Medicare Compliance & Reimbursement

Provider must educate Part D switchovers by autumn.

The feds are intent on making waves with Medicare Part D. To make sure that the new prescription drug benefit doesn't turn into an operational tsunami, providers can familiarize themselves with the program and its potential impact on long-term care.

Warning: Most nursing homes are already way behind where they should be in preparing for the pending Part D benefit, experts contend.

"Many people seem to be saying, 'Well, yes, it's big news, but isn't it going to be delayed?' - or 'Won't it just go away?'" reports Betsy Anderson, vice president with FR&R Healthcare Consulting in Deerfield, IL.
 
Don't Bet On A Delay

The Centers for Medicare and Medicaid Services shows all signs of sticking to the program's Jan. 1, 2006, implementation date, report trade groups, including the American Health Care Association.

Furthermore, providers have only until this fall to educate and guide residents whose drug coverage will shift from Medicaid to Medicare with the advent of Part D, cautions Mary Jo Carden, a principal with Dumbarton Group & Associates in Washington, DC.

Nursing home residents with full Medicaid coverage may enroll in a Part D prescription drug plan beginning Nov. 15, 2005 - and CMS has requested that nursing home staffers help in that process when appropriate.

To avoid being hit by the storm unprepared come Jan. 1, nursing homes must begin now to facilitate the change, Anderson tells MLR.

A big risk is that facilities that don't could find themselves footing the bill for drugs that are no longer covered and scrambling to keep the shift from hurting patient care, warns Anderson, who in recent months has conducted a number of seminars on Part D.

Communication and education will both be key as long-term care providers gear up for the change, offers Carden. Though the savvy provider is likely to take one serious look at Part D legislation and head straight for a seminar to learn more.