Reimbursement of State Costs for Provision of Part D Drugs

To ensure that the Medicare and Medicaid programs can respond expeditiously to the needs of the dual-eligible beneficiaries and beneficiaries who have enrolled in a Part D plan and have been determined to be eligible for the low-income subsidy.

This demonstration would allow States, that have
assisted with their dual eligible and low-income subsidy entitled populations in obtaining and accessing Medicare Part D coverage, to be reimbursed for their efforts.


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.

Office - Contact the Regional Administrator, Centers for Medicare and Medicaid Services (see appendix IV of the Catalog for addresses and telephone numbers).
Website Address

http://www.cms.hhs.gov



Program Accomplishments

None.

Uses and Use Restrictions

The demonstration permits Medicare payment to be made to States for amounts they have paid for a dual-eligible's Part D drugs, or a low-income subsidy entitled Part D plan enrollee's Part D drugs, to the extent that those costs are not otherwise recoverable from a Part D plan and are not required Medicaid cost-sharing on the part of the beneficiary.

In addition to providing Medicare funds to reimburse amounts paid by States for Part D drugs, the demonstration would also provide payments for certain administrative costs incurred by States.



Eligibility Requirements

Applicant Eligibility

State: Must have incurred costs in assisting dual eligibles and other low-income subsidy entitled beneficiaries receive the prescription medications they need.

Beneficiary Eligibility

State: Must have incurred costs in assisting dual eligibles and other low-income subsidy entitled beneficiaries receive the prescription medications they need.

Credentials/Documentation

Federal (Medicare) funds must go to a State Medicaid Agency with appropriately approved Section 402 demonstration proposals. Administrative costs will be determined in accordance with OMB Circular A-87 "Cost Principles for State and Local Governments".

Aplication and Award Process

Preapplication Coordination

States are encouraged to work with CMS in the development of their section 402 Medicare demonstration proposal.

This program is excluded from coverage under E.O.

12372.

Application Procedures

States will complete an application as provided by CMS to request approval for participation in this Medicare demonstration.

Award Procedures

Approved States will receive an initial payment based on CMS' review of submitted claims data to verify that the beneficiary is a dual eligible beneficiary or a low-income subsidy entitled beneficiary as defined in this demonstration and that the prescription drug is a Part D drug. CMS will also reimburse the State for additional costs determined by CMS to be eligible under the demonstration, including costs due to the State for drug payments that exceed plan payments, as well as allowed administrative costs specified in the demonstration application.

Deadlines

The State costs eligible for reimbursement under this Medicare demonstration must be related to the provision of Part D drugs to dual eligible and low-income subsidy entitled beneficiaries dispensed during the period of January 1, 2009 and no later than March 31, 2009.

Authorization

Authorized under Section 402 of the Social Security Amendment of 1967, as amended.

Range of Approval/Disapproval Time

The State costs eligible for reimbursement under this Medicare demonstration must be related to the provision of Part D drugs to dual eligible and low-income subsidy entitled beneficiaries dispensed during the period January 1, 2009 to no later than March 31, 2009.

Appeals

None.

Renewals

None.

Assistance Considerations

Formula and Matching Requirements

This program has no statutory formula or matching requirements. It is being funded under the Federal Supplementary Medical Insurance Trust Fund. THE STATES ARE NOT TO USE THE MEDICARE FUNDING UNDER THIS DEMONSTRATION AS STATE MEDICAID MATCHING FUNDS.

Length and Time Phasing of Assistance

Project Period: No payments shall be made for State costs associated with the provision of Part D drugs to dual-eligible and low-income subsidy entitled beneficiaries that are incurred after March 31, 2009. Budget Period: Qualifying costs are reimbursed in full.

Post Assistance Requirements

Reports

States must submit fiscal and statistical reports, as required by CMS.

Audits

The States may be subject to audit by other Federal agencies including the Office of the Inspector General.

Records

Financial records, supporting documents, statistical records, and all other records pertinent to the demonstration shall be retained for at least three years or until resolution of any audit questions.

Financial Information

Account Identification

75-8308-0-7-571.

Obigations

(Grants) FY 07 est not available; FY 08 est not available; and FY 09 est not available.

Range and Average of Financial Assistance

Floor: $0; Ceiling: Federal contractor will compute the reconciliation payments the Federal government will make to the States for amounts the State paid in excess of Part D prescription drug plan payments and associated administrative costs realized during the Part D prescription drug plan transition period.

Regulations, Guidelines, and Literature

None.

Information Contacts

Regional or Local Office

Contact the Regional Administrator, Centers for Medicare and Medicaid Services (see appendix IV of the Catalog for addresses and telephone numbers).

Headquarters Office

Program Contact: Christine Hinds, Centers for Medicare and Medicaid Services, 7500 Security Boulevard, Mail Stop C1-26-12, Baltimore, MD 21244. Telephone: (410) 786-4578.

Criteria for Selecting Proposals

None.



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