Program Descriptions
Program Number
93.794
Title
Reimbursement Of State Costs For Provision Of Part D Drugs
Federal Agency
CENTERS FOR MEDICARE AND MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
Authorization
Authorized under Section 402 of the Social Security Amendment of 1967, as amended.
Status
Active
Objectives
To ensure that the Medicare and Medicaid programs can respond expeditiously to the needs of the dual-eligible beneficiaries and beneficiaries who have enrolled in a Part D plan and have been determined to be eligible for the low-income subsidy. This demonstration would allow States, that have assisted with their dual eligible and low-income subsidy entitled populations in obtaining and accessing Medicare Part D coverage, to be reimbursed for their efforts.
Types of Assistance
Direct Payments for Specified Use.
Uses and Use Restrictions
The demonstration permits Medicare payment to be made to States for amounts they have paid for a dual-eligible's Part D drugs, or a low-income subsidy entitled Part D plan enrollee's Part D drugs, to the extent that those costs are not otherwise recoverable from a Part D plan and are not required Medicaid cost-sharing on the part of the beneficiary. In addition to providing Medicare funds to reimburse amounts paid by States for Part D drugs, the demonstration would also provide payments for certain administrative costs incurred by States.
Eligibility Requirements
Applicant Eligibility
State: Must have incurred costs in assisting dual eligibles and other low-income subsidy entitled beneficiaries receive the prescription medications they need.
Beneficiary Eligibility
State: Must have incurred costs in assisting dual eligibles and other low-income subsidy entitled beneficiaries receive the prescription medications they need.
Credentials/Documentation
Federal (Medicare) funds must go to a State Medicaid Agency with appropriately approved Section 402 demonstration proposals. Administrative costs will be determined in accordance with OMB Circular A-87 "Cost Principles for State and Local Governments".
Application and Award Process
Preapplication Coordination
States are encouraged to work with CMS in the development of their section 402 Medicare demonstration proposal. This program is excluded from coverage under E.O. 12372.
Application Procedure
States will complete an application as provided by CMS to request approval for participation in this Medicare demonstration.
Award Procedure
Approved States will receive an initial payment based on CMS' review of submitted claims data to verify that the beneficiary is a dual eligible beneficiary or a low-income subsidy entitled beneficiary as defined in this demonstration and that the prescription drug is a Part D drug. CMS will also reimburse the State for additional costs determined by CMS to be eligible under the demonstration, including costs due to the State for drug payments that exceed plan payments, as well as allowed administrative costs specified in the demonstration application.
Deadlines
The State costs eligible for reimbursement under this Medicare demonstration must be related to the provision of Part D drugs to dual eligible and low-income subsidy entitled beneficiaries dispensed during the period of January 1, 2009 and no later than March 31, 2009.
Range of Approval/Disapproval Time
The State costs eligible for reimbursement under this Medicare demonstration must be related to the provision of Part D drugs to dual eligible and low-income subsidy entitled beneficiaries dispensed during the period January 1, 2009 to no later than March 31, 2009.
Appeals
None.
Renewals
Assistance Considerations
Formula and Matching Requirements
This program has no statutory formula or matching requirements. It is being funded under the Federal Supplementary Medical Insurance Trust Fund. THE STATES ARE NOT TO USE THE MEDICARE FUNDING UNDER THIS DEMONSTRATION AS STATE MEDICAID MATCHING FUNDS.
Length and Time Phasing of Assistance
Project Period: No payments shall be made for State costs associated with the provision of Part D drugs to dual-eligible and low-income subsidy entitled beneficiaries that are incurred after March 31, 2009. Budget Period: Qualifying costs are reimbursed in full.
Post Assistance Requirements
Reports
States must submit fiscal and statistical reports, as required by CMS.
Audits
The States may be subject to audit by other Federal agencies including the Office of the Inspector General.
Records
Financial records, supporting documents, statistical records, and all other records pertinent to the demonstration shall be retained for at least three years or until resolution of any audit questions.
Financial Information
Account Identification
75-8308-0-7-571.
Obligations
(Grants) FY 07 est not available; FY 08 est not available; and FY 09 est not available.
Range and Average of Financial Assistance
Floor: $0; Ceiling: Federal contractor will compute the reconciliation payments the Federal government will make to the States for amounts the State paid in excess of Part D prescription drug plan payments and associated administrative costs realized during the Part D prescription drug plan transition period.
Program Accomplishments
None.
Regulations, Guidelines and Literature
None.
Information Contacts
Regional or Local Office
Contact the Regional Administrator, Centers for Medicare and Medicaid Services (see appendix IV of the Catalog for addresses and telephone numbers).
Headquarters Office
Program Contact: Christine Hinds, Centers for Medicare and Medicaid Services, 7500 Security Boulevard, Mail Stop C1-26-12, Baltimore, MD 21244. Telephone: (410) 786-4578.
Web Site Address
http://www.cms.hhs.gov
Related Programs
93.778, Medical Assistance Program
93.774, Medicare-Supplementary Medical Insurance
Examples of Funded Projects
None.
Criteria for Selecting Proposals
None.
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