DRUG PRICE NEGOTIATIONS BILL

3. DISABILITY ADVOCATES PRESS CONGRESS TO END MEDICARE WAIT

4. SENATORS INTRODUCE BIPARTISAN MEASURES TO IMPROVE PART D

5. NEW: MEDICARE PRIVATE HEALTH PLAN MONITORING PROJECT

6. CASE FLASH: MEDICARE PRIVATE HEALTH PLAN FRAUD

_____

1. FAST FACT

Medicare will distribute $30 million to help fund State Health Insurance

Assistance Programs (SHIPs), which provide counseling to people with Medicare.

Funding will be based on each state's Medicare population ( "

<http://www.kintera.org/TR.asp?ID=M725800746609323144550365> Medicare Gives $30M

for Senior Counseling, " United Press International, April 11, 2007).

2. SENATE PANEL APPROVES DRUG PRICE NEGOTIATIONS BILL

The Senate Finance Committee approved legislation April 12 that would lift the

prohibition on Medicare drug price negotiations. The bill (S. 3) now goes before

the full Senate for a vote this week.

Under the Medicare Modernization Act of 2003, which created Part D, the federal

government is barred from negotiating with drugmakers for lower prescription

drug prices, leaving it to private plans to negotiate individually.

While the proposed legislation would authorize the health and human services

secretary to negotiate on behalf of people with Medicare, it does not require

the negotiation. A House bill passed in January goes further, requiring

negotiation. The Bush administration has threatened to veto that bill.

The Senate bill does include a provision requiring companies sponsoring private

drug plans to report price, cost and claims data to agencies that advise

Congress. It also gives states access to drug claims data on people with both

Medicaid and Medicare, and makes information on drug prices charged by plans

available when individuals purchase their medicines.

3. DISABILITY ADVOCATES PRESS CONGRESS TO END MEDICARE WAIT

In a letter sent to key members of Congress last week, over 30 patient advocacy

groups, including the Medicare Rights Center, United Cerebral Palsy, the

National Multiple Sclerosis Society, Easter Seals and Paralyzed Veterans of

America, called on legislators to eliminate the two-year waiting period for

Medicare for people with disabilities.

" The two-year Medicare waiting period affects more than those individuals who

are now struggling to survive until their Medicare coverage begins, " stated the

letter. " Every American is at risk of a severely disabling illness or accident.

For individuals with progressive illnesses that all but guarantee that they will

one day have to file for disability, this built-in gap in coverage is a virtual

certainty. "

The letter was sent to House Speaker Pelosi and Senate Majority Leader

Harry Reid, as well as to Democratic and Republican leaders of the Senate

Finance Committee, House Ways and Means Committee and the House Energy and

Commerce Committee.

In the letter, the groups ask the lawmakers to eliminate the two-year waiting

period and enable people with disabilities to " receive Medicare coverage as soon

as they begin receiving Social Security Disability Insurance benefits. "

After individuals are determined by the Social Security Administration to be

unable to work due to debilitating health conditions and qualify for disability

income, they must wait five months for their first SSDI payment and another two

years before they can enroll in Medicare. The two-year wait was written into law

when Congress first extended Medicare to people with disabilities in 1972.

A new report from the Medicare Rights Center chronicles the experiences of 21

people with disabilities as they endured the two-year wait for Medicare coverage

that begins when they first receive Social Security Disability Insurance.

During their wait for Medicare, many people are unable to afford the costs of

medical care, go into debt and ending up in worse health, according to the

report. The 24-month wait for Medicare coverage resulted in serious medical and

financial burdens: some individuals spent their savings on private insurance and

soon became unable to continue paying high premiums for COBRA coverage; others

recounted going without medical checkups and treatments until Medicare began

covering them.

According to the report, there are about 1.5 million people in the waiting

period. Among them, 600,000 are uninsured. Twelve percent of individuals in the

waiting period die each year while waiting for Medicare coverage.

