 |
|
8. Low-Income Assistance |
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|
8.1 What is
Medicare? What is Medicaid?- CURRENTLY IN DEVELOPMENT |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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TBD |
|
|
CMS |
|
11306 |
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This publication will provide a basic overview of the Medicare and Medicaid programs. Note: Same as Reference #1.37 |
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8.2 You could save
in Medicare expenses |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
3/06 |
2 |
CMS |
Beneficiary |
10126 |
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|
This fact sheet contains information about Medicare Savings programs, including income and asset levels needed to qualify, questions to ask to determine eligibility, and steps needed to apply. |
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8.3 Extra Help On-Line
Application |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
3/07 |
N/A |
SSA |
Beneficiary |
Tool |
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|
It is an on-line application for extra help with the prescription drug costs. It is not an application for coverage under a prescription drug plan. |
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8.4 Information Partners Can Use On: Re-Assignment
|
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
10/06 |
4 |
CMS |
Partner |
11221-P |
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|
This tip sheet explains that Medicare is re-assigning certain people who qualify for extra help into new Medicare Prescription Drug Plans for coverage effective January 1, 2007. Re-assignment is based on those who qualify for extra help as of January 1, 2007. People who no longer qualify for extra help as of January 1, 2007, won’t be re-assigned. |
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8.5 Introduction to the Re-assignment Notice: Plan Premium Increase
Version
|
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
12/06 |
37 |
CMS |
Partner |
11209 |
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|
The purpose of this notice is to inform people who qualify for extra help and whose plan premiums are increasing what plan they will be re-assigned to if they don’t tell their current plan they want to stay or join a new plan on their own by December 31, 2006. |
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8.6 Low Income Subsidy (LIS) Redetermination External Q&As
|
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
http://www.cms.hhs.gov/partnerships/downloads/LISRedeterminationQA.pdf |
10/06 |
3 |
CMS |
Partner |
Reference |
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|
This resource provides answers to questions regarding the annual process of determining the people with Medicare who qualify for extra help paying for Medicare prescription drug coverage in 2006 and will continue to qualify in 2007. |
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8.7 Information Partners Can Use On: Housing Assistance from the Department of Housing and Urban Development (HUD), New Medicare Prescription Drug Coverage |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
2/06 |
4 |
CMS |
Partner |
Tip Sheet |
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|
This tip sheet explains the Medicare Part D, the different types of plans, and the impact of HUD qualifications as a result of extra help. |
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|
8.8 Medicare
Prescription Drug Coverage and other Federal Means-Tested Programs
|
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
http://www.cms.hhs.gov/partnerships/downloads/LISVignette.pdf |
7/05 |
2 |
CMS |
Partner |
Tip Sheet |
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|
This tip sheet explains the intersection between Part D and other means tested programs (Food Stamps, HUD, Medicaid, LIHEAP, and SSI). |
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8.9 The Extra Help with Basic Premiums |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
http://www.cms.hhs.gov/partnerships/downloads/ |
11/05 |
2 |
CMS |
Partner |
Tip Sheet |
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|
This tip sheet explains what extra help will pay if a beneficiary chooses an "enhanced" plan. |
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8.10 Information Partners Can Use: Medicaid Spend Down |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
http://www.cms.hhs.gov/partnerships/downloads/ |
2/06 |
3 |
CMS |
Partner |
11249-P |
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|
This tip sheet provides information on how Medicare will not cover prescription drugs, and how the new Medicare program will impact those on Medicaid. |
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8.11 Auto-Enrollment Notice
|
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
http://www.cms.hhs.gov/partnerships/downloads/ |
2/07 |
4 |
CMS |
Partner |
Mailing – 11154 |
