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Topic: Medicare Prescription Drug, Improvement, and Modernization Act

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	WPS Medicare Part B - 2004 Medicare Prescription Drug Improvement And Modernization Act (MMA) Drug Payment Limits ...
		The payment limits for new drugs or biologicals without AWP listings in the published compendia as of September 1, 2003 are based on 95 percent of the AWP reflected in the published compendia as of the first of the month the payment limit for the drug or biological is determined.
		Medicare contractors separately determine whether a particular drug meets the program's general requirements for coverage and, if so, whether payment may be made for the drug in the particular circumstance under which it was furnished.
		Examples of this latter determination include, but are not limited to, determinations as to whether a particular drug and route of administration are reasonable and necessary to treat the beneficiary's condition, whether a drug may be excluded from payment because it is usually self-administered, and whether a least costly alternative to the drug exists.
	www.wpsmedicare.com /provider/04dima.shtml (1241 words)

	AAGP - Advocacy - Medicare Prescription Drug Coverage
		The "Medicare Prescription Drug, Improvement, and Modernization Act, was passed by the House of Representatives on November 22, 2003, and the Senate on November 25, 2003.
		The drug benefits will be provided through risk-bearing private plans contracting with the government (including plans offering only the Part D coverage as well as integrated plans offering all Medicare benefits).
		Part B covered drugs in physician offices--New rules are established for payment for drugs and biologicals administered in the physician office setting, which are currently paid at 95 percent of average wholesale price (AWP).
	www.aagponline.org /advocacy/facts_meddrugcov.asp (3228 words)

	2003.12.8: Analysis of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003
		Under the full drug benefit, those paying full retail prices are expected to save an estimated 20 percent, on average, for their prescription drugs as plans compete to serve them by offering price discounts and other help to lower their total spending.
		Medicare beneficiaries of limited means and with income below 135 percent of poverty will be given immediate assistance through a Medicare-endorsed prescription drug discount card with $600 to apply toward purchasing their medicines.
		For employers that offer their Medicare-eligible retirees prescription drug coverage, the legislation also provides a 28 percent subsidy for the cost of drugs used by each enrollee up to $5,000, after a $250 deductible is met.
	www.hhs.gov /news/press/2003pres/20031208b.html (3249 words)

	Medicare Prescription Drug Improvement and Modernization Act: AUCD Summary
		Drug discount cards will be available to beneficiaries in April of 2004, which would provide savings of 15 to 25 percent per prescription until a permanent drug benefit is established in 2006.
		The prescription coverage that begins in 2006 includes a $35 average monthly premium, $275 yearly deductible, and a co-pay of 25 percent.
		The Medicare Rights Center estimates that up to nine million people will lose their retiree and State coverage of prescriptions which are more favorable programs compared to Medicare.
	www.aucd.org /legislative_affairs/medicare_law.htm (1717 words)

	THE MEDICARE PRESCRIPTION DRUG, IMPROVEMENT, & MODERNIZATION ACT OF 2003: ARE WE PLAYING THE LOTTERY WITH HEALTHCARE ...
		Standard prescription drug coverage has a $250 annual deductible and covers 75% of all costs associated with those drugs listed under the plan up to $2,250 (or a total annual benefit of $1,500).
		Medicare is left without any leverage as a government entity because private entities are able to negotiate discounts and establish drug formularies based solely on what the drug companies deem proper.
		Adding to the current healthcare coverage crisis, the MMA is predicted to lead employers to reduce or eliminate their employer-sponsored prescription drug coverage for an estimated 1/3 of all retirees as soon as Medicare begins to offer coverage in 2006.
	www.law.duke.edu /journals/dltr/articles/2004dltr0011.html (6660 words)

	Fact Sheet: Medicare Prescription Drug, Improvement, and Modernization Act of 2003
		For the first time in Medicare's history, a prescription drug benefit will be offered to all 40 million seniors and disabled Americans in Medicare to help them afford the cost of their medicines.
		There would be reduced premium, a $50 deductible, and 15% co-insurance (85% of their drug costs would be covered) for seniors with limited savings and incomes between 135% and 150% of the federal poverty level (individuals with yearly incomes under $13, 470 and senior couples under $18,180).
		Under a modernized Medicare, there will be better coverage for preventive care (e.g., a "welcome to Medicare" physical that would include screening for cancer, diabetes, and heart disease, as well as immunizations against pneumonia and the flu).
	www.whitehouse.gov /news/releases/2003/12/20031208-3.html (842 words)

	Medicare Prescription Drug, Improvement, and Modernization Act of 2003-Use of appropriated funds for flyer and print ...
		In addition, MMA authorized Medicare to endorse prescription drug discount cards that beneficiaries may purchase beginning in June 2004 to obtain discounts on covered prescription drugs until the drug benefit becomes available.
		The section on prescription drug plans lists five general characteristics of the plans, although it notes that plans may vary.
		For example, while all materials mention the new drug discount cards, none of them mention that the cards may not be free--that is individuals enrolling may be charged an annual fee of up to $30--and that savings may vary across covered drugs.
	www.gao.gov /decisions/other/302504.htm (5495 words)