Allowing all people with disabilities to have Medicare coverage at the time they

are deemed eligible for disability income by Social Security is estimated to

cost about $8.7 billion annually. That amount would be partially offset by $4.3

billion in reduced Medicaid spending, since many affected individuals qualify

for the low-income health coverage program for some time during the waiting

period.

The full text of the letter can be found at http://www.medicare

<http://www.medicarerights.org/Waiting_period_letter_Finance.pdf>

rights.org/Waiting_period_letter_Finance.pdf (version sent to the Senate Finance

Committee). The full report is available at http://www.medicare

<http://www.medicarerights.org/Too_Sick_To_Work_Too_Soon_For_Medicare.pdf>

rights.org/Too_Sick_To_Work_Too_Soon_For_Medicare.pdf .

4. SENATORS INTRODUCE BIPARTISAN MEASURES TO IMPROVE PART D

Legislation proposed in the Senate would make it easier for low-income people

with Medicare to apply and qualify for Extra Help, the subsidy program for

prescription drug coverage.

A bill introduced by Senators Jeff Bingaman, Democrat of New Mexico, and Gordon

, Republican of Oregon, would increase the amount of financial assets

individuals can have and still be eligible for Extra Help, raising the limit

from $11,710 to $27,500 for an individual and from $23,410 to $55,000 for a

couple. Advocates have argued that the current asset test unfairly hurts people

with low incomes but whose savings and other assets are above the current limit

and disqualify them from receiving assistance.

Senator stated that the increased asset limits proposed in the bill

" represent a good, bipartisan solution to the problem, " adding that repealing

the asset test entirely this year " may be a difficult feat to accomplish

politically and financially. "

The bill (S. 1102) also seeks to improve enrollment and simplify the application

process. If enacted, it would allow the Social Security Administration to use

income information the IRS already possesses to more easily identify and reach

out to eligible people with Medicare.

Applicants would no longer be required to report the value of life insurance

policies, pensions and retirement plans. Currently, individuals must calculate

and provide those pieces of information, which critics say deter otherwise

eligible low-income people with Medicare from applying.

The senators also introduced a separate bill amending what counts toward

individuals' out-of-pocket costs for drug coverage. Under Part D, when drug

spending by both the enrolled individual and the plan reaches the initial

coverage limit (around $2,400 in 2007), the individual must then pay the full

cost of covered drugs through the duration of the " doughnut hole. " After the

individual has spent $3,850 out of pocket on medicines, he or she will then

qualify for catastrophic drug coverage, where the plan pays for 95 percent of

the prescription costs.

Under current rules, outside assistance individuals receive paying for medicines

from AIDS Drug Assistance Programs, pharmaceutical companies' patient assistance

programs and the Indian Health Service does not count toward the calculation of

out-of-pocket spending. The Helping Fill the Medicare Rx Gap Act (S. 1103)

proposed by Senators Bingaman and would allow spending by these assistance

programs to be included in the amount spent out of pocket on medicines. The bill

would allow these programs to cover costs in the doughnut hole and have Medicare

resume coverage once the threshold for catastrophic coverage is hit.

Also included in the senators' legislative package are bills eliminating Part D

cost-sharing for people with both Medicaid and Medicare (dual eligibles)

residing in assisted living facilities and establishing improved outreach

efforts and a special enrollment period for low-income people with Medicare.

5. NEW: MEDICARE PRIVATE HEALTH PLAN MONITORING PROJECT

Medicare Rights Center has launched The

<http://www.kintera.org/TR.asp?ID=M725800976609323144550365> Medicare Private

Health Plan Monitoring Project to capture the experiences of people who have

signed up for a Medicare HMO, PPO, PFFS plan or any of the other types of

Medicare Advantage plans. Are you getting the medical care you need? Has your

doctor or hospital dropped out of your plan's network? Is it costing you more

than you expected? Were you misled into joining a plan? Are you locked-in to a

plan that no longer meets your needs? Please tell your

<http://www.kintera.org/TR.asp?ID=M725800996609323144550365> private health plan

story so we can bring your story to Capitol Hill.

