Medicare Compliance & Reimbursement
Facilities Should Help, But Not Steer, PDP Selection
Feds offer plan that can help beneficiaries decide on a PDP.
Many Medicare beneficiaries are already lost on the road to Part D, but facilities should not offer directions too freely. Guiding residents to a particular prescription drug plan could well send a facility toward noncompliance.
"Choosing a PDP can be a very complicated process, but CMS doesn't want providers 'steering' beneficiaries toward a particular plan," stresses Steve Jones, principal with Moore Stephens Lovelace in Clearwater, FL.
Starting Nov. 15, Medicare beneficiaries can sign on with the PDP of their choice. The choices they make will have big implications for both facilities and residents. Remember these points when benes ask about PDPs:
• PDPs are free within limits to devise their own formularies: One may cover a drug that another declines.
• In addition, the Centers for Medicare and Medicaid Services has granted PDPs the freedom to contract with the long-term care pharmacy providers of their choice.
• Given CMS' explicit instructions to healthcare providers not to influence beneficiaries' plan selection, nursing homes more than ever need to devise ways to research formulary restrictions quickly and efficiently, suggests attorney Chuck Sheets of Foley & Lardner's long-term care group in Chicago.
Tip: Facilities must find a software program that nurses can use instantly, from a PDA or handy computer, to advise them if a prescription is not on a beneficiary's formulary, advises Jones.
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