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|
This sample or model letter, mailing, or notice provides an explanation of the auto-enrollment notice. It also includes a sample letter that a beneficiary who qualifies for auto-enrollment might receive. |
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8.12 Monthly Deemed Notice |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
http://www.cms.hhs.gov/partnerships/downloads/deemednotice.pdf |
10/06 |
2 |
CMS |
Partner |
Mailing – 11166 |
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|
This sample or model letter, mailing, or notice provides an explanation of the deemed notice sent to beneficiaries alerting them to their eligibility for extra help. It also provides a sample letter. |
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8.13 Facilitated Enrollment Notice: Full Subsidy Version
|
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
http://www.cms.hhs.gov/partnerships/Downloads/11186.Full.pdf |
12/06 |
38 |
CMS |
Partner |
Mailing – 11186 |
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|
This sample or model letter, mailing, or notice provides explanation of facilitated enrollment - Provides a list of drug plans in each state and instructions for joining. |
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8.14 Facilitated Enrollment Notice: Partial Subsidy Version
|
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
http://www.cms.hhs.gov/partnerships/Downloads/ |
12/06 |
38 |
CMS |
Partner |
Mailing – 11191 |
|||||||||||||||||||||||
|
This sample or model letter, mailing, or notice provides an explanation of facilitated enrollment. It also provides a list of drug plans in each state and instructions for joining. |
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|
8.15 Sample Application for
Help with Medicare Prescription Drug Plan Costs |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
http://www.ssa.gov/prescriptionhelp/SSA-1020B-OCR-SM-INST_12-06.pdf |
12/06 |
8 |
SSA |
Beneficiary |
Tip Sheet |
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|
This tip sheet helps you to understand the application for Medicare Prescription Drug Plans. |
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|
8.16 Information
Partners Can Use on PACE |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
12/05 |
2 |
CMS |
Partner |
11251-P |
||||||||||||||||||||||||
|
This tip sheet explains how Part D affects people on PACE programs. Read latest notice announcing expansion of PACE program in rural areas. Learn more about PACE program. |
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|
8.17 What You Should Know About The
Medicare Prescription Drug Plans: Qualify For Extra Help And Pay No Penalty
In 2007 |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
1/07 |
2 |
SSA |
Beneficiary |
05-10126 |
||||||||||||||||||||||||
|
This fact sheet explains that a person with Medicare that qualifies for extra help may not be responsible for paying a penalty for late enrollment if they follow the steps provided. It explains what the extra help is, the income and resource requirements, and where to go to get assistance to select a plan. |
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8.18 Information Partners Can Use On: Qualifying For Extra Help and
Joining a Medicare Drug Plan
|
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
2/07 |
6 |
CMS |
Partner |
11236-P |
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|
This tip sheet explains how people with Medicare qualify for extra help and provides the 2007 costs for those that automatically qualify and those that apply and qualify. |
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8.19 CMS Perspective on Pharmaceutical Company Patient Assistance
Programs
|
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
https://www.cms.hhs.gov/apps/files/factsheets/Tauzin%20PAP.pdf |
2/06 |
9 |
CMS |
Partner |
Notice |
|||||||||||||||||||||||
|
This letter, or latest notice from Secretary Leavitt to the pharmaceutical industry, explains how the Medicare prescription drug coverage impacts the Pharmaceutical industry's patient assistance programs (PAPs). Read latest notice. |
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8.20 Information Partners Can Use On: Food Stamps |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
2/06 |
3 |
CMS |
Partner |
11243-P |
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|
This tip sheet helps explain Medicare Part D, extra help, and the impact on food stamp eligibility as a result of extra the help. |
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8.21 Choosing a Medicare Drug Plan for People with Medicare & Medicaid |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
http://www.cms.hhs.gov/States/Downloads/ |
2005 |
3 |
CMS |
Beneficiary |
Notice |
|||||||||||||||||||||||
|
This historical notice from states to their constituents explains to dual eligibles that Medicare will automatically enrollment them in a plan if they do not enroll in one before 12/31/2006. |
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|