6. CASE FLASH: MEDICARE PRIVATE HEALTH PLAN FRAUD

Ms. S is enrolled in a Medicare private health plan. Her sister is enrolled in a

different plan. When her sister invited her to hear a presentation at her house

by a representative from that health plan, Ms. S agreed to attend. At the

presentation, however, the sisters realized that the representative was from an

entirely different company. Ms. S told the representative that she was fine with

her current health plan and did not want to switch. Then Ms. S' neighbor came to

the door to tell her that her house was on fire. As Ms. S ran to the door in a

panic, the sales representative put a form in front of her and asked her to

quickly sign it before going. Flustered and preoccupied with an urgent

situation, Ms. S signed the form without reading it and raced to her house.

The next time Ms. S went to her doctor, she learned that she was no longer

enrolled in the same Medicare private health plan. She had been switched to a

new plan that did not contract with her doctor. The form the sales

representative had pushed her to sign as she ran out the door was to enroll her

in the Medicare private health plan he represented.

Ms. S called her local State Health Insurance Assistance Program (SHIP) for

help. A SHIP counselor called Medicare and explained that Ms. S did not

understand that she was signing an enrollment form, but was tricked into doing

it by the plan representative. Medicare agreed that this was a form of insurance

fraud and should not have happened. Ms. S was retroactively reenrolled into her

old plan, and she can now see her regular doctor.

Note: A drug plan representative cannot force you to sign anything, even if you

have invited the representative into your home to give you information about a

particular plan. If something like this happens to you, be sure to report this

fraudulent activity by calling the Medicare Rights Center hotline at

, or write to our Medicare Private Health Plan Monitoring Project by

going to http://www.medicare

<http://www.medicarerights.org/americanlives_story_frameset.html>

rights.org/americanlives_story_frameset.html.

To read more cases by subject, go to " Interesting Cases " on our web site at

www.medicarerights.

<http://www.medicarerights.org/interestingcasesframeset.html>

org/interestingcasesframeset.html .

_____

This message was generated by the Medicare Rights Center list-serve.

If you have trouble (un)subscribing or have questions about Medicare Watch,

please send an e-mail to medicarewatch@

medicarerights.org.

To sign up for additional newsletters, please visit our online registration form

at http://www.medicare

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rights.org/subscribeframeset.html.

If you want more information about the Medicare Rights Center, send an e-mail to

info@medicarerights .org.

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Fax:

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<http://www.kintera.org/TR.asp?ID=M725801206609323144550365> org

Medicare Watch is MRC's fortnightly newsletter, established to strengthen

communication with national and community-based organizations and professional

agencies about current Medicare policy and consumer issues. Each edition

contains news of recent policy developments affecting Medicare and health care

generally and a case story from our hotline that illustrates steps professionals

can take to get older adults and people with disabilities the health care they

need.

The Medicare Rights Center (MRC) is the largest independent source of Medicare

information and assistance in the United States. Founded in 1989, MRC helps

older adults and people with disabilities get good, affordable health care.

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April 18, 2007

We have a dedicated DA processing the apps for us but the Social Worker & I work very closely with the patient, identifying the need, etc...

Thanks,

n Melton

Seton Heart Specialty Care & Transplant Center

1301 W. 38th Street, Ste 514

Austin, Texas 78705

fax

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From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of , Sent: Wednesday, April 18, 2007 10:19 AMTo: TxFinancialCoordinators Subject: RE: Fwd: Issue 8, April 17, 2007

Are any of you responsible for getting the PA for Rx after the patients have been discharged or do the transplant nurses do this? Now I make the patient aware of their coverage for the Rx ( or getting them adequate coverage) and verify Par Pharmacies to obtain Rx. I am just curious

-----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of Louis Sent: Wednesday, April 18, 2007 10:42 AMTo: TxFinancialCoordinators Subject: Fwd: Issue 8, April 17, 2007

