Tag Archives for Medicare Part B

Time to be educated on senior issues with primary just weeks away

Published in RINewsToday on August 22, 2022

On Aug. 17, just twenty-eight days before Rhode Island’s Sept. 13th Primary Election, at the Warwick-based Pilgrim Senior Center, Gov. Dan McKee joined Lt. Governor Sabina Matos, House Speaker K. Joseph Shekarchi, other elected leaders and advocates to highlight recently passed legislative and budget initiatives that supported  Rhode Island’s senior population. The Governor ceremonially signed legislation passed this legislative session. 

Among those investments is $4 million in the FY 23 state budget to increase the Circuit Breaker Tax Credit available to qualifying seniors and adults with disabilities, raising the maximum credit received to $600 and increasing the income threshold for eligibility to $ 35,000.  This property tax credit program provides relief to eligible seniors and adults with disabilities who own or rent their homes. The budget also increases the amount of pension income that is exempt from state taxation for all retirees from the first $15,000 to the first $20,000.

Whether it’s tax relief, housing, food security, or utilities, our Administration is looking at these issues through the lens of ensuring our seniors are able to not just live in the Ocean State, but that they are also able to thrive here,” stated the McKee at the event, a continuation of his #RIMomentum Tour. “I am proud to deliver a budget and sign several pieces of legislation that support and protect our seniors, and I thank the sponsors and advocates who helped see them across the finish line,” he said.

“Both as chair of the Long Term Care Coordinating Council, and as a granddaughter whose family cares for a senior, I am dedicated to ensuring that every Rhode Islander has the support they need to live full, rich, and long lives. The budget we have passed this year, along with the bills signed today, will significantly improve on our seniors’ quality of life,” said Lt. Gov. Sabina Matos. “We are going to continue working to provide high-quality services to our neighbors of every age.”

With his ceremonially pen, the Governor also signed these pieces of legislation:

H7133B (Reps, Joseph M. McNamara) and S2207A (Sen. Joshua Miller): This legislation authorizes the creation and implementation of a pharmaceutical redistribution program by the Department of Health and the Board of Pharmacy to begin on Jan. 1, 2023.

H7246 (Representative Jason Knight) and S2228 (Senator Cynthia A. Coyne): This legislation lowers the age at which a victim can be considered an elder under the state’s elder financial exploitation laws.

H 7068 (Representative Kathleen A. Fogarty) and S2317   (Senator V. Susan Sosnowski): This legislation makes it easier for senior citizens to apply for Supplemental Nutrition Assistance Program benefits.

Aging Advocates Gear Up for Next Legislative Session

McKee’s ceremonial signing of legislation was a visible sign to aging advocates that state officials are recognizing that these are wise investments that foster healthy lives and economic security for our growing older population, says Maureen Maigret, Chair of the Aging in Community Subcommittee of the Long Term Care Coordinating Council and serves on the Board of Directors for the Senior Agenda Coalition and the Village Common of RI. “The budget builds on Subcommittee promoted legislation sponsored by Rep. Deb Ruggiero and Sen. Cynthis Coyne to expand the Property Tax Relief law and last year’s addition of close to $1Million in Governor McKee’s budget to increase income eligibility for the Office of Healthy Aging ‘At Home Cost Share’ program and to include persons under age 65 with Alzheimer’s and other dementias,” she said. 

According to Maigret, several items from the Sub-committee’s Strategic Plan that did not make it this year are the expansion of the Medicare Savings Program to help lower-income adults pay for Medicare Part B’s hefty premiums and extending the state Paid Family Leave law beyond six weeks which will help families needing to take time out of work to care for both older relatives and children needing medical/nursing care. “These are just some of the items we will be advocating for in 2023,” she said.

Maigret notes that September’s Primary Election is less than a month away. “New laws make it easier to vote.  You can apply online for a mail ballot for the Primary which must be sent in by August 23rd, she says. 

Becoming an Educated Voter on Senior Issues

According to Ballotpedia, the website encyclopedia of American politics, all 435 voting seats in the House of Representatives and 34 Senate Seats will be up for grabs on the midterm elections scheduled for Nov. 8, 2022 . The seats of five of the six non-voting members of the House are also up for election as well. 