8.22 What You Need To
Complete The Application For Help With Medicare Prescription Drug Plan Costs |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
1/07 |
2 |
SSA |
Beneficiary |
05-10128 |
||||||||||||||||||||||||
|
This fact sheet explains what information SSA will need to determine if he/she could be eligible for this extra help. Social Security will need to know your income and the value of the savings, investments and real estate (other than a home). A worksheet allows the person with Medicare to record the value of the resources and income that need to be identified for SSA so they can make the determination. |
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8.23 Le estamos enviando esta carta para informarle que la forma en que usted recibe sus medicamentos va a cambiar. |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
http://www.cms.hhs.gov/States/Downloads/ |
N/A |
2 |
CMS |
Beneficiary |
Notice |
|||||||||||||||||||||||
|
This sample or model letter, mailing, or notice is the Spanish SPAP Model Notice. |
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8.24 PACE Participant Information about Medicare Prescription Drug Coverage |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
12/05 |
N/A |
CMS |
Partner |
Link |
||||||||||||||||||||||||
|
This site, web page, or URL contains documents available for downloading that fall into two categories: Information regarding the Medicare Prescription Drug Benefit, and information regarding other PACE policy clarifications. The following documents relate to the Medicare Prescription Drug Benefit: PACE/Part D Implementation Timeframe, 2006 PACE/Part D Application, Addendum to Part D Application, Part D Bid Submission Deadline Waiver Guidance, Part D Bid Submission Deadline Waiver Form, and 2007 PACE/Part D Application. The following documents relate to other PACE policy clarifications: CMS Policy for Sentinel Event Reporting, CMS Policy on PACE Coverage Outside the U.S., CMS Policy on Notification of Alternative Care Settings, and Notice for Solicitation of Proposals for For-Profit PACE Demonstrations. Read latest notice announcing expansion of PACE program in rural areas. Learn more about PACE program. |
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8.25 Introduction to the Re-deeming Notice: Change in (Extra Help) Co-payment Level Version |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
|
8/06 |
2 |
CMS |
Partner |
11199 |
|||||||||||||||||||||||
|
Sample or model letter, mailing, or notice sent by CMS and SSA to inform people with Medicare who continue to automatically qualify for extra help (be deemed) in 2007 if their co-payment level will change. The notice informs what their co-payment will be as of January 1, 2007. |
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8.26 Getting Help with Medicare Prescription Drug Plan Costs Life Insurance: Face and Cash Values |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
3/06 |
2 |
SSA |
Beneficiary |
05-10108 |
||||||||||||||||||||||||
|
This fact sheet explains income and resources requirements for the extra help. It also explains life insurance and the difference between face and cash value. |
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|
8.27 Information
Counselors Can Use on: Issues Facing People who Have Medicare, Medicaid and
Retiree Drug Coverage |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
http://www.cms.hhs.gov/partnerships/downloads/retireeauto.pdf |
3/05 |
2 |
CMS |
Partner |
Tip Sheet |
|||||||||||||||||||||||
|
This tip sheet explains for counselors what people with Medicaid and a retiree health plan should consider before joining a Medicare prescription drug plan. NOTE: Same as section 5.10 |
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|
8.28 What You Need To
Complete The Application For Help With Medicare Prescription Drug Plan Costs |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
1/07 |
2 |
SSA |
Beneficiary |
05-10128 |
||||||||||||||||||||||||
|
This fact sheet explains what information SSA will need to determine if he/she could be eligible for this extra help. Social Security will need to know your income and the value of the savings, investments and real estate (other than a home). A worksheet allows the person with Medicare to record the value of the resources and income that need to be identified for SSA so they can make the determination. |
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8.29 La Cobertura Medicare Para Recetas Medicas Y Otros Programas Federales Que Requieren Investigación De Los Recursos Económicos Del Solicitante |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
7/05 |
2 |
CMS |
Partner |
Tip Sheet |
||||||||||||||||||||||||
|
Spanish translation on Housing Assistance From The Department Of Housing And Urban Development (HUD) - This tip sheet assists in counseling on the Medicare Part D, the extra help and how the extra help impacts HUD eligibility. |
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|
8.30 What do I need