Welcome to MEDICARE WATCH, a biweekly electronic newsletter of the Medicare Rights CenterVol. 10, No. 8: April 17, 2007Contents:

FAST FACT SENATE PANEL APPROVES DRUG PRICE NEGOTIATIONS BILL DISABILITY ADVOCATES PRESS CONGRESS TO END MEDICARE WAIT SENATORS INTRODUCE BIPARTISAN MEASURES TO IMPROVE PART D NEW: MEDICARE PRIVATE HEALTH PLAN MONITORING PROJECT CASE FLASH: MEDICARE PRIVATE HEALTH PLAN FRAUD

1. FAST FACTMedicare will distribute $30 million to help fund State Health Insurance Assistance Programs (SHIPs), which provide counseling to people with Medicare. Funding will be based on each state’s Medicare population (“ Medicare Gives $30M for Senior Counseling,” United Press International, April 11, 2007).2. SENATE PANEL APPROVES DRUG PRICE NEGOTIATIONS BILLThe Senate Finance Committee approved legislation April 12 that would lift the prohibition on Medicare drug price negotiations. The bill (S. 3) now goes before the full Senate for a vote this week.Under the Medicare Modernization Act of 2003, which created Part D, the federal government is barred from negotiating with drugmakers for lower prescription drug prices, leaving it to private plans to negotiate individually.While the proposed legislation would authorize the health and human services secretary to negotiate on behalf of people with Medicare, it does not require the negotiation. A House bill passed in January goes further, requiring negotiation. The Bush administration has threatened to veto that bill.The Senate bill does include a provision requiring companies sponsoring private drug plans to report price, cost and claims data to agencies that advise Congress. It also gives states access to drug claims data on people with both Medicaid and Medicare, and makes information on drug prices charged by plans available when individuals purchase their medicines. 3. DISABILITY ADVOCATES PRESS CONGRESS TO END MEDICARE WAITIn a letter sent to key members of Congress last week, over 30 patient advocacy groups, including the Medicare Rights Center, United Cerebral Palsy, the National Multiple Sclerosis Society, Easter Seals and Paralyzed Veterans of America, called on legislators to eliminate the two-year waiting period for Medicare for people with disabilities.“The two-year Medicare waiting period affects more than those individuals who are now struggling to survive until their Medicare coverage begins,” stated the letter. “Every American is at risk of a severely disabling illness or accident. For individuals with progressive illnesses that all but guarantee that they will one day have to file for disability, this built-in gap in coverage is a virtual certainty.”The letter was sent to House Speaker Pelosi and Senate Majority Leader Harry Reid, as well as to Democratic and Republican leaders of the Senate Finance Committee, House Ways and Means Committee and the House Energy and Commerce Committee.In the letter, the groups ask the lawmakers to eliminate the two-year waiting period and enable people with disabilities to “receive Medicare coverage as soon as they begin receiving Social Security Disability Insurance benefits.”After individuals are determined by the Social Security Administration to be unable to work due to debilitating health conditions and qualify for disability income, they must wait five months for their first SSDI payment and another two years before they can enroll in Medicare. The two-year wait was written into law when Congress first extended Medicare to people with disabilities in 1972.A new report from the Medicare Rights Center chronicles the experiences of 21 people with disabilities as they endured the two-year wait for Medicare coverage that begins when they first receive Social Security Disability Insurance.During their wait for Medicare, many people are unable to afford the costs of medical care, go into debt and ending up in worse health, according to the report. The 24-month wait for Medicare coverage resulted in serious medical and financial burdens: some individuals spent their savings on private insurance and soon became unable to continue paying high premiums for COBRA coverage; others recounted going without medical checkups and treatments until Medicare began covering them.According to the report, there are about 1.5 million people in the waiting period. Among them, 600,000 are uninsured. Twelve percent of individuals in the waiting period die each year while waiting for Medicare coverage.Allowing all people with disabilities to have Medicare coverage at the time they are deemed eligible for disability income by Social Security is estimated to cost about $8.7 billion annually. That amount would be partially offset by $4.3 billion in reduced Medicaid spending, since many affected individuals qualify for the low-income health coverage program for some time during the waiting period.The full text of the letter can be found at http://www.medicarerights.org/Waiting_period_letter_Finance.pdf (version sent to the Senate Finance Committee). The full report is available at http://www.medicarerights.org/Too_Sick_To_Work_Too_Soon_For_Medicare.pdf .4. SENATORS INTRODUCE BIPARTISAN MEASURES TO IMPROVE PART DLegislation proposed in the Senate would make it easier for low-income people with Medicare to apply and qualify for Extra Help, the subsidy program for prescription drug coverage.A bill introduced by Senators Jeff Bingaman, Democrat of New Mexico, and Gordon , Republican of Oregon, would increase the amount