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10/5/2006 12:00:00 AM



TO:                 Affiliate Executive Directors

                        Clinic Directors

                        Residential Directors

                        Day Services Directors

                        Service Coordinators

FROM:           Deb Williams, Vice President, Reimbursement & Regulatory Compliance

DATE:            October 5, 2006


We have just received information from the NYS Office of Mental Retardation and Developmental Disabilities (OMRDD) regarding significant changes to the benchmark prescription drug plans (PDPs) for dually eligible (Medicaid and Medicare) consumers.   


As you know, dually eligible consumers were initially auto-assigned to a benchmark plan (a benchmark plan is a plan where the premium is $0).  At this point, agencies or consumers either chose to stay in the auto-assigned plan, switched to another benchmark plan with no cost to the consumer, or switched to a non-benchmark plan and paid the additional cost for the premium. 

With the first year of the Part D program coming to an end, plans/companies have a choice of staying in the program, leaving the program or making changes to their benefits.  Unfortunately, we have been informed that only 6 of the 15 original benchmark plans in 2006 will remain in the program for 2007 without changes to their benefit structure.   

Based on the 2007 CMS plan listings for New York State, there will be a total of 13 benchmark plans available from 12 companies. 

The 6 benchmark plans enrolled in 2006 that will continue in 2007 are

      1.   American Progressive (Prescription Pathway Bronze) (S5825-045)

      2.   Humana PDP Standard (S5552-003)

      3.   Simply Prescriptions (Excellus/FLRx) (S3521-001)

      4.   Unicare (Anthem/Medicare Rx Rewards Value (S5960-003)

      5.   UnitedHealthcare (new AARP MedicareRxPlan - Saver) (S5921-203)

      6.   WellCare Signature (plus new WellCare Classic) (S5967-037/140)

Attached is an email from OMRDD providing more detailed information about the plan changes.


Additionally, the notification to beneficiaries regarding the changes in the plans as well as reassignment of consumers to new plans could be problematic (see #3 below). 

Following are the processes for notification and reassignment:

      1.   If a PDP drops out of the Part D program, CMS will reassign the individuals who are full subsidy eligible (dually eligible individuals are full subsidy) to a new plan effective January 1, 2007.   Reassignment letters will be sent out in early November on blue paper.

      2.   If a PDP’s monthly premium cost does not increase by more than $2 over the benchmark cost for 2007, full subsidy eligible people will be allowed to stay in the same PDP and will continue with no monthly premium for the plan.  These individuals will not get a special letter from CMS.

      3.   If a PDP’s monthly premium increases by more than $2 over the benchmark cost for 2007, CMS will issue a reassignment letter only if the person meets the following criteria:  the person remains full subsidy eligible for 2007 and the person was auto-assigned to a plan in 2006 and remained in the same plan.  This letter will also be on blue paper and mailed early in November.

Please note that in situation #3 above, any dual eligible who elected a new benchmark plan in 2006 over the original auto-assigned plan, will not automatically be reassigned to a new benchmark plan nor will they be notified if the current plan’s monthly premium increases by more than $2 over the benchmark for 2007.  They will be liable for the extra premium cost or can avoid extra charges by switching to another fully subsidized benchmark plan.

Individuals should carefully read their Annual Notice of Change letters from their plans. 

As we obtain additional information, we will be sure to provide it to you.  If you have any questions, please do not hesitate to contact me (518) 436-0178. 

[Attachments can be obtained by contacting the Affiliates Services Office at (518) 436-0178.]

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