Medicare_Prescription Drug Coverage

To provide prescription drugs to Medicare beneficiaries through their voluntary participation in prescription drug plans, with an additional subsidy provided to lower-income beneficiaries.



Agency - Department of Health and Human Services

The Department of Health and Human Services is the Federal government's principal agency for protecting the health of all Americans and providing essential human services, especially to those who are least able to help themselves.

Website Address

http://www.cms.hhs.gov



Program Accomplishments

As of January 30, 2007, approximately 39 million enrollees had comprehensive drug coverage.

Uses and Use Restrictions

Payments will be made to participating prescription drug plans.

Eligibility Requirements

Applicant Eligibility

A non-governmental entity organized and licensed under State law as a risk-bearing entity eligible to offer health insurance in each State in which it is to offer a plan, meeting the requirements in 42 CFR 423.504 and 42 CFR 423.505.

Beneficiary Eligibility

Individuals who are entitled to Medicare benefits under Part A or enrolled in Part B, who reside in the plan's service area, and who are not enrolled in a Medicare Advantage plan, other than a Medicare savings account plan or private fee-for-service plan that does not provide qualified prescription drug coverage.

Credentials/Documentation

None.

Aplication and Award Process

Preapplication Coordination

This program is excluded from coverage under E.O.

12372.

Application Procedures

Potential sponsors apply to CMS to become an approved prescription drug plan. Generally, individuals enroll directly with the prescription drug program sponsor. The sponsor forwards the enrollment and eligibility information to CMS, which verifies eligibility for the drug benefit. Some individuals who are entitled to both Medicare and Medicaid have been enrolled automatically. Low income beneficiaries may complete a subsidy application at any Social Security office or through their State Medicaid office.

Award Procedures

Payment will be made by CMS to the prescription drug plan sponsors.

Deadlines

Beneficiaries must enroll according to the enrollment periods specified in 42 CFR 423.38. Plans must submit bids by the first Monday in June of the year proceeding the calendar year they wish to participate.

Authorization

Authorized under the Medicare Prescription Drug, Improvement and Modernization Act of 2003, Public Law 108-173, as Section 1860D of the Social Security Act.

Range of Approval/Disapproval Time

Up to six months for plan sponsors.

Appeals

Sponsors whose applications to become a prescription drug plan sponsor are rejected have the right to a reconsideration and appeal process. Beneficiaries have the right to a reconsideration and appeal process for adverse coverage determinations.

Renewals

Contracts with sponsors may be renewed annually. Beneficiaries may enroll and disenroll from plans according to the timeframes established in 42 CFR 423.30-423.46.

Assistance Considerations

Formula and Matching Requirements

None.

Length and Time Phasing of Assistance

Indefinite.

Post Assistance Requirements

Reports

Plans must provide periodic reports to CMS, enrollees and the general public on cost; utilization; availability, accessibility and acceptability of services; fiscal soundness and other information required by CMS.

Plans must provide an annual report of business transactions and combined financial statements.

Also, reports as required under the Employee Retirement Income Security Act of 1974.

Audits

Periodic audits of plans by HHS, the Comptroller General or their designees. Periodic audits by CMS and the HHS Office of Inspector General (OIG) of plan cost reporting. Audit by CMS of financial records of at least one-third of participating plans every year.

Records

None.

Financial Information

Account Identification

75-8308-0-7-571.

Obigations

(Benefit Outlays) FY 07 $49,103,284,000; FY 08 est $45,087,000,000; and FY 09 est $54,815,000,000.

Range and Average of Financial Assistance

Determined by plan offerings,number of enrollees and utilization.

Regulations, Guidelines, and Literature

Regulations governing this program were authorized under Section 1860D of the Social Security Act, as enacted under Public Law 108-173, and were published on January 21, 2005.

Information Contacts

Regional or Local Office

None.

Headquarters Office

Program Contacts: Eligibility and enrollment: Lynn Orlosky, Centers for Medicare and Medicaid Services, Department of Health and Human Services, 7500 Security Boulevard, Baltimore, MD 21244-1850. Telephone: (410) 786-9064. Benefits and beneficiary protections: Vanessa Duran, Centers for Medicare and Medicaid Services, Department of Health and Human Services, 7500 Security Boulevard, Baltimore, MD 21244-1850. Telephone: (214) 767-6435. Plan bidding process: Mark Newsom, Centers for Medicare and Medicaid Services, Department of Health and Human Services, 7500 Security Boulevard, Baltimore, MD 21244-1850. Telephone: (410) 786-3198.

Criteria for Selecting Proposals

None.



Social Entrepreneurship
Spotlight



First Benefit Corporation in Afghanistan Brings People Hope

First Benefit Corporation in Afghanistan Brings People Hope
Roshan, the first telecommunications company that transformed the “luxury” of a phone call in Afghanistan...



Jobs in the Social Sector

  Education Jobs
  Foundation Related Jobs
  Executive Director Jobs
  Foundation Related Jobs
  Education Jobs





More Federal Domestic Assistance Programs


Indian Health Service Sanitation Facilities Construction Program | Tribal Colleges and Universities Program | Violence Against Women Act Court Training and Improvement Grants | Greater Research Opportunities (GRO) Fellowships For Undergraduate/Graduate Environmental Study | Affordable Care Act (ACA) Expansion of Physician Assistant Training Program |  Site Style by YAML | Grants.gov | Grants | Grants News | Sitemap | Privacy Policy


Edited by: Michael Saunders

© 2004-2016 Copyright Information Organizers, LLC