of financial assets individuals can have and still be eligible for Extra Help, raising the limit from $11,710 to $27,500 for an individual and from $23,410 to $55,000 for a couple. Advocates have argued that the current asset test unfairly hurts people with low incomes but whose savings and other assets are above the current limit and disqualify them from receiving assistance.Senator stated that the increased asset limits proposed in the bill “represent a good, bipartisan solution to the problem,” adding that repealing the asset test entirely this year “may be a difficult feat to accomplish politically and financially.”The bill (S. 1102) also seeks to improve enrollment and simplify the application process. If enacted, it would allow the Social Security Administration to use income information the IRS already possesses to more easily identify and reach out to eligible people with Medicare.Applicants would no longer be required to report the value of life insurance policies, pensions and retirement plans. Currently, individuals must calculate and provide those pieces of information, which critics say deter otherwise eligible low-income people with Medicare from applying.The senators also introduced a separate bill amending what counts toward individuals’ out-of-pocket costs for drug coverage. Under Part D, when drug spending by both the enrolled individual and the plan reaches the initial coverage limit (around $2,400 in 2007), the individual must then pay the full cost of covered drugs through the duration of the “doughnut hole.” After the individual has spent $3,850 out of pocket on medicines, he or she will then qualify for catastrophic drug coverage, where the plan pays for 95 percent of the prescription costs.Under current rules, outside assistance individuals receive paying for medicines from AIDS Drug Assistance Programs, pharmaceutical companies’ patient assistance programs and the Indian Health Service does not count toward the calculation of out-of-pocket spending. The Helping Fill the Medicare Rx Gap Act (S. 1103) proposed by Senators Bingaman and would allow spending by these assistance programs to be included in the amount spent out of pocket on medicines. The bill would allow these programs to cover costs in the doughnut hole and have Medicare resume coverage once the threshold for catastrophic coverage is hit.Also included in the senators’ legislative package are bills eliminating Part D cost-sharing for people with both Medicaid and Medicare (dual eligibles) residing in assisted living facilities and establishing improved outreach efforts and a special enrollment period for low-income people with Medicare.5. NEW: MEDICARE PRIVATE HEALTH PLAN MONITORING PROJECTMedicare Rights Center has launched The Medicare Private Health Plan Monitoring Project to capture the experiences of people who have signed up for a Medicare HMO, PPO, PFFS plan or any of the other types of Medicare Advantage plans. Are you getting the medical care you need? Has your doctor or hospital dropped out of your plan’s network? Is it costing you more than you expected? Were you misled into joining a plan? Are you locked-in to a plan that no longer meets your needs? Please tell your private health plan story so we can bring your story to Capitol Hill.6. CASE FLASH: MEDICARE PRIVATE HEALTH PLAN FRAUDMs. S is enrolled in a Medicare private health plan. Her sister is enrolled in a different plan. When her sister invited her to hear a presentation at her house by a representative from that health plan, Ms. S agreed to attend. At the presentation, however, the sisters realized that the representative was from an entirely different company. Ms. S told the representative that she was fine with her current health plan and did not want to switch. Then Ms. S’ neighbor came to the door to tell her that her house was on fire. As Ms. S ran to the door in a panic, the sales representative put a form in front of her and asked her to quickly sign it before going. Flustered and preoccupied with an urgent situation, Ms. S signed the form without reading it and raced to her house.The next time Ms. S went to her doctor, she learned that she was no longer enrolled in the same Medicare private health plan. She had been switched to a new plan that did not contract with her doctor. The form the sales representative had pushed her to sign as she ran out the door was to enroll her in the Medicare private health plan he represented.Ms. S called her local State Health Insurance Assistance Program (SHIP) for help. A SHIP counselor called Medicare and explained that Ms. S did not understand that she was signing an enrollment form, but was tricked into doing it by the plan representative. Medicare agreed that this was a form of insurance fraud and should not have happened. Ms. S was retroactively reenrolled into her old plan, and she can now see her regular doctor.Note: A drug plan representative cannot force you to sign anything, even if you have invited the representative into your home to give you information about a particular plan. If something like this happens to you, be sure to report this fraudulent activity by calling the Medicare Rights Center hotline at , or write to our Medicare Private Health Plan Monitoring Project by going to http://www.medicarerights.org/americanlives_story_frameset.html.To read more cases by subject, go to "Interesting Cases" on our web site at www.medicarerights.org/interestingcasesframeset.html .