Ballotpedia notes, state elective offices up for election in 2022 include 36 gubernatorial seats, 30 lieutenant gubernatorial seats, 30 attorney general seats, and 27 secretary of state seats. Including down-ballot races, there are 309 state executive offices up for election across 44 states in 2022, says Ballotpedia.

Also, 88 of the country’s 99 state legislative chambers will also hold regularly scheduled elections, representing 6,278 of the nation’s 7,283 legislative seats, adds Ballotpedia.

The Washington, DC-based AARP gears up its efforts, through its “Our Voices Decide” campaign, to ensure that America’s seniors can continue to maximize their influence on this year’s midterm elections (at both the state and national levels) like they have for previous elections. 

According to AARP Rhode Island, AARP in every state has a voter engagement page that provides information on when, how and where to vote and, in many states, recent changes in voting laws. Ours is at www.aarp.org/RIVotes. This webpage is updated frequently. 

Many states also post video voter guides, in which candidates are asked questions. In Rhode Island – and in every state — candidates were strictly limited to 60 seconds or less to respond. Texts of the questions and answers on video are posted online. The candidate responses appear in alphabetical order, just as they would appear on the ballot, says AARP Rhode Island.

AARP has provided voting information for many years. AARP Rhode Island featured videos of candidates for Governor in 2020. We chose to feature candidates in three contested 2022 Primary races – Governor, 2nd Congressional District and Providence Mayor, says AARP Rhode Island.

“Voting gives you the power to decide what our future looks like,” AARP Rhode Island State Director Catherine said. “But you have to be in the know to vote. AARP Rhode Island sees the importance of collecting the most up-to-date election information, including key dates and deadlines, to make sure that the voices of voters 50+ are heard. We are doing everything we can to make sure older Rhode Islanders are prepared to vote and know the safe and secure voting options included in the new, AARP Rhode Island-backed Let RI Vote Act. Our Video Voter Guide takes this a step further and with an important focus, giving older voters clear, concise answers on issues that impact their lives. Debates and candidate forums seldom focus on these questions and that is why AARP steps in to give voters a non-partisan, trusted resource to better understand where candidates stand before they cast their votes,” she says.

“In Rhode Island and across the country, the data clearly shows that 50+ voters will be the deciders in the 2022 elections,” said Taylor. “We are working with dozens of advocacy volunteers who are fighting for voters 50+ to make their voices heard on the issues that matter – especially in Rhode Island where we are in the midst of a housing crisis, nursing homes are in jeopardy, the cost of long-term care is skyrocketing and where people want leaders who are committed to making local communities more livable,” she adds.

“At the federal level, older voters want to know candidates’ positions on protecting and strengthening the Social Security benefits Americans have paid into and earned through years of hard work, protecting and improving Medicare benefits, lowering prescription drug prices, and supporting family caregivers who risk their careers and financial futures to care for parents, spouses, and other loved ones,” Taylor said.

Other Resources…

On August 3 the Senior Agenda Coalition of RI co-hosted a Governor’s Candidates Forum hosted by 17 organizations (www.senioragendari.org/coalition). To learn how the candidates from both parties responded to seven questions about aging policy and issues. Go to www.youtube.com/watch?v=okQ5FguKMao

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Controversial move by CMS limits coverage for new Alzheimer’s drug, Aduhelm 

Published in RINewsToday on April 25, 2022

Earlier this month, amid the pleas of the Alzheimer’s Association, the National Committee to Protect Social Security and Medicare, and other aging advocacy groups, the Centers for Medicare & Medicaid Services (CMS) made its final decision to limit their Medicare coverage of the controversial Alzheimer’s drug, ADUHELM® , for only those Medicare recipients participating in clinical studies overseen by the National Institutes of Health (NIH) or in other approved clinical trials.

When releasing its decision on April 7, CMS noted from the onset, the federal agency “ran a transparent, evidence-based process that incorporated more than 10,000 stakeholder comments and more than 250 peer-reviewed documents into the determination” to make its decision.

Calls for More Rigorous Studies

According to CMS, over 6 million older Americans are believed to have Alzheimer’s, and this prevalence is expected to rise to 14 million by 2060, barring effective interventions. CMS stated that effective treatments are needed, and because of the early, but promising, evidence and the immense burden of this devastating disease on the Medicare population, the agency is finalizing Medicare coverage, calling for rigorous studies approved by the U.S. Federal Drug Administration (FDA) and NIH to help answer whether this class of drugs improves health outcomes for patients.

