Reimbursement of State Costs for Provision of Part D Drugs

 

To ensure that the Medicare and Medicaid programs can respond expeditiously to the needs of the dual-eligible beneficiaries and beneficiaries who have enrolled in a Part D plan and have been determined to be eligible for the low-income subsidy. This demonstration would allow States, that have assisted with their dual eligible and low-income subsidy entitled populations in obtaining and accessing Medicare Part D coverage, to be reimbursed for their efforts.

Deleted 08/20/2009 (Archived.) 93.794 CENTERS FOR MEDICARE AND MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES Direct Payments for Specified Use. None. New program. Authorized under Section 402 of the Social Security Amendment of 1967, as amended. State: Must have incurred costs in assisting dual eligibles and other low-income subsidy entitled beneficiaries receive the prescription medications they need. State: Must have incurred costs in assisting dual eligibles and other low-income subsidy entitled beneficiaries receive the prescription medications they need. Federal (Medicare) funds must go to a State Medicaid Agency with appropriately approved Section 402 demonstration proposals. Administrative costs will be determined in accordance with OMB Circular A-87 "Cost Principles for State and Local Governments." States are encouraged to work with CMS in the development of their section 402 Medicare demonstration proposal. This program is excluded from coverage under E.O. 12372. States will complete an application as provided by CMS to request approval for participation in this Medicare demonstration. Approved States will receive an initial payment based on CMS' review of submitted claims data to verify that the beneficiary is a dual eligible beneficiary or a low-income subsidy entitled beneficiary as defined in this demonstration and that the prescription drug is a Part D drug. CMS will also reimburse the State for additional costs determined by CMS to be eligible under the demonstration, including costs due to the State for drug payments that exceed plan payments, as well as allowed administrative costs specified in the demonstration application. The costs eligible for reimbursement under this Medicare demonstration must be incurred by the States related to the provision of Part D drugs to dual eligible and low-income subsidy entitled beneficiaries for prescription drugs provided between January 1, 2006 and February 15, 2006. The costs eligible for reimbursement under this Medicare demonstration must be incurred by the States related to the provision of Part D drugs to dual eligible and low-income subsidy entitled beneficiaries for prescription drugs provided between January 1, 2006 and February 15, 2006. The States may request an extension of time for the Section 402 Demonstration beyond the February 15, 2006 date. None. Not applicable. The demonstration permits Medicare payment to be made to States for amounts they have paid for a dual-eligible's Part D drugs, or a low-income subsidy entitled Part D plan enrollee's Part D drugs, to the extent that those costs are not otherwise recoverable from a Part D plan and are not required Medicaid cost-sharing on the part of the beneficiary. In addition to providing Medicare funds to reimburse amounts paid by States for Part D drugs, the demonstration would also provide payments for certain administrative costs incurred by States. States must submit fiscal and statistical reports, as required by CMS. The States may be subject to audit by other Federal agencies including the Office of the Inspector General. Financial records, supporting documents, statistical records, and all other records pertinent to the demonstration shall be retained for at least three years or until resolution of any audit questions. This program has no statutory formula or matching requirements. It is being funded under the Federal Supplementary Medical Insurance Trust Fund. THE STATES ARE NOT TO USE THE MEDICARE FUNDING UNDER THIS DEMONSTRATION AS STATE MEDICAID MATCHING FUNDS. Project Period: No payments shall be made for State costs associated with the provision of Part D drugs to dual-eligible and low-income subsidy entitled beneficiaries that are incurred after February 15, 2006. Budget Period: Qualifying costs are reimbursed in full. Contact the Regional Administrator, Centers for Medicare and Medicaid Services (see appendix IV of the Catalog for addresses and telephone numbers). Program Contact: Christine Hinds, Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Mail Stop C1-26-12, Baltimore, MD 21244. Telephone: (410) 786-4578. http://www.cms.hhs.gov 75-8308-0-7-571. FY 05 $0; FY 06 est $56,000,000; and FY 07 est $0. Floor: $0; Ceiling: Federal contractor will compute the reconciliation payments the Federal government will make to the States for amounts the State paid in excess of Part D prescription drug plan payments and associated administrative costs realized during the Part D prescription drug plan transition period. Not applicable. Not applicable.