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TO:  IPA NJ Members                    FROM:  Heidi A. Stokes                        DATE:  February 3, 2006

1.  Congress Passes Budget Reconciliation Act

Wednesday, February 1, 2006, the U.S. House of Representatives passed the Budget Reconciliation Act that cuts $3.6 billion over 5 years from Medicaid reimbursement to pharmacists.  The final vote was 216 to 214.  The reimbursement cuts are scheduled to go into effect in January 2007.  Meanwhile, we will continue to fight for a supplemental dispensing fee increase in both Medicaid and PAAD.

2.  Medicare Part D Update

A.  Late-Month Dual Eligible Switching May Cause Problems

The Medicare Modernization Act permits dual eligibles to change Part D plans every 30 days and can switch plans on the last day of the month at 11:59 p.m.  This means they should have coverage on the first day of the following month.

While this is allowed under the law, Medicare and the Part D plans simply cannot handle applications that quickly.  The likelihood that a dual eligible will have a physical card or confirmation letter decreases significantly if they apply in the second half of the month.

So, to avoid being placed in the position of providing emergency supplies or wasting time on the phone obtaining coverage information, advise your patients to change no later than the 15th of the month to allow ample time for the enrollment to be processed by the plan and verified by Medicare.

B.  Tips to Help With Eligibility (E1) Check

Tip #1.  The most important information for the E1 system is the beneficiary’s Medicare ID.  The number should be entered into the Cardholder ID field exactly as it is shown on the patient’s blue and white Medicare card.

Tip #2.  If you do not have the patient’s Medicare ID number, the patient’s complete Social Security number is the next best thing.  It is important that you do not include any dashes when entering this information.

Tip #3.  If the patient’s Medicare ID number and Social Security number are not available, you can input other patient identifiers to match the eligibility system.  These include ZIP code, gender, last name, first name or birthday.  This is not a preferred method to access eligibility.  However, the system will attempt to match based on this information.

Tip #4.  If you are experiencing difficulties accessing the E1 system, contact your software vendor.  If you are receiving incomplete or no information call 866-835-7595, 24 hours a day, 7 days a week, to obtain eligibility information.