	Medicare.gov - Information on the Medicare Prescription Drug Coverage
		The Medicare Prescription Drug Plan Finder can be accessed at www.medicare.gov, or through a customer service representative at 1-800-MEDICARE, or through the many organizations working with Medicare to help people take advantage of the new drug coverage.
		Once the Medicare Prescription Drug Plan finder is fully operational, it will help you to personalize your search for a drug plan, and look at a side-by-side, personalized comparison of up to three plans at a time so you can find one that meets your needs.
		Coverage: The Medicare Prescription Drug Plan Finder makes it easy for you to see what kind of coverage each plan offers and it gives you personalized information on plans that might meet your needs for you based on the coverage they offer and their other features.
	www.medicare.gov /medicarereform/drugbenefit.asp (2024 words)

	The following are items important to the Medicare Prescription Drug Improvement and Modernization Act
		Medicare will have to begin dipping into its trust fund this year to keep up with expenditures and will go broke by 2019 (6).
		Under the Medicare legislation, drugs can be imported from Canada but only if the Secretary of HHS certifies both that it is safe and that it would significantly reduce costs.
		Acting Medicare Administrator Dennis Smith stated “while not a drug benefit, the voluntary drug card program is an important first step in providing Medicare beneficiaries with the tools they need to better afford the cost of prescription drugs” (19).
	www.naswnc.org /medicare_faceoff.htm (1114 words)

	Various Proposals for Prescription Drug Coverage under Medicare (Site not responding. Last check: 2007-10-10)
		A Summarization of the Medicare Prescription Drug Improvement, and Modernization Act of 2003
		To encourage employers to maintain drug coverage for their retirees, Medicare will provide tax-free subsidies equal to 28% of costs between $250 and $5,000 in drug expenses per retiree provided that the drug benefit is at least comparable to the standard Part D benefit.
		Medicare and Prescription Drug Coverage-Part II we present all the prescription drug coverage plans under Medicare that we were aware of at the time.
	www.therubins.com /medicare/proposed.htm (12655 words)

	AUCD Comments Regarding Proposed Rule Governing the Medicare Prescription Drug, Improvement and Modernization Act of ...
		They also rely extensively on prescription drug coverage to maintain basic health needs and are the poorest and most vulnerable of all Medicare beneficiaries.
		We recommend that CMS revamp the exceptions process to: establish clear standards by which prescription drug plans must evaluate all exceptions requests; to minimize the time and evidence burdens on treating physicians; and to ensure that all drugs provided through the exceptions process are made available at the preferred level of cost-sharing.
		AUCD is concerned about provisions in the proposed regulations to allow Medicare drug plans to involuntarily disenroll beneficiaries for behavior that is "disruptive, unruly, abusive, uncooperative, or threatening" (§ 423.44).
	www.aucd.org /legislative_affairs/MMA_comments.htm (1184 words)

	The American Geriatrics Society - Medicare Prescription Drug Improvement and Modernization Act (Site not responding. Last check: 2007-10-10)
		Section 712 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 clarifies that Congress intended to provide an exception to the initial residency period for geriatric fellowship programs to accommodate programs that provide 2 years of training for geriatricians who intend to teach geriatrics.
		The Medicare Prescription Drug Improvement Act clarifies that Medicare will now allow a 2nd year of geriatric medicine fellowship training to count as 1 FTE and be fully reimbursable under GME, regardless of accreditation.
		Section 422 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 requires the portion of teaching hospitals' resident limits (as mandated by the Balanced Budget Act of 1997) that is "unused" to be redistributed to teaching hospitals seeking to increase their resident limits.
	www.americangeriatrics.org /staging/policy/gca_medEd_prov.shtml (793 words)

	The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) - Geriatrics
		There is not a limit on the number of drugs a plan will cover in a given calendar year, though Medicare drug plans, like most other prescription plans, do use a formulary, or list of preferred medications.
		If you do not join a Medicare drug plan by May 15, 2006 you can still join, though you may have to wait until November 15, 2006 to join and then you may be assessed a higher premium (at least 1% per month for each month you wait to join).
		There is ‘extra help’, also called a ‘low-income subsidy’ to help those with Medicare who have limited resources to help them pay for the prescription drug plan.
	www.bellaonline.com /articles/art40288.asp (408 words)

	SAMHSA: The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) (Site not responding. Last check: 2007-10-10)
		The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA)
		The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (commonly referred to as the Medicare Modernization Act, or the MMA) changes many aspects of the Medicare program.
		prescription drug coverage for all people with Medicare, and
	www.samhsa.gov /MMA/index.aspx (129 words)

	Medicare Prescription Drug, Improvement, and Modernization Act
		(b) AMENDMENTS TO SOCIAL SECURITY ACT- Except as otherwise specifically provided, whenever in division A of this Act an amendment is expressed in terms of an amendment to or repeal of a section or other provision, the reference shall be considered to be made to that section or other provision of the Social Security Act.
		Medicare inpatient hospital payment adjustment for low-volume hospitals.
		Improvements in national and local coverage determination process to respond to changes in technology.
	aspe.hhs.gov /mits/text/index.cfm (1169 words)