to know about Medicare prescription drug coverage to help my homeless
clients? |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
www.cms.hhs.gov/HomelessnessInitiative/Downloads/ |
2006 |
2 |
CMS |
Partner |
Fact Sheet |
|||||||||||||||||||||||
|
This fact sheet provides information regarding numerous resources (tip sheets, fact sheets, and training materials) available to assist partners in counseling people who are homeless. |
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8.31 Sample Social Security Administration (SSA) Letters |
||||||||||||||||||||||||||||
Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
http://www.cms.hhs.gov/partnerships/downloads/ssaletters.pdf |
2006 |
15 |
SSA |
Partner |
Tool |
|||||||||||||||||||||||
|
Set of sample or model letter, mailing, or notice offering examples of a Resource Worksheet and an Income Worksheet. Generated by SSA, these worksheets accompany the following notices involving Resources and/or Income: all subsidy award notices, subsidy pre-decisional notices, subsidy denial notices, notices of change, notices of planned action, notices of termination, and notices of review. |
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8.32 State Medicaid Manual |
||||||||||||||||||||||||||||
Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
9/05 |
N/A |
CMS |
Partner |
Reference |
||||||||||||||||||||||||
|
This reference makes
available to all State Medicaid agencies, in a form suitable for ready
reference, informational and procedural material needed by the States to
administer the Medicaid program. It is an official medium by which CMS issues
mandatory, advisory, and optional Medicaid policies and procedures to the |
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8.33
|
||||||||||||||||||||||||||||
Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
8/05 |
N/A |
CMS |
Partner |
Reference |
||||||||||||||||||||||||
|
This reference is under development. |
||||||||||||||||||||||||||||
8.34 Information Pharmacists Can Use On: Helping People with
Medicare Apply for Extra Help
|
||||||||||||||||||||||||||||
Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
1/07 |
2 |
CMS |
Partner |
11291-P |
||||||||||||||||||||||||
|
This tip sheet explains that Pharmacists continue to be a valuable resource in helping people with Medicare apply for extra help paying their Medicare drug plan costs. People with Medicare who received extra help in 2006 and don’t automatically qualify in 2007 must apply through the Social Security Administration to see if they are eligible for extra help in 2007. Pharmacists are encouraged to continue helping people with Medicare submit applications for extra help. |
||||||||||||||||||||||||||||
8.35 Low-Income Assistance Posters (English & Spanish) |
||||||||||||||||||||||||||||
Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
12/05 |
N/A |
SSA |
Partner |
Tool |
||||||||||||||||||||||||
|
Set of job aid, visual aid, or tools raising awareness about extra help. |
||||||||||||||||||||||||||||
8.36 Video Files from SSA Regarding Medicare Prescription Drug Coverage (English & Spanish) |
||||||||||||||||||||||||||||
Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
N/A |
N/A |
SSA |
Partner |
Multimedia |
||||||||||||||||||||||||
|
This site, web page, or URL provides SSA’s library of multimedia videos in various formats. Includes: 1. Social Security Can Help With Prescription Drug Costs and 2. Overview and Tutorial for the Application for Help With Medicare Prescription Drug Plan Costs. |
||||||||||||||||||||||||||||
8.37 Prescription Drug Coverage Contracting - Interested Third Party
|
||||||||||||||||||||||||||||
Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
http://www.cms.hhs.gov/PrescriptionDrugCovContra |
10/06 |
N/A |
CMS |
Partner |
Link |
|||||||||||||||||||||||
|
This site, web page, or URL contains information for Part D Sponsors on Safety-Net Providers, Part D Pharmacy Contracting Contact List, State Pharmaceutical Assistance Program Contacts, State Contacts for ICF-MR/ IMD Providers, State Run Veterans’ Homes Contact List. Includes Frequently Asked Questions (FAQ) regarding pharmacy access for people residing in intermediate care facilities for the mentally retarded (ICFs/MR) and institutes for mental disease (IMDs). Learn more about 2007 PDP Eligibility and Enrollment Guidance. Same as section 6.14 |
||||||||||||||||||||||||||||
|
8.38 Part D
Pharmaceutical PAP Information |
||||||||||||||||||||||||||||
Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/ |
1/06 |
2 |
CMS |
Partner |
Notice |
|||||||||||||||||||||||
|
This historical notice provides CMS’s perspective on pharmaceutical company patient assistance programs (PAPs). Read latest notice. |
||||||||||||||||||||||||||||
|
8.39 States -
Excluded Drug Coverage by State Medicaid Programs |
||||||||||||||||||||||||||||
Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
3/07 |
N/A |
CMS |
Partner |
Link |
