Office on Disability

Introduction

The U.S. Department of Health and Human Services Office on Disability (OD) convened a regularly scheduled Quarterly Constituent Input Meeting on September 20, 2005, in the Deputy Secretary’s Conference Room, Hubert H. Humphrey Building, Washington, D.C.  Over 30 constituent organizations and HHS agencies and offices were represented, either in person of by conference call.[1]  These quarterly meetings provide representatives from the national disability organizations (representing 54 million Americans with disabilities of all kinds) opportunity to be heard by HHS on key topics of concern both to the Federal government and to persons with disabilities. 

CMS Administrator Dr. Mark McClellan and his senior staff joined those in attendance at the meeting to focus attention on the implementation plans for the new Medicare Prescription Drug benefit program.  This was the third constituent input meeting on this important new benefit for persons with disabilities and other qualifying under the Medicare program.

Office on Disability Director Margaret Giannini, MD, FAAP, opened the meeting by welcoming those in attendance.  She explained the ground-rules for the meeting.  Each participant was asked to state at least one issue, and then to provide at least one recommendation that responds to the issue raised.  If time permitted, participants had the opportunity to participate in a second round of questions and answers.

Meeting Summary

The following provides a summary of the questions of the disability constituency organization representatives who attended the meeting and shares the observations, comments and suggestions made by CMS Administrator McClellan and his staff, as well as constituent responses and recommendations.

CMS Response to Hurricane Katrina

Dr. McClellan began by providing particularly timely information related to Hurricane Katrina response.  He indicated temporary shelters and medical clinics were set up.  CMS will provide an uncompensated Medicaid waiver for short- and long-term care, payment to healthcare providers for services.  CMS will ensure states receive proper reimbursement. 

To be eligible for the uncompensated Medicaid waiver, an individual must be either directly affected by the hurricane and/or be unable to pay for medical services.  For individuals who may not be eligible for Medicaid, the uncompensated Medicare waiver can help defray costs associated with healthcare needs and reimburse expenses paid toward medical assistance.

Dr. McClellan’s overall assessment of healthcare providers in the gulf coast region suggests they remain committed to rebuilding and improving healthcare in the hurricane-affected areas.  The purpose of making Medicaid waivers is available is to provide more support for community-based healthcare facilities in the region, including independent- and assisted-living facilities.  The Administration on Aging is working with community-based assisted-living facilities to meet the needs of primarily older adults affected by the hurricane.

Questions and Answers – Hurricane Katrina

Is CMS responding to individuals affected by Hurricane Katrina related to their eligibility to receive benefits under the new Medicare Prescription Drug program? 

Yes,CMS is responding to the needs of individuals affected by the hurricane who need prescriptions to be filled.

How do individuals affected by the hurricanes receive Medicare/Medicaid services without proper identification cards? 

Individuals can be verified for Medicare and Medicaid coverage by using their social security card.  The state-to-state list or plan finder help authenticate the date given on Medicare and Medicare I.D. number from cards.  Newly eligible or current recipients enrolled in Medicare or Medicaid may not have cards verifying their eligibility.

Will the hurricane evacuees to Texas and Arkansas be covered for new patient care under the current Medicaid and Medicare health plans? 

Yes, CMS is working to cover the newly and existing eligible Medicaid and Medicare recipients.  States will receive 100% reimbursement for eligible services and follow up care will be provided.

Some individuals referred to shelters are unable to be accommodated due to either the lack of a caregiver or appropriate medical equipment.  How is CMS working with the Red Cross to identify individuals in this situation and provide proper support services to them? 

Currently, the Medicaid waiver policy is in effect allowing individuals to receive appropriate medical care and treatment. 

Hurricane Katrina has displaced three tribal communities.  What coordination is occurring to help individuals within the tribal community to access Medicaid/Medicare services? 

