(Note: United Spinal Association urges members to contact their legislators on this important issue. For more information, go here.)
We received this message today from National Senior Citizens Law Center on an issue important to members of United Spinal:
The following letter was sent to CMS from the below signed organizations representing low income seniors and people with disabilities. The letter cites concerns that since mid-October, the www.medicare.gov website and 1-800-MEDICARE system are no longer providing for enrollment in Medicare Part D plans for 2006. This is in violation of CMS policy and presents a grave barrier for low-income seniors and individuals with disabilities, and all others who seek to exercise their right to sign up or to change plans in order to obtain the prescription drugs they need. Those affected include all dually eligible individuals (the 6.4 million individuals currently on both Medicare/Medicaid), those in Medicare Savings Programs, all institutionalized individuals, as well as certain other people with special enrollment rights, such as people turning 65.
CMS directs individuals to call the plans to enroll. Yet many plans turn people away. Advocates are deeply concerned that many of America ’s most vulnerable patients will not be able to access their medically necessary prescriptions. The current limitations on enrollment are particularly worrisome in light of the time lags that surround the enrollment process generally.
The last sentence of the letter reads, “Time is of the essence, delay on ensuring and enforcing this right may lead to a potentially dangerous and unacceptable health access crisis.”
For more information contact Jeanne Finberg, Directing Attorney, National Senior Citizens Law Center, 510.663-1055 x 305 or Kevin Prindiville 510.663-1055 x 307.
November 9, 2006
Leslie V. Norwalk
Acting Administrator
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore , Maryland 21244-1850
Dear Ms. Norwalk,
Re: 2006 Part D enrollment – Urgent Request
Each of the organizations named below advocates on behalf of low income older people and/or people with disabilities. Collectively, we seek your immediate assistance on an urgent matter affecting low-income Medicare beneficiaries and others entitled to Medicare Part D benefits. Since mid-October, the www.medicare.gov website no longer provides for enrollment in plans for 2006. The site currently says, “Online enrollment will be available beginning November 15, 2006,” implying that it will only be available for 2007 enrollments for the remainder of 2006. In addition, we are told that the 1-800-MEDICARE system is also not taking 2006 enrollments. This is a matter of serious concern for all individuals with Special Enrollment Period (SEP) rights, a group which includes all dually eligible individuals (the 6.4 million individuals currently on both Medicare/Medicaid), those in Medicare Savings Programs, and all institutionalized individuals, as well as many others. Individuals in their Initial Enrollment Period are also affected.
CMS’ own PDP Guidance on Eligibility, Enrollment and Disenrollment states that: “CMS will provide an on-line enrollment center through the www.medicare.gov web site and the 1-800-MEDICARE call center. PDP sponsors may, and are strongly encouraged to, accept enrollment requests made through this process in addition to, or in place of, their own internet enrollment processes.” (Guidance at 30.1.2). Despite this clear statement, there is currently no CMS on-line mechanism by which an individual can enroll (or change plans) through the website or 800 number for 2006. This absence is a grave barrier for low-income seniors and individuals with disabilities, and all others who seek to exercise their right to change plans in order to obtain the prescription drugs they need.
Although some 1-800-MEDICARE representatives have advised individuals to call individual plans to enroll for 2006, their advice is inconsistent and many plans across the country are turning people away. Either they are uninformed about or are failing to respect the right of individuals to join a 2006 plan or for those with an SEP to change plans. Advocates in a number of states report that plans have recently refused to enroll dual eligibles and others over the phone for 2006. Some plans even require a home visit for 2006 enrollments and will not enroll individuals over the phone or online, opening the door to significant marketing abuses, including fraud and undue influence.
In the absence of vigorous, individualized advocacy, many beneficiaries are not able to enroll in or switch drug plans; some beneficiaries may go without necessary drugs, or face unwarranted costs, or be unduly pressured or financially abused by a salesperson in their home as a result of this situation. We are particularly concerned about the large numbers of people who do not have an advocate or know that they can get assistance.
The current limitations on enrollment are particularly worrisome in light of the time lags that surround the enrollment process generally. For instance, an individual whose eligibility for Medicare Part D begins as of December 1, but fails to connect with an informed plan representative until November 15, likely will face a gap in enrollment. Experienced advocates have learned that in order to avoid a gap in coverage, applications for new or changed enrollments are best submitted far in advance. Erroneous information from plans and the unavailability of enrollment through www.medicare.gov and 1-800-MEDICARE make this kind of conscientious advocacy very difficult.
In light of the current situation, we ask CMS to immediately take action to ensure 2006 CMS enrollments as follows:
- Reinstate the www.medicare.gov’s capability to enroll individuals for November and December, 2006; provide a retroactive right of enrollment to all individuals who tried to change plans in October for November, but were unable to do so; and publicize this change broadly to the general public;
- Reinstate the 1-800-MEDICARE system for 2006 enrollments; OR create a specialized number for 2006 changes with trained staffpersons; provide a retroactive right of enrollment to all individuals who tried to change plans in October for November, and were unable to do so; and publicize these changes broadly to the general public;
- If No.1. above is not technically possible, provide an explanation on the website, with alternative means of 2006 plan enrollment with CMS, such as 2, above. Currently it is very difficult to find the 2006 enrollment information on the website. It must be clearly identified in understandable language, and accessible;
- Provide a blanket waiver of late enrollment penalties for November and December and publicize this broadly to the general public;
- Immediately provide a specialized directive to the prescription drug plans regarding their responsibilities with respect to 2006 enrollments and SEP and IEP responsibilities;
- Sanction plans that refuse to enroll or assist individuals in making 2006 plan changes and publicly report CMS action and individual plan sponsor performance statistics to deter future problems.
As advocates for vulnerable populations, we call on CMS to take these immediate and direct actions so that all seniors and individuals with disabilities can be assured that plan changes can and will take place as needed for their health and well-being. We have reports of a nationwide problem affecting many people from advocates across the country. We appreciate the email response sent by Danielle R. Moon to Jeanne Finberg acknowledging the issue. Unfortunately, it did not address any of our concerns about 2006 enrollments or indicate that CMS is taking appropriate action to protect beneficiaries.
Time is of the essence, delay on ensuring and enforcing this right may lead to a potentially dangerous and unacceptable health access crisis. Thank you for your prompt attention to this matter.
Sincerely yours,
Jeanne Finberg
National Senior Citizens Law Center
On behalf of:
American Academy of HIV Medicine, Washington D.C.
Bay Area Legal Aid, California
California Advocates for Nursing Home Reform
California Health Advocates
Community Legal Services, Inc., Philadelphia, Pennsylvania
Consumers Union , publisher of Consumer Reports
Families, USA
Florida Legal Services
Legal Aid Society of District of Columbia
Legal Aid Society of San Mateo County , Health Consumer Center
Legal Services of Northern California
Medicare Rights Center
National Health Law Program
Neighborhood Legal Services, Health Consumer Center
New York AIDS Coalition
Protection & Advocacy, Inc., California
Project Inform, San Francisco
Senior Citizens’ Law Office, Albuquerque, New Mexico
Vermont Legal Aid
Western Center on Law and Poverty
cc: Abby Block, CMS
Senator Max Baucus
Senator Charles Grassley
Congressman Tom Davis
Congressman John D. Dingell
Congresswoman Nancy Pelosi
Congressman Pete Stark
Congressman Bill Thomas
Congressman Henry Waxman
