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PART D RESOURCES PAGE

Medicare Part D Prescription Drug Program

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Training Materials on Medicare Part D, Updated for 2008

UPDATE: Effective July 1, 2007, it will be mandatory for all EPIC members to join a Medicare Part D plan (with some exceptions). This memo from    Selfhelp explains this change, and how it will work. Revised June 12, 2007

CMS Region II Complaint Procedures and Complaint Form

NSCLC Advocate's Guide for Solving Problems Under Part D

CMS Manual for Part D Plans on Coverage Determinations and Appeals

A.            URGENT -- Enrollment in Part D Could Cause Retirees or their Spouses to  Lose Retiree Health Coverage

URGENT ALERT TO Medicare Beneficiaries who have Retiree health Coverage -- Part D Might Hurt you!

   NYSDOH GIS on Retiree Benefits

CMS Notice to Retiree Plan Sponsors about Risks - 12-29-05

CMS Tip Sheet on Employer/Union Plans - Special Concerns for Dual Eligibles and Others “Auto-Enrolled” In Part D

Kaiser Foundation Survey On Retiree Health Costs and Part D

B.         LISTS OF PART D PLANS IN NYS

C.         WHAT PART D PLANS COVER AND DON’T COVER

NEW - Part D Basic Plan Deductibles, Coverage Limits, and Co-Payments (including with Extra Help) for 2007

Chart of Drugs Excluded from the Medicare Drug Program - But covered by Medicaid or EPIC

Charts of Transition Policies of Plans in NYS - Whether they will provide a 15-, 30-, or 60 day temporary supply of drugs not on their formulary for new enrollees

            List of NYS Plan Transition policies (PDF)

            List of NYS Plan Transition policies (Excel)

CMS Guidance on Part B vs. Part D Coverage

New -    CMS Clarification of Plan Due Diligence in Prior Authorization of Part B versus Part D Coverage Determinations

CMS 2007 Formulary Guidelines

New -    Changes from Draft Guidance

New -    CMS Final 2007 Formulary Guidelines

CMS re Formulary Changes During the Plan Year

Medicare Parts B/D Coverage Issues

CMS Guidance to Plans re. Home Infusion Therapy

CMS Guidance to Plans re Transition Policies

New -    Next Steps on Formulary Transition Policies (issued March 17, 2006)

            Strengthening Implementation of Formulary Transition Policies

            Pharmacy Transition Policies

            Expedited Processes for Application of Cost Sharing for Dually Eligible and Other Low-Income Beneficiaries

 D.            Enrollment Issues for Dual Eligibles and those with the Low Income Subsidy

Medicare Part D - Basic Benefit and Costs, Coordination with Other Coverage - Valerie Bogart, Selfhelp

Appendix 

Drug Plan Lists and Contacts 

Letter to State Medicaid Directors regarding Redetermination of LIS Status and Ongoing Auto-Enrollment

        Notices that Dual Eligibles and Low Income Subsidy Recipients have received or will receive

              Reduction of Benefits Notice" from State Medicaid to Dual eligibles sent in 12-05 - English and Spanish

              CMS Notice to Dual Eligibles of Auto-Assigned Drug Plan  (sent November 2005)

              3 CMS Notices Sent May 2005 to People Deemed Eligible for the "Low Income Subsidy": 

                  Letter to "Full Dual Eligibles" - have Medicare and Medicaid with no spend-down           

                  Letter to People in Medicare Savings Program (QMB, SLIMB, QI-I         

                  Letter to People on SSI and who also have  Medicaid  

              CMS Notices Sent in 12/05 and after to people newly deemed eligible for the Low Income Subsidy 

Letter to People in Medicare Savings Program or on SSI  

E.         USING PART D ONCE IT STARTS - Exceptions, Appeals, Etc.

CMS Region II Complaint Procedures and Complaint Form - NYC HRA Policy Bulletin

Advocate's Guide to Solving Problems Under Part D: Assisting Low Income Beneficiaries in the Early Months of 2007 - National Senior Citizens Law Center

Exceptions and Appeals: A Practical Guide - National Senior Citizens Law Center

Navigating Part D Appeals - Trilby de Jung, Empire Justice Center

Appendix 

Advocacy Guide for Requesting Exceptions and Appeals - National Health Law Program

CMS FAQ on Part D Exceptions & Appeals

Charts of Transition Policies of Plans in NYS - Whether they will provide a 15-, 30-, or 60 day temporary supply of drugs not on their formulary for new enrollees, while enrollee either requests an “exception” or switches to a different covered drug:

      List of NYS Plan Transition policies (PDF)

      List of NYS Plan Transition policies (Excel) 

CMS guidance for pharmacies

New -    CMS Manual for Part D Plans on Coverage Determinations and Appeals

Form needed to authorize assisting a client with Part D

Form to Report Enrollment Problems for Duals

Form for Pharmacist to Fax Request to Physician to Prescribe Alternate Medication or to Request Exception to Cover Non-Formulary Drug

