Letter from Mark B. McClellan to Shelley Berkley, October 3, 2006, regarding Medicare Part D (6 pages)

DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services OCT " 3 2006 Administrator Washington, DC 20201 The Honorable Shelly Berkley House of Representatives Washington, DC 20515 Dear Ms. Berkley: Thank you for your letter calling on CMS to increase efforts to enroll low-income senior's in Part D prescription drug plans. We agree that it is critical to ensure that these beneficiaries are able to access and take advantage of the extra help that is available to them under the new prescription drug benefit. We want to work with you as we continue our outreach efforts targeted towards finding and enrolling eligible but un-enrolled low income subsidy (LIS) beneficiaries. More than 90 percent of people with Medicare now have coverage for prescription drugs. CMS estimates that approximately 13 million people with Medicare are eligible for the Medicare Prescription Drug Coverage Low Income Subsidy (LIS) in 2006. The LIS population has been historically challenging to reach, with less than 60% of those eligible for Medicaid enrolling in that program. To date, nearly 10 million of these individuals are enrolled in Medicare drug plans. CMS is continuing outreach activities to the remaining three million low income individuals. Anyone found eligible for the LIS will be able to immediately enroll rather than waiting for the next open enrollment period, and will not face a penalty. To make sure beneficiaries who are determined to qualify for the LIS do not miss out on their comprehensive drug coverage, CMS is facilitating the enrollment of beneficiaries in a drug plan if they do not choose a plan on their own. Outreach efforts to this critical population will be data-driven, with our focus on identifying LIS-eligible populations at the state, county, community and individual level. Once identified, these individuals will be targeted with a multi-pronged education and outreach campaign that leverages existing information intermediaries and resources. Initiatives include direct mailings and phone calls to beneficiaries, along with local outreach from community groups, intergovernmental partners, health care providers and pharmacists. Given that many beneficiaries may be difficult to reach through traditional means, CMS has special initiatives targeting both urban minority beneficiaries, and beneficiaries in rural areas who may be isolated from general community outreach efforts. Partnerships with key stakeholders for the LIS population are continuing. Critical to reaching this population is CMS partnership with the Social Security Administration (SSA). SSA is continuing their extensive LIS outreach efforts through targeted community outreach and application events. Using files from CMS, SSA is reaching out to beneficiaries who received the $600 transitional assistance under the temporary drug card and who appear eligible for LIS and have not applied. In addition, a targeted Page 2 - The Honorable Shelly Berkley mailing to 500,000 individuals was sent the week of June 12. This mailing included those who are highly likely to be eligible for LIS. SSA continues to collaborate with CMS on next steps, lessons learned, best practices, and effective interventions to reach the LIS population. Additionally, on July 6, 2006 CMS announced the publication of an Extra Help/LIS Outreach Toolkit. The outreach and education initiatives outlined in the plan are designed to identify all remaining likely LIS eligible beneficiaries who have not yet applied for the LIS or joined a plan; ensure that these beneficiaries complete the LIS application process; and encourage them to make an active choice of Medicare drug plans. CMS will strive to coordinate to the fullest extent possible with relevant federal state and local partners to maximize the effectiveness and return on investment of all outreach efforts. CMS needs the help of members of Congress like you to ensure that our outreach efforts to this population are as successful as possible. An ongoing grant (funded by CMS) to reach, qualify beneficiaries for LIS. and enroll beneficiaries in a plan is being conducted by NCOA (the National Council on the Aging). In this grant, a series of mini-interventions are being tested to identify best practices for reaching lower-income beneficiaries. As these interventions are tested and results are known, the best practices and lessons learned will be shared broadly with partners in order to build on these successes and reach more beneficiaries. To date, over 1.5 million beneficiaries have been identified as "likely" to qualify for the LIS through this grant. To provide more details about plans to reach these beneficiaries, I have attached the Action Plan we have put in place to reach this target audience during the Special Enrollment Period (SEP) for the LIS. The SEP for this population that began on May 16 and will continue through November 15, 2006. CMS is working to ensure that people with limited income and resources who stand to benefit most from Part D do not miss out on this comprehensive, low-cost drug coverage. I am very happy to work with you on this urgent issue and thank you for raising this issue to my attention. I also will provide this response to the cosigners of your letter. Mark B. McClellan, M.D., Ph.D. Low Income Subsidy Action Plan