Handbook for New Medicare Prescription Drug Benefit Inaccurate, Advocacy Groups Say, USA

Main Category: Medicare / Medicaid / SCHIP
Article Date: 10 May 2005 - 10:00 PDT

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Some health plans and advocates for Medicare beneficiaries have said that the draft handbook for the new Medicare drug benefit is "sprinkled with omissions, inaccuracies and material that could make an already complicated endeavor even more confusing," the... Washington Post reports (Connolly, Washington Post, 5/7). In April, House Democrats Charles Rangel (N.Y.), John Dingell (Mich.), Henry Waxman (Calif.), Pete Stark (Calif.) and Sherrod Brown (Ohio) in a letter to CMS Administrator Mark McClellan asked the agency to stop production of the 2006 "Medicare & You" handbook, which they said included a number of omissions and inaccuracies (Kaiser Daily Health Policy Report, 4/27). Now other groups, who also have been reviewing the handbook, are registering their own complaints, including the "glaring omission" of any mention of the gap in drug coverage -- the so-called "doughnut hole" -- for beneficiaries who reach a certain out-of-pocket spending level, the Post reports. The handbook also does not explain that most drug plans will limit coverage of medications through the use of formularies, the critics said. In addition, they said the document contains unfamiliar terminology, such as "creditable coverage"; includes misleading information about switching health plans; and uses income figures that conflict with numbers being used by the Social Security Administration.

Comments
Tricia Neuman, a Kaiser Family Foundation vice president and director of its Medicare Policy Project, said, "With one in four of the people on Medicare having cognitive or mental impairments, education is a real challenge. They themselves may be difficult to educate. The challenge then is reaching the people who make decisions with and for them." Analysts at the Medicare Rights Center said, "The web of choices facing people with Medicare is challenging to explain and comprehend. But we believe that the draft handbook makes these choices even more difficult to understand, rather than less." An unnamed senior lobbyist also noted that the handbook refers to Medicare Advantage as "Medicare Health Plans," saying, "For the past year, everyone's been educating consumers about a new option called Medicare Advantage. I don't know why the name change, but it's going to be really confusing." Leslie Norwalk, deputy administrator at CMS, said that Medicare Advantage plans fall under the umbrella of Medicare Health Plans, and the agency likely will use both terms. She added that the critics "made lots of legitimate points," saying, "We're quite confident we'll address the issues that arise" (Washington Post, 5/7).

Education Effort
The circulation of the handbook to patient advocacy groups is part of an effort to obtain feedback from outside groups on the materials that will be used to educate beneficiaries about the new drug benefit. The "massive multimillion dollar" education effort will include letters to be mailed this month alerting beneficiaries who are eligible for low-income assistance of the subsidies they will receive under the new Medicare law. According to CongressDaily, the mailing marks "what is almost certain to be the next front in the protracted partisan debate over the new law." Democrats have criticized previous efforts to educate beneficiaries about the new law, and some officials question "whether lawmakers who have been critical of the new benefit will pitch in to sign up seniors," CongressDaily reports. One Democratic aide said district offices are preparing to help beneficiaries understand the program and warn them about possible shortcomings. "We're not going to gloss over the problems, and we want people to make sure they understand what those are before they enroll," he added (CongressDaily, 5/6).

Related News
Two newspapers recently examined other issues related to Medicare. Summaries of the articles appear below.

• CQ HealthBeat: CMS on Thursday released new guidelines for Medicare coverage of power wheelchairs, scooters and similar devices that adopt a "function-based determination of medical necessity," CQ HealthBeat reports. Previously, CMS used a "bed or chair" standard to define medical necessity for such devices. The new policy approves coverage for mobility devices based on the beneficiaries' ability to safely accomplish mobility-related activities of day-to-day life, including using the toilet, grooming and eating. McClellan said the new criteria are part of CMS' effort "to ensure that seniors who need mobility help will get it promptly and that we are paying appropriately for mobility-assistive equipment." The guidelines also are intended to eliminate "most honest billing errors," according to Kimberly Brandt, director of CMS' Program Integrity Group. However, Robert Hayes, president of the Medicare Rights Center, said the new policy "imprisons people in their homes" because it means that beneficiaries who require "a wheelchair to leave home for medical care, shopping or even employment" will not receive coverage for the device. ITEM Coalition added that the policy "fails to recognize the beneficiary's need to access his/her community." The Medicare Rights Center has asked the Bush administration to intervene in the matter (CQ HealthBeat, 5/6).
  
  
• New York Times: Low-income beneficiaries who qualify for subsidies under the new drug benefit might experience a reduction in food stamp benefits, Bush administration officials said Saturday. In a document sent to congressional offices last week, HHS addressed beneficiaries, saying, "You may qualify for extra help paying for your Medicare prescription drug costs." However, "With the Medicare prescription drug coverage, you may see your food stamp benefits go down as you spend less on drugs. Using the new Medicare benefit means you will have more cash to spend on food that you used to spend on prescription drugs," the document added. McClellan said, "Medicare beneficiaries will get comprehensive help with their drug costs and will have significantly more resources for all their other basic necessities, including food." He added that the savings on prescription drugs will more than offset any loss from lower food stamp benefits, so "low-income seniors will be better off" (Pear, New York Times, 5/8).

"Reprinted with permission from kaisernetwork.org kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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