Fact Sheet: Medicare Part D Appeals and Grievances

How to access your plan letter for consumers and pharmacists

Notice pharmacists must or give to member when a drug is not covered by plan

Plan Notice of Denial of Exception

The Exceptions and Appeals Process: Issues and Concerns in Obtaining Coverage Under the Medicare Part D Prescription Drug Benefit

What If Scenarios For Pharmacists

Forms for requesting exceptions and appeals

      CMS model form

Letter template for physician to request Exception from Part D plan

F.         How Medicaid in NYS will “Wrap Around” Part D -- LIMITED Wrap Around

"Wrap Kit" - Selected DOH documents explaining the current status of the wrap, exactly how pharmacists use it, and who to call with questions.

Feb. 10, 2006 Letter from State Dept of Health to Pharmacists Explaining Temporary Medicaid Extension

Gov. Pataki Statement -- Medicaid Extended Thru Mar. 8, 2006 but Vetos Law that would Extend Further

DOH and Gov. Pataki Announcement of Extension of Medicaid Thru Feb. 3, 2006

DOH Medicaid Update December 2005

GIS 05 MA/024: Medicare Prescription Drug Coverage

Medicaid Spend-down Recipients may now Join EPIC - New April 2006 - Q&A from the NYS Office for the Aging

Update on Medicare Part D Implementation from Empire Justice Center's Legal Services Journal, Sept. '05"

G.         TOOLS FOR USING “PLAN FINDER” AND CHOOSING A DRUG PLAN

Medicare Part D - Formularies, ADAP, Individual Health Insurance, Using PlanFinder, and Co-Pays - Greg Otten, GMHC

Appendix 

Analysis of the Plan Finder: Pitfalls and Stumbling Blocks

Checklist for Medicare Drug Program - How to Assess What Steps to Take for Individuals in NYS

CMS Worksheet for Helping Dual Eligibles Find the Best Medicare Drug Plan for Them

Epocrates web tool (FREE - shows if a med is covered by a Part D plan)

How to Compare Medicare Prescription Drug Plans

Links to the CMS “Plan finder” -- http://www.medicare.gov/pdphome.asp

Plan Finder tool http://www.medicare.gov/MPDPF/Public/Include/DataSection/Questions/Questions.asp 

Formulary finder http://plancompare.medicare.gov/formularyfinder/selectstate.asp

Demonstration  http://www.medicare.gov/medicarereform/partdprototype.asp  

     GMHC Plan Finder Tips (PDF)

Medicaid Spend-down Recipients may now Join EPIC - New April 2006 - Q&A from the NYS Office for the Aging  

Medicare Prescription Drug Plan Finder: Tips for Using the Search Results

H.         HOW PART D WORKS WITH EPIC or ADAP

UPDATE: Effective July 1, 2007, it will be mandatory for all EPIC members to join a Medicare Part D plan (with some exceptions). This memo from    Selfhelp explains this change, and how it will work. Revised June 12, 2007

Guide To EPIC and the Medicare Part D Drug Benefit  (NYFAHC)

EPIC and Part D  (Medicare Rights Center)

EPIC & Medicare (NYS DOH)

EPIC Part D Notification Letters 3 4 7 9

Medicare Part D and ADAP (from the New York State Department of Health)

I.         “Extra Help” or the Low Income Subsidy

Applying for and Keeping "Extra Help" with Medicare Part D - David Silva, Selfhelp

Information on Application & Eligibility 

SSA Application for "Extra Help" or Low Income Subsidy for Drug Program (sample only - must use original not downloaded copy)

SSA Policy Instruction 1/12/06 on Use of Generic Extra Help Application Award and Denial Notices

Toolkit on the Low Income Subsidy - Access to Benefits Coalition

J.          GENERAL INFORMATION ON PART D

            1.            National Information

CMS Home Page on Prescription Drugs

Kaiser Foundation Resources

CMS fact sheet on Part D and Food Stamps

All CMS Fact Sheets

A Guide To Medicare Part D Prescription Drug Coverage for people with developmental disabilities - Georgetown University

Medicare Drug 101 - Medicare Rights Center

Families USA Medicare Drug Law Materials for Advocates and Consumers

Families USA Health Assistance Partnership

            http://www.healthassistancepartnership.org/medicare/medicarerxdrugbill-1.html

      http://www.healthassistancepartnership.org/medicare/ 

CMS Webpage on Creditable Coverage 

2.            Information Targeted to New York State 

List of organizations that can help with Part D appeals - NYLAG 

NY Statewide Senior Action Council 

GMHC - Client fact sheets, etc. 

Coalition of Voluntary Mental Health Agencies

Provider Guide to Medicare Part D   

NYC Managed Care Assistance Program -- Client fact sheets are or will be posted at

      http://www.nycmccap.org/index.html    

Selfhelp Medicare Part D Training DVD and Materials - Order Form