“Science, evidence, and stakeholder input led our team of career civil servants and clinicians through this national coverage determination process. There is potential for promise with this treatment; however, there is not currently enough evidence of demonstrating improving health outcomes to say that it is reasonable and necessary for people with Medicare, which is key consideration for CMS when making national coverage determination, said Dr. Lee Fleisher, CMS Chief Medical Officer and Director of the Center for Clinical Standards and Quality, in a statement announcing CMS’s regulatory payment decision.

“In arriving at this final decision, we looked at the unique circumstances around this class of treatments and made a decision that weighed the potential for patient benefit against the significance of serious unknown factors that could lead to harm,” added Fleisher. “If a drug in this class shows evidence of clinical benefit through the traditional FDA approval process, then CMS will provide broad access and ensure the results from the rigorous trials are generalizable for people with Medicare participating in a CMS-approved study, such as a registry,” she said, noting that this decision was made to provide CMS flexibility to respond quickly to providing coverage for any new drugs in this class showing a clinical benefit. 

Biogen, a biotechnology company that manufacturers ADUHELM®m , was quick to give its opinion about CMS’s final decision about coverage of this drug. The Cambridge, Massachusetts based company charged that “this unprecedented decision effectively denies all Medicare beneficiaries access to ADUHELM®m , the first and only FDA approved therapy in a new class of Alzheimer’s drugs. It may also limit coverage for any future approved treatment in the class. These coverage restrictions, including the distinction between accelerated approval and traditional approval, have never been applied to FDA-approved medicines for other disease areas.”

When additional data from this new class of treatments become available, Biogen urged CMS to reconsider its final decision for all FDA-approved amyloid-beta targeting therapies. The company says that it is carefully considering its options and will provide updates as the company further evaluates the business impact of this decision.

Creating Unnecessary Barriers to Care 

Calling the CMS decision wrong, the Chicago-based Alzheimer’s Association expressed deep disappointment, charging that it has essentially ignored the needs of people living with Alzheimer’s disease. “CMS has created unnecessary barriers for individuals with Alzheimer’s disease. Patients with Alzheimer’s, a fatal disease, should have FDA approved treatments covered by Medicare just as those facing other diseases do,” said Harry Johns, Alzheimer’s Association chief executive officer. 

Notably, CMS has said in its decision the only way for patients to access the first approved FDA treatment targeting amyloid in those living with Alzheimer’s is to enroll in a clinical trial. While we note CMS has expanded where those clinical trials may take place, in reality this remains an unnecessary and never before imposed barrier to access an FDA-approved treatment, says Johns.

“People living with MCI, Alzheimer’s disease and other dementia deserve the same access to therapies given to those living with other conditions like cancer, heart disease and HIV/AIDS. They deserve the opportunity to assess if an FDA-approved treatment is right for them,” said Joanne Pike, Dr.P.H., Alzheimer’s Association president. “Drugs that treat people in the early stages of Alzheimer’s could mean more time for individuals to actively participate in daily life, have sustained independence and hold on to memories longer,” she said.

According to the Alzheimer’s Association, CMS has incorporated one of its recommendations into the final rule. “Importantly, CMS has decided to utilize a registry for future treatments granted full FDA approval. The Alzheimer’s Association registry will play an important role in collecting and analyzing real-world data. This registry will monitor and report clinical and safety endpoints for patients treated with FDA-approved AD therapies, including accompanying diagnostics, to track the long-term outcomes associated with these therapies in real-world settings. Similar successful registries in heart disease and cancer have enabled researchers, clinicians, health systems and payers to track the long-term performance of therapies using a large, real-world evidence dataset,” the advocacy group says. 

The Alzheimer’s Association also expressed strong concern about the immediate impact CMS’s decision will have on Alzheimer’s and dementia research and innovation. “The agency’s decision to essentially reject the Accelerated Approval Pathway for monoclonal antibodies targeting amyloid for the treatment of Alzheimer’s disease is broad overreach. Accelerated approval is a pathway created by Congress and utilized by FDA to allow for earlier approval of drugs that treat serious conditions, and that fill an unmet medical need. Alzheimer’s is a deadly disease with no survivors,” stated the advocacy group.