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This online tool or library lists information regarding excluded drug coverage by each State Medicaid program. Effective January 1, 2006, Medicaid beneficiaries who are entitled to receive Medicare benefits under Part A or Part B no longer receive their pharmacy benefits under their State Medicaid agency, except for excluded drugs. Each State has the option to cover these drugs for their Medicaid beneficiaries who also have Medicare coverage. Please note this does not apply to the territories. |
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8.40 Citizenship
Guidelines for Medicaid Eligibility |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
http://www.cms.hhs.gov/MedicaidEligibility/ |
3/07 |
N/A |
CMS |
Partner |
Link |
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|
Effective July 1, 2006, Public Law No. 109-171 Deficit Reduction Act of 2005 Section 6036 requires individuals to provide satisfactory documentary evidence of citizenship or nationality when initially applying for Medicaid or upon a recipient’s first Medicaid re-determination. This site, web page, or URL contains copies of the law, the State Medicaid Director Letter that includes detailed information regarding this statute and the specific documents that are recognized as satisfactory documentary evidence of citizenship and identity and an associated Medicaid Fact Sheet. |
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8.41 Deficit Reduction Act of 2005 – The Law |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
1/06 |
80 |
CMS |
Partner |
Link |
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This site, web page, or URL provides text of the Act. Signing into law announced. Learn more about the Medicaid Integrity Program (MIP), the first national strategy to detect and prevent Medicaid fraud and abuse. See also how-to guides to help special needs plans (SNP), understand, integrate and coordinate/offer coordination of services between Medicare and Medicaid for dual eligible/dual-eligible/persons who are dually eligible. |
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8.42 HHS Federal Poverty Guidelines (FPL)
|
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
1/07 |
N/A |
HHS |
Partner |
Link |
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This site, web page, or URL by the U.S. Department of Health and Human Services provides background and current year guidelines for the Federal Poverty Level (FPL). Future updates are posted here as soon as available. |
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8.43Guidance to States on the Low Income Subsidy |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
http://www.cms.hhs.gov/States/Downloads/ |
5/05 |
40 |
CMS |
Partner |
Reference |
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This historical reference provides guidance for States in processing SSA applications and making determinations for subsidy eligibility upon request. It will be updated periodically to reflect changes as necessary. The MMA provides extra help (a subsidy) with prescription drug costs for eligible individuals whose income and resources are limited. This help takes the form of subsidies paid by the Federal government to the drug plan in which the Medicare beneficiary enrolls. The subsidy provides assistance with the premium, deductible and co-payments of the program. Beneficiaries may apply for the Low-Income Subsidy (LIS) with the Social Security Administration (SSA) starting in May 2005 or with their State Medicaid agency starting in July 2005. |
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8.44 CMS Mailing List MMA_STATES – Listserv Updates
|
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
http://www.cms.hhs.gov/apps/mailinglists/ |
10/06 |
N/A |
CMS |
Partner |
Link |
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The “CMS MMA_STATES” platform hosts library of latest notices provided as an electronic mailing list service for those interested in subscribing to e-mails with CMS news and updates relevant at the State level. The National Institutes of Health (NIH) hosts most CMS listservs. Example of recent message topics include: a list of resources designed to help people with Medicare manage and reduce their out-of-pocket costs if they reach the coverage gap in their Part D prescription drug coverage; CMS guidance on procedures for the 2007 reassignment of beneficiaries eligible for a low income subsidy (LIS) of their Part D coverage; a new fact sheet developed to help explain the complaint process and the channels for communication to partners who may be navigating the complaint process on behalf of a Medicare beneficiary. |
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8.45 Tool Helpful in
Finding Unreached Low-Income Individuals with Medicare in Your Community
|
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
http://www.cms.hhs.gov/partnerships/downloads/ |
7/06 |
N/A |
CMS |
Partner |
Tool |
