The Centers for Medicare & Medicaid Services (CMS) has proposed implementing legislation that will eliminate Medicare Part D cost sharing for dual eligible beneficiaries in assisted living and other home and community-based (HCB) settings on January 1, 2012 – the earliest possible date allowable under Sec. 3309 of the Affordable Care Act (ACA).
Over the past several years, NCAL has led of a coalition of almost 40 national organizations urging passage of the Part D co-pay legislation and has been urging CMS to implement Sec. 3309 as soon as possible. Under the original Part D law, dual eligibles (those covered by both Medicare and Medicaid) in institutional settings had no cost sharing while a similar population living in community-based settings, including assisted living communities, was required to make co-payments. Assisted living residents average 8-10 medications and those on Medicaid often have difficulty affording their Part D co-payments. Sec. 3309 will eliminate Part D cost sharing for dual eligibles in HCB settings covered under Medicaid waivers, a 1915(i) state plan amendment, or under a Medicaid managed care plan.
In proposed rules published in the Nov. 22 Federal Register, the agency states: “We believe it is important to provide this benefit at the earliest possible date, since it will provide assistance to an estimated 600,000 beneficiaries a year. In proposing an effective date, we considered the administrative impact on States, and we believe that even the earliest possible effective date will provide States with adequate time for implementation.” See http://edocket.access.gpo.gov/2010/pdf/2010-28774.pdf. NCAL will be submitting comments to CMS on the proposed rule supporting implementation of Sec. 3309 of the ACA on Jan. 1, 2012.