“The decision by CMS is a step backward for families facing Alzheimer’s disease,” said Maria C. Carrillo, Ph.D., Alzheimer’s Association chief science officer. “Years of increased research funding has led to more progress and innovation than ever before, but today’s decision may halt this progress as developers question if there is a pathway forward to coverage,” she said.

Calls for Reducing Cost of Medicare Part B Premiums

Max Richtman, President and CEO of the National Committee to Preserve Social Security and Medicare, calls on CMS to “swiftly reduce the hefty 2022 Medicare Part B premium increase ($21.60 per month), now that the agency has made its final decision to limit coverage of the controversial Alzheimer’s drug, ADUHELM®m, to patients in clinical trials.” 

“The spike in Medicare Part B premiums was partly based on the drug’s exorbitant cost (originally priced at $56,000 per year) and the potential expense of wider coverage,” says Richtman, noting that the agency is still “reviewing” Part B premiums, under previous direction from HHS Secretary Xavier Becerra. “Medicare beneficiaries struggling to pay their bills need relief from this year’s premium increase as soon as possible, warns Richtman. .

“The Aduhelm controversy highlights the urgent need for Medicare to be able to negotiate drug prices with Big Pharma. If the price of Aduhelm had been negotiated, it is unlikely that it would have impacted Medicare premiums so dramatically in the first place,”  adds Richtman, 

For a fact sheet on Medicare coverage policy for monoclonal antibodies directed against amyloid for the treatment of Alzheimer’s disease, visit https://www.cms.gov/newsroom/fact-sheets/medicare-coverage-policy-monoclonal-antibodies-directed-against-amyloid-treatment-alzheimers-disease.

To read the final NCD CED decision memorandum, visit https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&ncaid=305.

Medicare slow to fix equity issue for seniors’ access to at-home COVID test kits

Published on Feb. 7 in Rhode Island News Today

Today home test kits were made available in a variety of ways – but, for Medicare recipients, it was a different story, being forced to go thru a different purchasing and payment process than those having private insurance, or no insurance. That process required the oldest and most at-risk population to take more than several steps, put up their own money, do a lot of paperwork, to seek reimbursement.

The White House made changes in testing so that at-home tests are now fully covered by health insurances. Those insured can pick up their test kits in a store and have them paid for at the time of purchase by their insurance, at no cost to the person. They aren’t required to visit their physician or get a prescription to obtain the free test. They have a limit of 8 test kits per month.

But, when the program began, this was not the plan for those insured through the government’s Medicare and Medicare Advantage plans.

Red Tape… Upfront Charges for COVID-1

Jane, a 65-year old Medicare beneficiary from Warwick went through the steps to get a kit after a relative she had seen found out she was exposed to COVID.  Before Medicare announced easing up on the purchasing process of COVID-19 test kits, she expressed frustrations to this writer about the regulatory hoops she faced because she was on Medicare – purchasing the test kits and getting reimbursed for the upfront charges. “First, I had to request a prescription from my physician and say that I had either been exposed to someone who had COVID, or I was having symptoms, myself,” recalls the frustrated Medicare beneficiary.  “Once my physician sent the prescription over to CVS, I was notified that it would take a couple of days before I could pick up the kits and that I would only be given two kits per prescription”, she fumed, knowing that sometimes it takes 4 or 5 days of testing to test positive, but was only eligible to receive two, and she might have to go through the whole process again in a few days.

“Three days later CVS finally left me a message saying these kits were in. I used the drive-up window for pickup and the cashier asked me for $46,” Jane remembered.  “When questioning this charge, a pharmacist came to the window to assist and told me that I had to pay for the kits upfront and then seek reimbursement,” she added.

Paying for the kits, Jane went home, and called Blue Cross, her Medicare supplement company and was told she needed to request a copy of the prescription which took hours to finally request with the back and forth phone calls to her busy doctor’s office. It was almost two weeks later she finally got a copy of the receipt detailing her $46 payment for the kits. She was then able to upload the copy of the prescription and a copy of her receipt to a BCBS reimbursement screen on her computer (or she could have printed the form out and mailed the whole package in). At press time, Jane is still waiting for her reimbursement, being told it will take from 4 to 6 weeks to receive a check.

It’s better late than never, says Jane, when she heard that Medicare would now cover free over-the-counter COVID-19 tests. “Not everyone can put out $46 and wait two months to get it back, home health tests were made available in a variety of ways – but, for Medicare recipients, there was a different process. More concerning was all the steps I had to take to complete the process they had originally intended for us to do. How many people would really complete all those steps?” she says. “We talk a lot about equity, but seniors need equitable healthcare processes, too.”