Special Enrollment Period of May 16-November 75, 2006 Background The Center for Medicare & Medicaid Services (CMS) estimates that approximately 13 million people with Medicare are eligible for the Medicare Prescription Drug Coverage Low Income Subsidy (LIS) in 2006. To date, nearly 10 million of these individuals are enrolled in Medicare drug plans. Full-benefit dual eligibles are auto-enrolled into a plan by CMS if they do not join on their own. Other people who qualify for the LIS are facilitated-enrolled into a plan by CMS if they do not join on their own, including beneficiaries with SSI-only (no Medicaid), those who apply at SSA or with their State, and those in Medicare Savings Programs. Issue Estimates show that there are approximately 3 million Medicare beneficiaries remaining who are likely to qualify for the LIS, but have not yet applied for the LIS or enrolled in a Medicare drug plan. These beneficiaries are scattered throughout the country and are more likely to be less educated, more isolated from their communities, and members of minority groups. Because of these factors, they are traditionally hard to reach due to barriers posed by literacy, geography, language, or culture. Identifying, qualifying and enrolling all remaining eligible beneficiaries in Medicare prescription drug coverage is a CMS priority. CMS established a Special Enrollment Period (SEP) for people who qualify for the LIS. Those who qualify will be able to join a Medicare drug plan immediately without paying a penalty, and will not have to wait for the next open enrollment period. This SEP for people who qualify for the LIS began on May 16 and will continue through November 15, 2006. Objectives ? CMS outreach and education initiatives outlined in this plan are designed to identify all remaining likely LIS-eligible beneficiaries who have not yet applied for the LIS or joined a plan; ensure that these beneficiaries complete the LIS application process; and encourage them to make an active choice of Medicare drug plans. ? CMS will strive to coordinate to the fullest extent possible with relevant federal, state and local partners to maximize the effectiveness and return on investment of all outreach efforts. Strategy To ensure that every person with Medicare who qualifies for the LIS gets subsidized Medicare prescription drug coverage, CMS outreach efforts to this critical population will be data-driven, with focus on identifying LIS-eligible populations at the state, county, community and individual level. Once CMS has identified these individuals, they will be targeted with a multi-pronged education and outreach campaign that leverages existing information intermediaries and resources. Initiatives include direct mailings and targeted telephone calls to beneficiaries, along with local outreach from community groups, intergovernmental partners, heath care providers and pharmacists. Given that many beneficiaries may be difficult to reach through traditional means, CMS has special initiatives targeting both urban minority beneficiaries, and beneficiaries in rural areas who may be isolated from general community outreach efforts. Data-driven Approach As identifying LIS-eligible beneficiaries is paramount, CMS is relying on a data-driven approach to target outreach and education efforts to areas that are likely to have large populations of qualifying beneficiaries. CMS coordinated with the U.S. Census bureau to identify counties with large numbers of potential LIS-eligibles, then compared these data to enrollment figures to identify counties where a lower percentage of LIS-eligible beneficiaries are enrolled. These are the counties where CMS will target future grassroots outreach efforts. (As eligibility for the LIS is contingent on both income and assets, these numbers are estimates only.) CMS plans to continue to mine every source of available data to identify potential LIS-eligibles at the state, local, and individual level whenever possible. Coordination with SSA, the States, and other partners will be critical to the success of these efforts. Leveraging Partnerships for Grassroots Outreach Ongoing partnerships at the federal, national, state and community levels continue to play a significant role in reaching the LIS population. CMS continues to meet with a range of partners to refine and implement a detailed plan that leverages combined resources to maximum effect, with initiatives such as enrollment events, health fairs, personalized counseling, and laptop distribution planned in targeted areas. Partnership efforts include the following: ? Social Security Administration (SSA): The CMS partnership with SSA is critical to reaching the LIS population. SSA will continue their extensive LIS outreach efforts through targeted education and application events, in addition to direct mailings and follow-up phone calls to likely LIS-eligibles. CMS plans to coordinate closely with SSA to follow up SSA phone calls and mailings with personalized grassroots outreach designed to fully penetrate areas where potential LIS-eligibles have been identified. ? Intergovernmental Partners: CMS has been working with other intergovernmental partners via CMS-funded grants designed to reach and qualify beneficiaries for the LIS, including the Administration on Aging (AOA), the United States Department of Agriculture/Cooperative State Research, Education and