This message was generated by the Medicare Rights Center list-serve.If you have trouble (un)subscribing or have questions about Medicare Watch, please send an e-mail to medicarewatchmedicarerights (DOT) org.To sign up for additional newsletters, please visit our online registration form at http://www.medicarerights.org/subscribeframeset.html.If you want more information about the Medicare Rights Center, send an e-mail to infomedicarerights (DOT) org.Medicare Rights Center520 Eighth Avenue, North Wing, 3rd FloorNew York, NY 10018Telephone: Fax: Web site: www.medicarerights.orgMedicare Watch is MRC’s fortnightly newsletter, established to strengthen communication with national and community-based organizations and professional agencies about current Medicare policy and consumer issues. Each edition contains news of recent policy developments affecting Medicare and health care generally and a case story from our hotline that illustrates steps professionals can take to get older adults and people with disabilities the health care they need.The Medicare Rights Center (MRC) is the largest independent source of Medicare information and assistance in the United States. Founded in 1989, MRC helps older adults and people with disabilities get good, affordable health care. Unsubscribe from this mailing.Modify your profile and subscription preferences.

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April 18, 2007

Our

transplant nurses do it at our center.

Pamela N.

Drayton

Data/Financial

Coordinator-Renal Txp Dept F-4

Newark Beth

Israel Medical Center

Newark, NJ

07112

phone

fax

Pdrayton@...

Fwd: Issue 8, April 17, 2007

Welcome to MEDICARE WATCH, a biweekly electronic newsletter of the Medicare

Rights Center

Vol. 10, No. 8: April 17, 2007

Contents:

1.

FAST FACT

2.

SENATE PANEL

APPROVES DRUG PRICE NEGOTIATIONS BILL

3.

DISABILITY

ADVOCATES PRESS CONGRESS TO END MEDICARE WAIT

4.

SENATORS

INTRODUCE BIPARTISAN MEASURES TO IMPROVE PART D

5.

NEW: MEDICARE

PRIVATE HEALTH PLAN MONITORING PROJECT

6.

CASE FLASH: MEDICARE

PRIVATE HEALTH PLAN FRAUD

1. FAST FACT

Medicare will distribute $30 million to help fund State Health Insurance

Assistance Programs (SHIPs), which provide counseling to people with Medicare.

Funding will be based on each state’s Medicare population (“ Medicare

Gives $30M for Senior Counseling,” United Press International, April

11, 2007).

2. SENATE PANEL APPROVES DRUG PRICE

NEGOTIATIONS BILL

The Senate Finance Committee approved legislation April 12 that would lift the

prohibition on Medicare drug price negotiations. The bill (S. 3) now goes

before the full Senate for a vote this week.