Other E-alert

The Medicare Savings Programs and Extra Help are important programs designed to help low-income Americans afford Medicare coverage. Many people who are eligible for these programs are not yet enrolled. Each May, the Social Security Administration (SSA) sends letters to 2 million low-income Medicare beneficiaries, informing them about the Medicare Savings Programs and how they can help with Medicare costs. These include the Qualified Medicare Beneficiary (QMB), Specified Low-income Medicare Beneficiary (SLMB), and Qualifying Individual (QI) programs.

On March 11, 2021, the Centers for Medicare & Medicaid Services (CMS) released the updated State Phased-Down (SPD) Billing Guide. The Medicare Prescription Drug Improvement and Modernization Act of 2003 (Medicare Modernization Act or MMA) established the Medicare Part D prescription drug benefit. As a result, Medicare became the primary payer for most prescription drugs for full-benefit dually eligible individuals.

On September 8, CMS released the updated Manual for State Payment of Medicare Premiums (formerly called “State Buyin Manual”). The manual updates information and instructions to states on federal policy, operations, and systems concerning the payment of Medicare Parts A and B premiums (or buy-in) for individuals dually eligible for Medicare and Medicaid.

E-alert regarding the following CMS guidance and resources related to the COVID-19 Pandemic:

- Medicare Part A and Part B Enrollment Equitable Relief for the COVID-19 Pandemic

- Updated Guidance for Medicare Advantage and Part D Plans

- New CMS Toolkit on State Actions to Mitigate COVID-19 Prevalence in Nursing Homes

On January 17, 2020, the Centers for Medicare & Medicaid Services (CMS) issued additional guidance and clarification on four topics related to CY2021 requirements for Dual Eligible Special Needs Plans (D-SNPs). The guidance follows on an October 2019 an HPMS memo summarizing the new D-SNP requirements and providing guidance on contract and operational changes needed for CY2021.

Under the Medicare-Medicaid Financial Alignment Initiative, the Centers for Medicare & Medicaid Services (CMS) is measuring consumer experience in multiple ways, including through beneficiary surveys such as the Consumer Assessment of Healthcare Providers and Systems (CAHPS). As part of the MA-PD CAHPS survey, respondents are asked to rate their health plan on a scale from 0 to 10, where 0 is the worst health plan possible and 10 is the best health plan possible.

On November 15, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a final rule implementing a new opioid treatment program (OTP) benefit under Medicare Part B, starting January 1, 2020.