Extension Services (Extension Educators), the Health Resources and Services Administration (HRSA), the Department of Housing and Urban Development (HUD), and the Administration for Children and Families (ACF). National Council on the Aging (NCOA): An ongoing CMS-funded grant to reach and qualify beneficiaries for LIS, and enroll beneficiaries in a plan is being conducted by NCOA. ? Providers: CMS continues to work with physicians, providers, community health centers and their staff to provide counseling services and enrollment activities aimed at the low-income population. ? Pharmacists: Thousands of pharmacies across the country are providing in-store LIS counseling and materials for limited income Medicare beneficiaries. Two prominent pharmacy chains (Wal Mart and Target) have also agreed to disseminate LIS applications to beneficiaries they believe are likely to qualify for the LIS. ? Community-based Organizations: CMS continues to leverage existing relationships with hundreds of community-based organizations around the country, including schools, small businesses, senior-centers, community centers, churches, and other faith-based groups. These groups are able to provide highly targeted education and outreach at the community, neighborhood and even individual levels. 2 ? State Health Insurance Assistance Program (SHIP): Thousands of SHIP counselors across the country will be available to assist beneficiaries with both LIS applications and enrollment into drug plans. SHIPs also include LIS in their outreach and education activities. ? State Medicaid Directors: CMS is working with State Medicaid Directors to help their newly-eligible beneficiaries transition to Medicare prescription drug coverage. Geographically/Ethnically Targeted Outreach CMS has special initiatives targeting both urban minority beneficiaries and beneficiaries in rural areas who may be isolated from general community outreach efforts. ? Working with the National Medical Association (NMA) and the National Association for the Advancement of Colored People (NAACP) to target CMS/AoA outreach grants to areas with the greatest number of LIS-eligibles ? Working through the AoA/CMS contract with the National Association of Area Agencies on Aging (n4a) to target minority, low-income, limited English speaking, homebound, disability and rural populations. Organizations targeting these groups through their local affiliates include the National Center and Caucus for Black Aged, Inc. (NCBA), the National Association of Nutrition and Aging Services Providers (NANASP), Meals on Wheels Association of America (MOWAA), the National Adult Day Services Association (NADSA), and the National Council for Independent Living (NCIL) ? Also working through the AoA/CMS contract with the National Hispanic Council on Aging (NHCOA), the Asociacion Nacional Pro Personas Mayoras (ANPPM), the National Alliance for Hispanic Health, the National Asian Pacific Center on Aging (NAPCA) to reach Latino and Asian populations ? Working with churches in rural and minority communities to continue to spread the LIS and Medicare prevention messages ? Coordinating with the United States Department of Agriculture Extension Educators to promote LIS-education and enrollment activities in rural extension offices ? Working with School of Pharmacy students in rural counties ? Providing tools for enrollment in rural areas (i.e. laptops) ? Working with state officials to apply for LIS on behalf of their SPAP members, particularly in the states that did not use the Middleware solution. ? CMS will continue to conduct partner training and participate in public events to educate on LIS. ? Continuing to provide direct and indirect outreach to beneficiaries with disabling health conditions through the Disability Wing, Open Door Forums, the RO disability outreach team, and via numerous newsletters, magazines, websites, and conference calls sponsored by disability organizations for their membership. ? Coordinating through partnerships with Tribes and the Indian Health Service (HIS) as well as our network of CMS Regional Native American Contacts, case managers and IHS/Tribal Business Office Coordinators to reach the American Indian and Alaska Native populations with appropriate messaging surrounding Part D and the LIS. Multimedia Specific CMS educational materials targeting the LIS population includes direct mailings to beneficiaries, targeted educational materials, and earned media activities. 3 ? The existing CMS infrastructure is also being heavily mined for message vehicles, with LIS messaging planned for inclusion on the 1-800-MEDICARE helpline, in the Medicare Summary Notices (MSN), in Part B Explanation of Benefits (EOB) mailings and in the "Welcome to Medicare" package. CMS continues to send deemed, auto, and facilitated enrollment notices on a monthly basis to beneficiaries who automatically qualify for the LIS. ? CMS is also updating a number of printed fact sheets and tip sheets to inform beneficiaries and our partners about the LIS, and these will continue to be disseminated through public and partner events. ? A number of earned media tactics are being considered to continue disseminating LIS messages through the media in targeted geographic areas, including public service radio announcements, TV/radio appearances by CMS spokespersons, and articles for newspapers and other community news vehicles. 4