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This job aid, visual aid, or tool comes in the form of an Excel spreadsheet released to assist in targeting ongoing outreach activities. The spreadsheet is part of a large, zipped set of files (28 MB) within a LIS Outreach Toolkit; the fact sheets and other documents are already available and described above. The spreadsheet provides a general estimate of the number of Part D-eligible Medicare beneficiaries who are not yet enrolled in Medicare Rx and might be eligible for the low-income subsidy (LIS) by county. These numbers are not intended to be publicly quoted. Rather, these numbers are general estimates designed to inform our combined efforts to better assist people with limited income obtain the medications they need. Check for future updates or visit the CMS partner center. |
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8.46 Review of Your Eligibility for Extra Help with Medicare Prescription Drug Plan Costs Begins August 2006: Some Things You Should Know |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
8/06 |
2 |
SSA |
Beneficiary |
05-10111 |
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This fact sheet explains the actions taken to review the eligibility status of those people with Medicare that were eligible for assistance in 2006 are still eligible. |
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8.47 Medicare Prescription Drug Assistance – Notice of Review |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
10/06 |
4 |
SSA |
Partner |
OMB No. 0960-0723 |
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Sample or model letter, mailing or notice (SSA-L1026). Notice the beneficiary will receive will be tailored to his or her personal situation and will not be identical to this sample. |
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8.48 Social Security Administration Review Of Your Eligibility For Extra Help |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
http://www.ssa.gov/prescriptionhelp/SSA-1026B-OCR-SM-INST.pdf |
8/06 |
10 |
SSA |
Partner |
1026B |
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Sample or model letter, mailing or notice (SSA-L1026) - cover letter/set of instructions and accompanying form are necessary to review the person with Medicare’s continuing eligibility for extra help with Medicare Prescription Drug plan costs. |
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8.49
Patient Assistance Programs (PAP) |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
3/07 |
N/A |
Rx Assist |
Partner |
Link |
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|
This type of job aid, visual aid, or tool (reference chart) is readily available online and can address issues raised in the "Bridging the Coverage Gap" tip sheet. It helps people look into Patient Assistance Programs offered by manufacturers of drugs. SHIP counselors may find the reference chart helpful. Many other PAP websites exist: e.g. BenefitsCheckUp website; Partnership for Prescription Assistance; also check with various drug manufacturers, or ask your health care provider. Read latest notice/FAQ Tool. |
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8.50 Medicaid Infrastructure Grant |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
3/07 |
N/A |
CMS |
Partner |
Link |
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|
CMS provided supplemental funding to the Medicaid Infrastructure Grant (MIG) States to conduct outreach to Medicaid buy-in participants to inform them of the transition of prescription drug coverage from Medicaid to Medicare Part D for those who are dually entitled. This site, web page, or URL contains materials submitted by various States and are approved by CMS for use in this outreach. See also Medicaid Infrastructure Grants to support the employment of people with disabilities. Learn more about Medicaid. |
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8.51
Auto Versus Facilitated Enrollment of Low-Income Populations |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
http://www.cms.hhs.gov/States/Downloads/AutoversusFacilitatedEnrollment.pdf |
4/06 |
4 |
CMS |
Partner |
Tool |
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|
This job aid, visual aid, or tool details the differences and similarities between auto and facilitated enrollment. Learn more |
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8.52
How-To Guides to Integrated Medicare and Medicaid Models |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
http://www.cms.hhs.gov/DualEligible/04_IntegratedMedicareandMedicaidModels.asp |
3/07 |
N/A |
CMS |
Partner |
Link |
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|
This site, web page, or URL provides how-to guides in the areas of Enrollment, Marketing and Quality, which provide clarification on many Medicare and Medicaid rules and suggest streamlined processes that States and plans can use to fulfill Medicare and Medicaid requirements. E-mail questions here. Guides help states and special needs plans (SNP), understand, integrate and coordinate/offer coordination of services between Medicare and Medicaid for dual eligible/dual-eligible/persons that are dually eligible. |