Just days ago, the Centers for Medicare & Medicaid Services (CMS) announced that beneficiaries in either Original Medicare or Medicare Advantage will be able to get over-the-counter COVID-19 tests at no cost starting in early spring, estimated to be in April. Under the new CMS initiative, Medicare beneficiaries will be able to access up to eight over-the-counter COVID-19 tests per month for free. Tests will be available through eligible pharmacies and other participating entities. This policy will apply to COVID-19 over-the-counter tests approved or authorized by the U.S. Food and Drug Administration (FDA). A prescription will not be required.

CMS Unveils New Medicare Benefit

According to CMS, this new initiative will enable payment from Medicare directly to participating pharmacies and other participating entities to allow Medicare beneficiaries to pick up tests at no cost. This is the first time that Medicare has covered an over-the-counter test at no cost to beneficiaries.

CMS’s announcement follows last month’s announcement that the Biden-Harris Administration would be requiring commercial health insurance companies to cover at-home COVID tests for free.

Until the new benefit kicks in, Medicare beneficiaries can access free tests through a number of channels established by CMS, too. Now, they can request four free over-the-counter tests for home delivery at covidtests.gov. Or beneficiaries can access COVID-19 tests through health care providers at over 20,000 free testing sites nationwide. Many cities and towns are also giving out free test kits at drive-up handout programs as the state receives supplies.

CMS’s Feb. 3 statement noted that Medicare beneficiaries can also access lab-based PCR tests and antigen tests performed by a laboratory when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional at no cost. In addition to accessing a COVID-19 lab test ordered by a health care professional, people with Medicare can also already access one lab-performed test without an order, also without cost sharing, during the public health emergency, says CMS.

In addition, CMS says that Medicare Advantage plans may offer coverage and payment for over-the-counter COVID-19 tests as a supplemental benefit in addition to covering Medicare Part A and Part B benefits. Medicare beneficiaries covered by Medicare Advantage should check with their plan to see if it includes such a benefit.

Finally, all Medicare beneficiaries with Part B are eligible for the new benefit, whether enrolled in a Medicare Advantage plan or not.

“AARP applauds today’s announcement that will guarantee access to at-home over-the-counter COVID-19 tests at no cost for Medicare’s 64 million beneficiaries and we thank [Health and Human Resources]Secretary Becerra and CMS Administrator Brooks-LaSure for their diligence in addressing this issue. Expanded access to no-cost testing will help protect seniors who have been hit hardest by the pandemic and ensure they can remain connected with their loved ones and community.,” says AARP Executive vice president and Chief Advocacy and Engagement Officer Nancy LeaMond in a statement issued with CMS’s Feb. 3rd announcement of the new Medicare benefit.

“Every American should have an easy way to get at-home COVID tests. We know that people 65 and older are at much greater risk of serious illness and death from this disease – they need equal access to tools that can help keep them safe. The cost of paying for tests and the time needed to find free testing options are barriers that could discourage Medicare beneficiaries from getting tested, leading to greater social isolation and continued spread of the virus, adds LeaMond.

Successfully Advocating the Seniors

Last month, Senators Sherrod Brown (D-OH) and Debbie Stabenow (D-MI) along with 17 of their  Senate colleagues including Rhode Island Democratic Senators Reed and Sheldon Whitehouse wrote to HHS Secretary Becerra and  CMS Administrator Brooks-LaSure urging them to expand Medicare coverage of free at-home rapid COVID-19 testing.

Aging groups also joined the Senators in pushing Medicare to offer the new testing kick benefit.  “It is clear that regular testing is a crucial part of managing the spread of COVID-19. That’s why AARP has been calling for coverage of at-home tests, says AARP’s LeaMond, noting that the nation’s largest aging advocacy group “will continue to watch for details about when and how at-home COVID tests are made available to those in Medicare.”

Thankfully CMS quickly heeded their calls.

For more information, please see these Frequently Asked Questions, https://www.cms.gov/files/document/covid-19-over-counter-otc-tests-medicare-frequently-asked-questions.pdf (PDF)

Stay tuned for free N95 masks to be made available to all coming up soon.