Washington, DC – The American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) today praised the Centers for Medicare & Medicaid Services (CMS) for issuing a final regulation that allows more dually-eligible Medicare and Medicaid beneficiaries with limited incomes and resources to remain in the Medicare prescription drug plan in which they are enrolled, without having to pay a premium.
“The new final rule issued by CMS is an intelligent, flexible response to some of the challenges that have arisen in the Medicare prescription drug plan, and many highly vulnerable dually-eligible Medicare and Medicaid recipients will benefit,” stated Bruce Yarwood, President and CEO of AHCA. “We are thankful for this change which allows more of these beneficiaries to stick with their existing Part D Plans as opposed to being forced to migrate to another plan, which is confusing and frustrating.”
According to CMS, the new rules apply to people with Medicare who are eligible for Medicare’s extra help program, the low-income subsidy (LIS) provided under the Part D prescription drug program. Currently, LIS beneficiaries who are enrolled in prescription drug plans that no longer offer a zero-premium plan, and who have not made an affirmative choice to change plans, are reassigned by Medicare to a different prescription drug plan in their region that offers coverage with no premium. The final rule changes the way that Medicare will calculate the regional low-income subsidy benchmarks, based on comments received on the proposed rule issued in January.
The LIS benchmarks reflect the amount of a plan’s premium that will be paid by the Federal government through the low-income subsidy. For example, the Federal government pays up to 100 percent of the Part D premium for LIS beneficiaries who are in plans with premiums below the regional LIS benchmark. Lower low-income subsidy benchmarks means there are fewer plans that offer low or zero-premiums for low-income subsidy beneficiaries, which results in more beneficiaries being reassigned to other plans.
Under the final rule, these benchmarks will be weighted based on each plan’s share of enrollees receiving the low-income subsidy, rather than their share of total Part D enrollment. This means plans with a greater number of low-income subsidy enrollees will be a larger factor when CMS calculates the benchmark. This will help to ensure that the premium subsidy amount better reflects the plans that low-income subsidy beneficiaries are enrolled in. This will result in fewer LIS beneficiaries seeing their drug coverage disrupted by having to change prescription drug plans in order to avoid paying a premium. For example, if the regulation issued today had been in place for 2008, the number of reassignments would have been reduced by 850,000.
The American Health Care Association and National Center for Assisted Living (NCAL) represent nearly 11,000 non-profit and proprietary facilities dedicated to continuous improvement in the delivery of professional and compassionate care provided daily by millions of caring employees to 1.5 million of our nation's frail, elderly and disabled citizens who live in nursing facilities, assisted living residences, subacute centers and homes for persons with mental retardation and developmental disabilities. For more information, please visit www.ahca.org or www.ncal.org.