[BeckySchecky]

We hope you had a great and long holiday weekend! Here’s what’s going on this week…

Plan Finder Redesign
Recently the Centers for Medicare & Medicaid Services (CMS) launched a redesigned Plan Finder tool on the Medicare Website.

CMS offers a tutorial video to walk you through the new layout and features.

If you have questions or would like to share ideas about the redesigned tool, CMS has expanded the agenda for today’s SHIP MMA Forum Call to include time to hear from you. The call is from 3-4 p.m. EST. Call-in number is 1-800-603–1774. Passcode is "SHIP."

Before the CMS SHIP MMA Forum, you may want to look over several explanatory tools CMS developed about the redesigned Plan Finder. View CMS’s PowerPoint Presentation and FAQs on the Plan Finder.

The SHIP MMA Forum later today is an opportunity for you to ask questions and share your observations on the redesign.

DMEPOS Competitive Bidding Program: Phase One Begins January 1, 2011
The Affordable Care Act helped reignite the DMEPOS (Durable Medical Equipment Prosthetics, Orthotics, and Supplies) Competitive Bidding Program, and very soon some of your clients will see the program’s benefits.

Beginning January 1, 2011, clients with Original Medicare (clients in Medicare Advantage are not affected; they will continue to get their DMEPOS from suppliers contracting with the MA plans), who live or visit the following areas, will begin to see lower out-of-pocket costs and a better opportunity for CMS to monitor the quality of durable medical equipment and supplies provided and paid for under Medicare:

• Charlotte, North Carolina
• Cincinnati and Cleveland, Ohio
• Dallas, Texas
• Kansas City, Missouri
• Miami and Orlando, Florida
• Pittsburgh, Pennsylvania
• Riverside, California

According to CMS, only suppliers who have submitted competitively low bids and have agreed to certain terms and conditions about both reimbursement and the quality of the equipment and supplies they provide will be allowed to continue to operate in the Medicare program. (Current suppliers who did not win a contract to be a Medicare DMEPOS supplier may continue to supply their current customers if they agree to the same terms as the contract winners.) The lower-bid contracts help save the Medicare program and your clients a significant amount of money. The new bids should be closer to the prices paid by commercial insurers.

For example:

Suppliers currently charge $75.32 for a monthly supply of diabetic supplies (100 lancets and 100 test strips). Medicare pays 80 percent ($60.26) and your client pays 20 percent ($15.06).

Starting January 1, 2011, the new amount for these supplies in these areas will be $33.44. Medicare pays 80 percent ($26.75); your client pays ($6.69) — more than 50 percent savings!

Your clients with Original Medicare (living or visiting in the areas mentioned above) can expect to see a significant decrease in the amount DMEPOS suppliers charge for the following:

• Oxygen, Oxygen Equipment, and Supplies
• Standard Power Wheelchairs, Scooters, and Related Accessories
• Certain Types of Complex Power Wheelchairs and Related Accessories
• Mail-Order Diabetic Supplies
• Enteral Nutrients (delivered through a feeding tube) , Equipment, and Supplies
• Continuous Positive Airway Pressure (CPAP) Devices, Respiratory Assist Devices (RADs), and Related Supplies and Accessories
• Hospital Beds and Related Accessories
• Walkers and Related Accessories
• Support Surfaces (Group 2 mattresses and overlays) in the Miami area only

The areas covered by DMEPOS competitively contracted suppliers will be expanding over the next few years.

More Resources on the DMEPOS Competitive Bidding Program
Are you unfamiliar with the DMEPOS Competitive Bidding Program and not sure what it all means? Click here to learn more from MyMedicareCommunity on the bidding program such as background on how it came to pass, why it’s only limited to certain areas in 2011, and who your clients can contact if they have questions or problems with their future DMEPOS supplier.

CMS also have developed three new counselor and beneficiary resources to help you:

• a 10-page Guide to Answer Consumer Questions
• an 8-page Fact Sheet for Beneficiaries
• a 28-slide PowerPoint Training Presentation

The CMS materials can also be found in CMS’s DMEPOS Toolkit. CMS will announce the contracted DMEPOS suppliers this September, when contracts are finalized (bids were already submitted last year). We will post this information as soon as it’s made available.

Update on SilverScript and Incorrect Pricing Info
A few weeks ago, CMS announced that refunds may be available for two SilverScript PDPs (CVS Caremark Complete and CVS Caremark Plus) that had posted incorrect pricing information on their Website’s comparison tools for brand drugs. Currently it appears about 700,000 people with Medicare are enrolled in these plans nationwide. (The plans are active in all 50 states, the District of Columbia, and Puerto Rico.) The inaccurate pricing information, which also appeared on Medicare’s Plan Finder tool, was publicly available between October 8, 2009 and January 8, 2010.

CMS investigated the situation, and found that even though the prices appeared less than what the actual drug cost, people enrolled in these plans were not charged the higher, incorrect amount at the pharmacy. Therefore, it has been decided that no refunds will be issued.

That said, some of your clients may have joined these plans during this time frame, believing they would get brand drugs at a lower cost (some up to 4 percent lower).

Special Enrollment Period
To accommodate people in these two SilverScript plans who are dissatisfied with the incorrectly posted info, they will get a SEP (Special Enrollment Period) to change plans if they decide to. The SEP lasts through December 31, 2010. To get the SEP, your client will need to call 1-800-MEDICARE and request to switch plans based on misleading information.

Your clients in these SilverScript drug plans will get a letter from SilverScript soon telling them about this SEP. CMS is currently reviewing the letter, so it will go out as soon as it’s approved (see model letter).

How You Can Help?
Your clients may have picked one of these plans based on the incorrect pricing information on the comparison tool. You can let them know they can use the SEP to switch to another plan that better meets their needs.

Get Support Right Here!
Have questions after reading these Updates? Want to know what others in the field think? Now you can! Check out the MyMedicareCommunity Forums, and browse by topic to see what others are saying. Read and join the recent discussion started on the Plan Finder Redesign — or start your own discussion now!

The terms social media and online networking are the latest buzz. Everything from blogs, to chats, to forums – and the list of keeps growing. Never used a “forum” before? No worries, you can learn how to right here.

Forums are an opportunity to communicate online with other professionals in the field, on specific topics. The forum allows you to exchange tips, words of advice, or just share sentiments with each other. This way, you have the unconditional support you need to best help and serve your clients.