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Please scroll down to the bottom of the page for downloadable materials and helpful links. Please note the number in bracket next to a bold item in the page content corresponds to the downloadable item or link at the bottom of the page. STATE PHARMACEUTICAL ASSISTANCE PROGRAMS (SPAPs) Qualified SPAPS: During the first two years of the Part D program, CMS required that SPAPs provide wrap-around benefits to their beneficiaries regardless of the Part D plan the beneficiary chose to enroll in. However, based on the experience in the first two years of the program, CMS clarified our policy in the 2008 Call Letter to explicitly permit States to adopt reasonable coordinating criteria that will allow the SPAPs and plans to provide quality coordination of care and benefits in the interest of our mutual beneficiaries. As a result of revised policies, CMS replaced the former qualified SPAP checklist with the {13} Standardized Template and Instructions. This letter provides instructions to SPAPs regarding coordinating criteria and CMS' plan non-discrimination policy. The {15} current qualified SPAP list is also available (current as of 4/15/08). {14} 2009 Call Letter: The 2009 Call Letter discusses useful information and operational reminders for the Medicare Advantage and other private plan options (Part C) and prescription drug (Part D) programs.It references current CMS guidance and directs you to the documents or websites where you can locate in-depth information on important topics. {12} SPAPs: Comparison Chart: This chart provides detail on benefits and eligibility for all of the qualified SPAPs. {11} Coordination of Benefits: State Services The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and subsequent regulations require unprecedented coordination between the CMS, State programs, insurers, employers, and all other payers of prescription drug coverage to ensure that the benefits provided to Part D beneficiaries by all parties are maximized and the integrity of the Medicare program is assured. The CMS and the COB contractor have worked to anticipate and accommodate all of the coordination needs of the Part D benefit. {10}2006 SPAP Special Enrollment Period The attached a memo serves to clarify the existing Special Enrollment Period (SEP) provided to members of Qualified State Pharmaceutical Assistance Programs (SPAPs). {9}SPAP Fact Sheet The Medicare prescription legislation provides special relief for State Pharmacy Assistance Programs - state-funded programs that provide low-income and medically needy senior citizens and individuals with disabilities financial assistance for prescription drugs. {6} 2005/2006 SPAP Transitional Grant Distribution Awards Grants issued to 21 states for fiscal year 2005 to help educate low-income Medicare beneficiaries, who currently get their prescription drugs through state-funded programs, about the new Medicare prescription drug coverage coming in 2006. {5} 2005/2006 SPAP Grant Guidance General guidance for SPAP States that receive grant funds, provided by MMA, for outreach and education effort. {4}2006 SPAP Model Notice Model Language for State Letters to SPAP Beneficiaries about the new Medicare prescription drug coverage. For the Spanish version of the model notice, please click on Materials in Spanish. DOCUMENTS FROM SPAP WORKGROUPS On March 28-29, 2005, the National Governor's Association hosted a Workshop for State Pharmaceutical Assistance Programs (SPAPs) through a grant from the Centers for Medicare & Medicaid Services. The purpose of this workshop was to provide support to SPAPs during the transition to Medicare Part D. Below is a list of the documents distributed at the meeting, which can be found at the bottom of the page for dowloading: {3}The Memorandum to Potential Part D Sponsors, State Medicaid Directors, and SPAPs This document is from Leslie Norwalk, Administrator (acting) of CMS, regarding SPAP Assistance for Low Income Subsidy Eligible Individuals under the Medicare Prescription Drug Benefit. {2}Qualified SPAP Guidelines This document provides guidance regarding the appropriate role for SPAPs as we work together to implement the new Medicare drug benefit. {1} CMS Response to SPAP Commission Report (2005) CMS's responses to the State Pharmaceutical Assistance Transition Commission (SPATC) recommendations.
Page Last Modified: 12/01/2008 4:24:26 PM
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