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7.2.1
Introduction
Medicare eligible behavioral health recipients, including persons who are
dually eligible for Medicare (Title XVIII) and Medicaid (Title XIX/XXI)
receive Medicare Part D prescription drug benefits through Medicare
Prescription Drug Plans (PDPs) or Medicare Advantage Prescription
Drug Plans (MA-PDs). Medicare Part D coverage includes co-payment
requirements of all persons. However, Medicare Part D co-payments are
waived when a dual eligible person enters a Medicaid funded medical
institution for at least a full calendar month. Medical institutions must
notify the Arizona Health Care Cost Containment System (AHCCCS)
when a dual eligible person is expected to be in the medical
institution for at least a full calendar month to ensure co-payments
for Part D are waived. The waiver of co-payments applies for the
remainder of the calendar year, regardless of whether the person
continues to reside in a medical institution. Given the limited
resources of many dual eligible persons and to prevent the
unnecessary burden of additional co-pay costs, it is imperative that
these individuals are identified as soon as possible.
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7.2.2
References
The following citations can serve as additional resources for this
content area:
7.2.3
Scope
To whom does this apply?
This section
applies to all facilities designated as a medical institution (provider types
02, 71,
78, B1, B2, and B3).
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7.2.4
Did you know…?
- Enrollees with Medicare Part D
prescription drug coverage and AHCCCS (health insurance and
Medicare Savings Programs), dual eligibles, have minimal
prescription drug co-payments. Part D co-payments will be waived
when dual eligible persons enter an institution, with the intent to remain for at least a full calendar month.
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7.2.5
Definitions
Dual
Eligible
Institutionalized
individual
Medicare
Advantage Prescription Drug Plan (Ma-PD)
Medical
Institution
Prescription Drug
Plan (PDP)
7.2.6
Objectives
To inform behavioral health providers designated as
medical institutions of reporting and tracking requirements for dual eligible
persons to ensure Medicare Part D co-pays are waived.
7.2.7
Procedures
7.2.7-A.
Reporting requirements
To ensure that dual eligible persons’ Medicare Part D co-payments are waived when it is expected that dual eligible persons will be in a medical institution, funded by Medicaid, for at least a full calendar month, AHCCCS must be notified immediately upon admittance. Reporting must be done using
PM Form 7.2.1, AHCCCS Notification To Waive Medicare Part D Co-Payments For Members In A Medical Institution That is Funded By Medicaid. Providers must not wait until the person has been discharged from the medical institution to submit the form. Reporting must be done on behalf of the following:
- Persons who have Medicare Part “B” only;
- Persons who have used their Medicare Part “A” lifetime inpatient benefit; and
- Persons who are in continuous placement in a single medical institution or any combination of continuous placements that are identified below.
Medical
Institutions
Medical institutions include the following behavioral health
providers:
- Acute
Hospital (PT 02)
-
Psychiatric Hospital – IMD (PT 71)
-
Residential Treatment Center – IMD (PT B1, B3)
-
Residential Treatment Center – Non IMD (PT 78, B2)
Notification
of admission of Gila River RBHA members to an IMD should be faxed
to the attention of the Gila River RBHA Billing Clerk at (602) 528-1374
or mailed to the following address utilizing PM
Form 7.2-GR, TITLE XIX INSTITUTION FOR MENTAL DISEASE ADMISSION/DISCHARGE
NOTIFICATION FORM:
Hu Hu Kam Memorial
Hospital
ATT: RBHA Billing Clerk
P.O. Box 38
Sacaton, AZ 85147
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7.2 Medical
Institution Reporting for Medicare Part D
Last Revised: 10/22/2010
Effective Date: 12/01/2010 |
