DUAL ELIGIBLES: Health Plans, CMS Agree To Reimburse States; Stopgap Drug Coverage for Dual Eligibles

Subscribe or sign in to view the full article.

Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article explains how CMS, HHS, health plans, and states responded to early Medicare Part D access problems affecting dual eligibles. It focuses on temporary reimbursement arrangements for emergency prescription coverage, the role of states as payers of last resort, and parallel Senate efforts to advance legislation in case administrative fixes were not enough. The piece is relevant to Medicare, Medicaid, health plan operations, and policy stakeholders tracking Part D transition issues and federal-state reimbursement policy.

Why This Topic Matters

It helps readers understand a temporary federal response to drug coverage disruptions affecting dual eligibles, along with the policy and reimbursement implications for states, plans, pharmacies, and Congress.

Article Sections

  1. Stopgap coverage and reimbursement response

    The article describes the early Part D transition issues, the temporary state coverage response, and the initial federal and health plan positions on reimbursement.

  2. Misinformation ignites reaction from health plans, Senate groups

    This section summarizes stakeholder reactions, including Senate legislative proposals and broader concerns about coverage disruptions and reimbursement responsibility.

  3. CMS, HHS see states as 'payers of last resort'

    The final section covers a closed-door federal and Senate meeting, the temporary reimbursement framework, and the ongoing possibility of legislative action.

What You Will Learn

  • How federal agencies and health plans responded to early Medicare Part D transition problems
  • Why states became involved in emergency prescription coverage for dual eligibles
  • What broad policy and reimbursement issues were being debated in Congress
  • How temporary administrative action affected the need for legislation

Who Should Read This

  • Medical coders and billing professionals
  • Health plan administrators
  • Medicare and Medicaid policy staff
  • Pharmacy reimbursement stakeholders
  • Healthcare compliance and reimbursement analysts

Subscribe or sign in to view the full article.

You have ED coding questions, and we deliver money-in-the-bank answers to help you defeat your claim issues and secure optimal reimbursement.

Stay in the know and avoid federal reproach with your subscription to TCI’s ED Coding and Reimbursement Alert.

  • Current newsletters added each month
  • Fully searchable archives - over 2100 articles
  • ALL years/issues back to 1998 organized by year and issue
  • Codes mentioned in articles are linked to Code Information pages
  • Code Information pages link back to related articles

This feature is currently unavailable for online purchase. For more information, please call 801-770-4203 or Contact Us.

Related Articles

Articles are listed in order of calculated relevance.

demo
request yours today
subscribe
start today
newsletter
free subscription

Thank you for choosing Find-A-Code, please Sign In to remove ads.

Aimee- AI -powered coding assistant - Try it now for Free Would you like Aimee - AI
to help you with this?