Individuals within tribal communities affected by Hurricane Katrina are eligible for Medicaid/Medicare services.  If an individual is not eligible or able to access services through Medicaid/Medicare, the uncompensated Medicaid waiver may be utilized.  Both the Office on Disability and the Indian Health Service can serve as excellent points of first contact for assistance.

In reference to nursing homes serving as temporary shelters, how is CMS working with the Red Cross to address the needs of individuals residing in temporary shelters? 

Medicaid waivers will be in effect.

Questions and Answers –

Medicare Prescription Drug Benefits

How will CMS provide support for enrolling individuals into the prescription drug plan? 

Many plans offer different benefits and options, thereby allowing individuals to select a plan based upon their personal needs.  Specific information on prescription drug plan will be available soon.

CMS’s  Medicare Prescription Drug Program provides:

• Plan options (that include plans with no deductibles).
• Prescription drug plans that provide comprehensive drug coverage across that are portable across different states, of particular help for displaced individuals). 
• Adaptable plans (process will begin in November).
• Coverage for persons with dual eligibility
• Demonstration programs (integrated care, long-term care support, and Medicare-Medicaid).
• “Money follows the person” initiative explains the Medicare prescription drug plan benefits.

Currently, the Senate has reform proposals addressing fraudulent use of Medicare and Medicaid.  Proposed Medicaid reforms involve giving individuals more control over selecting how they receive benefits and services.  Further, this change allows beneficiaries to reduce costs for their healthcare services.  Some immediate needs and concerns for Medicaid reform include Hurricane Katrina response, Family Option Act, Asset Rules and Fraud Prevention.  A comprehensive long-term supplement is needed to address the needs and issues associated with many individuals seeking long-term care services.

Since Medicare I.D. numbers and Social Security numbers do not always match, how can healthcare professionals help beneficiaries receive their benefits? 

Have the beneficiary obtain a letter from the Social Security office identifying themselves as Medicaid and/or Medicare eligible.

Does Medicare’s Prescription Drug Benefit program  include coverage for both persons residing in nursing home facilities and for persons living in the community?

Yes.  In fact CMS is providing ongoing outreach to educate and inform both nursing home facilities (including staff and administration) and individuals eligible for the Medicare Prescription Drug program who reside in the community.

How are individuals who are institutionalized being monitored and recorded during this transition?  

Individuals, who are institutionalized, receiving medical services are monitored by location (or temporary shelter/housing).  CMS is committed to fully supporting both organizations and providers delivering healthcare services.

If individuals are randomly assigned to a prescription drug benefit plan, how can the beneficiary (or individual) change to another plan? 

In order to change to a different prescription drug benefit plan from one to which they may have been assigned, individuals should contact and work directly with their State Medicaid office.  A beneficiary may change plans anytime before or after January 1, 2006.  Beginning at the end of October, Special Needs plans and general Medicaid changes can occur.

How can professionals who need extra assistance to understand eligibility criteria for the Medicare Prescription Drug plan?

Dr. Giannini will send out clarified language regarding  the Medicare Prescription Plan benefit eligibility requirements.

How or what is the process involved in assigning individuals to a Medicare Prescription Drug Program plan? 

Individuals will be automatically assigned to a plan, but will have the option later to alter the prescription drug benefit plan.

Can we discuss the issue related to CMS interim rule on Power Wheelchair and Power Operated Vehicle Claims? 

The suggestion is made to submit suggestions in writing to the Office on Disability regarding recommendations and suggestions regarding this issue due to time constraints.  Dr. Giannini recommended this issue be addressed further at the next Constituent Input meeting.

Closing Remarks

Due to emergency meetings related to Hurricane Katrina response, Dr. Giannini advised that further discussion would need to be curtailed.  Items remaining on the agenda for this meeting will be rescheduled for discussion at the next regular constituent input meeting.  In the meantime, Dr. Giannini urged that if constituent organizations and representatives identify ways in which the HHS can be of further assistance in addressing issues related to Hurricane Katrina and other issues before the next constituent input meeting, they contact the Office on Disability for further guidance and support.