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8.53 Hurricane and National Disaster Medical System Information |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
12/05 |
N/A |
CMS |
Partner |
Link |
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|
This site, web page, or URL provides Disaster Response information |
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8.54 Pharmaceutical Manufacturer Patient Assistance Program Information
|
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/07_PAPData.asp |
12/06 |
N/A |
CMS |
Partner |
Link |
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|
This web site provides links to references and resources for a variety of PAP related topics, such as patient assistance programs operating outside the Part D benefit. |
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8.55 Introduction to the Re-deeming Notice: Loss of (Extra Help) Status Version |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
|
8/06 |
3 |
CMS |
Partner |
11198 |
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Sample or model letter, mailing, or notice used by CMS and SSA to (1) inform some people with Medicare that they no longer automatically qualify for extra help (aren’t deemed) as of January 1, 2007, and (2) encourage them to apply for extra help to see if they will continue to qualify for assistance. |
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8.56 CMS Announces Part D Low Income Subsidy (LIS) Redetermination Information |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0668.pdf |
8/06 |
5 |
CMS |
Partner |
Notice |
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|
Special Edition (SE) article, or latest notice to alert providers that Medicare and Social Security are making decisions about whether some people who qualify for extra help (also referred to as the low-income subsidy) in 2006 will continue to qualify in 2007. People affected by these changes will receive information from Medicare or Social Security. Use the information provided in this SE to help counsel those affected by these changes and help them understand their options for getting help paying for Medicare prescription drug coverage. |
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8.57 Medicare/Medicaid Relationship Brochure |
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
http://www.cms.hhs.gov/MLNProducts/downloads/Relationship_Brochure.pdf |
9/06 |
2 |
CMS |
Partner |
ICN 006378 |
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Job Aid, visual aid, or tool (brochure) that discusses those Medicare beneficiaries who have limited income and resources might be getting help paying for their out-of-pocket medical and prescription expenses from their State Medicaid Program. For persons eligible for full Medicaid coverage, the Medicaid program supplements Medicare coverage by providing services and supplies under the State program. |
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8.58 Reassignment of Medicare
Beneficiaries Receiving LIS
|
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
http://www.cms.hhs.gov/partnerships/downloads/ReassignmentOverview.pdf |
12/06 |
2 |
CMS |
Partner |
11284-P |
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|
This resource provides statistics regarding the number of beneficiaries that are LIS-Eligible Beneficiaries Enrolled in Part D in 2006, LIS beneficiaries eligible for reassignment in 2007, LIS-eligible beneficiaries who will be reassigned in 2007, and LIS beneficiaries CMS will reassign outside their current organization in 2007 to avoid new premium liability. |
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8.59 What You Need To Complete the Application for Help with Medicare Prescription
Drug Plan Cost
|
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
|||||||||||||||||||||||
|
1/07 |
6 |
SSA |
Beneficiary |
05-10124 |
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|
This
pamphlet tells a person with Medicare
what information SSA will need to determine if he/she could be eligible for
this extra help. Social Security will need to know your income and the value
of the savings, investments and real estate (other than a home). A worksheet allows the person with Medicare to
record the value of the resources and income that need to be identified for
SSA so they can make the determination. |
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8.60 Tips for Completing the Application
for Help with Medicare Prescription Drug Plan Costs
|
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Web Address |
Pub Date |
No. of Pages |
Published By |
Appropriate Audience |
Pub Number/ Type |
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|
1/07 |
2 |
SSA |
Beneficiary |
05-10122 |
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|
This tip sheet provides guidance to help people with Medicare complete the Extra Help application. Following these tips will help the Social Security Administration (SSA) process your application as quickly as possible |
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