	Medicare Drug Act (Site not responding. Last check: 2007-10-10)
		You may be aware of some significant changes affecting Medicare as a result of the Medicare Modernization Act that become law in late 2003.
		One of the most significant changes involves a new prescription drug benefit (Medicare Part D) that will become available to Medicare beneficiaries on January 1, 2006.
		Enrolling with another prescription drug plan, even if it’s advertised as a plan exclusively for Medicare beneficiaries, may result in cancellation of your prescription drug benefits through the Fund.
	www.ewtf.org /medicare_drug_act.htm (219 words)

	Medicare and Prescription Help
		Medicare beneficiaries are eligible for the extra help if they have limited income and resources.
		The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (P.L. 108-173), enacted December 8, 2003, requires the Social Security Administration (SSA) to undertake a number of additional Medicare-related responsibilities.
		SSA and the Centers for Medicare and Medicaid Services (CMS) are working together to provide persons with limited income and resources extra help paying for their prescription drugs.
	www.socialsecurity.gov /prescriptionhelp (876 words)

	ACCC Public Policy: Medicare Prescription Drug, Improvement, and Modernization Act--Directed Studies (Site not responding. Last check: 2007-10-10)
		Section 621 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) directs two distinct Congressional agencies—the Medicare Payment Advisory Commission (MedPAC) and the General Accountability Office (GAO—to conduct three separate studies that will have a significant impact on reimbursement to hospital outpatient departments.
		MEDPAC REPORT ON DRUG APC DESIGN.—The Medicare Payment Advisory Commission shall submit to the Secretary, not later than July 1, 2005, a report on adjustment of payment for ambulatory payment classifications for specified covered outpatient drugs to take into account overhead and related expenses, such as pharmacy services and handling costs.
		With respect to the surveys conducted under clause (i), the Comptroller General shall report to Congress on the justification for the size of the sample used in order to assure the validity of such estimates.
	www.accc-cancer.org /PUBPOL/pubpol_mma.asp (535 words)

	Medicare Prescription Drug, Improvement, and Modernization Act of 2003
		Specifically, the Secretary is to assess: (1) the current standards of practice, clinical services, and other service requirements generally utilized for such pharmacy services; and (2) evaluate the impact of those standards with respect to patient safety, reduction of medication errors, and quality of care.
		The report is to contain a description of the Secretary’s plans to implement this Act in a manner consistent with applicable state and federal laws designed to protect the safety and quality of care of nursing facility patients.
		Medicare is designed for aged and disabled individuals (typically people over 65 years of age).
	www7.nationalacademies.org /ocga/Laws/PL108_173.asp (2694 words)

	Overview
		This landmark legislation provides seniors and individuals with disabilities with a prescription drug benefit, more choices, and better benefits under Medicare.
		The Centers for Medicare and Medicaid Services (CMS) has created this update to provide the public and other interested parties with up-to-date information on CMS' efforts to implement the new legislation.
		Lyndon Johnson established that commitment by signing the Medicare Act of 1965.
	www.cms.hhs.gov /MMAUpdate (283 words)

	SAMHSA - MMA Act of 2003: Medicare Prescription Drug Coverage (Site not responding. Last check: 2007-10-10)
		Beginning January 1, 2006, new Medicare prescription drug plans will be available to people with Medicare.
		Insurance and other private companies will work with Medicare to offer these drug plans and make prescription drug coverage available to all 42 million Medicare beneficiaries, including the approximately 6.5 million low-income beneficiaries who are also enrolled in Medicaid.
		This means that starting January 1, 2006, Medicaid will no longer pay for most of the prescription drugs for people with both Medicare and Medicaid.
	www.samhsa.gov /MMA/rx_coverage.aspx (181 words)

	Wiggin & Dana LLP - United States - The Medicare Prescription Drug, Improvement and Modernization Act: Regulatory ...
		The new Medicare Prescription Drug, Improvement and Modernization Act (MMA), signed by President Bush on December 8, 2003, has been described as the most significant restructuring of the Medicare program since Medicare's enactment in 1965.
		Although attention has focused on the prescription drug benefit authorized by this law (the new "Part D" of Medicare), other lesser-known provisions in the MMA will affect the day-today operations of health care providers.
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	www.mondaq.com /i_article.asp_Q_articleid_E_26895 (281 words)

	Summaries of the Medicare Prescription Drug Improvement & Modernization Act of 2003 - Kaiser Family Foundation
		Summaries of the Medicare Prescription Drug Improvement and Modernization Act of 2003 - Kaiser Family Foundation
		Summaries of the Medicare Prescription Drug Improvement & Modernization Act of 2003
		These summaries, prepared by Health Policy Alternatives, Inc., provide an overview of the prescription drug provisions of the Medicare legislation (P.L. 108-173) signed by the President on December 8, 2003.
	www.kff.org /medicare/med011604pkg.cfm (95 words)

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