NCAL Leads Coalition Calling for Changes in Medicare Part D Program

Urges Senate Aging Panel to Waive Part D Co-Payments for Dually-Eligible Seniors Receiving Care in HCBS and Assisted Living Residences

Contact:
Donna Doneski, AHCA/NCAL, (202) 898-6321
For Immediate Release
January 31, 2007

Washington, DC –In a statement submitted to a Senate Special Aging Committee hearing today, the National Center for Assisted Living (NCAL) called for Congress to change the Medicare Part D program by waiving Part D co-payments for dually-eligible seniors (those covered by both Medicare and Medicaid) in home and community-based care settings (HCBS) including assisted living and residential care facilities (AL/RC).

“As Medicare Part D enters its second year, it is clear the program has helped millions of seniors and people with disabilities gain access to needed medications,” stated David Kyllo, Executive Director of NCAL. “However, we believe that the existing gap in Medicare Part D coverage may well have been a mistake of omission made as policymakers put together this complex legislation and that Medicare Part D needs to be modified so that our frailest dually-eligible seniors are treated equally.”

In his statement, Kyllo told the Senate panel that poor, frail elderly Medicare beneficiaries who also receive services under Medicaid home- and community-based programs “need and deserve” the same prescription drug benefits as dually-eligible beneficiaries living in nursing homes. “These are elderly citizens who have prescription needs similar to nursing home patients but often are financially unable to afford the co-payments on their Part D prescriptions,” continued Kyllo’s statement. “This is a hole in the Part D safety net that needs to be mended.”

Recognizing the vulnerability and special needs of very low-income people living in long term care facilities, the Medicare Modernization Act of 2003 exempted the dually-eligible living in “long term care facilities” from any cost-sharing for Part D prescription drugs. Technically, the Centers for Medicare & Medicaid Services (CMS) defines a long term care facility under Part D as a nursing facility, an intermediate care facility for people with mental retardation and developmental disabilities, or an inpatient psychiatric hospital. Unfortunately, Kyllo pointed out, the 2003 legislation did not extend the co-payment waiver to dually-eligible residents of AL/RC facilities and others in HCBS, even though these seniors are eligible for nursing home care and have similar needs, vulnerabilities, and income limitations.

NCAL’s statement urged Congress to reintroduce bipartisan legislation introduced in the 109th Congress in order to provide relief to this group of frail and elderly individuals. “The Home and Community Services Co-payment Equity Act (S. 2409 and H.R. 5907) would eliminate Part D co-payments for more than one million low-income Americans, including dually-eligible residents of AL/RC facilities and other licensed facilities such as group homes for people with developmental disabilities, psychiatric health facilities, and mental health rehabilitation centers. The dually-eligible receiving services at home under HCBS waivers also would save on their existing Part D co-payments,” the NCAL Executive Director noted in submitted testimony.

“Remedying this gap in prescription coverage is based upon simple common sense, and is supported by a growing coalition of more than thirty-five national organizations representing consumers, health care and long-term care providers, geriatric care professionals, pharmacists, and state officials,” Kyllo stated. According to an analysis of the Part D co-payment legislation done for AHCA/NCAL by the Lewin Group, by 2008 the HCBS dually-eligible population impacted by this legislation will be larger than the number of dual eligible beneficiaries living in nursing homes and other institutions.

The NCAL statement for the record also noted that this legislation would help to maintain a level playing field between institutional and community-based services under Medicaid: “For many years, policymakers and the public have supported expanding options for people to receive long-term care services at home and in community-based settings under the Medicaid program and NCAL supports the principle of Medicaid providing services in the setting that best meets each individual’s needs and preferences.”

 “For a small investment in covering Part D co-pays, Congress would remove an impediment preventing some from living at home or in an assisted living facility, and thereby save state and federal dollars, since these care settings may be less expensive than nursing homes,” concluded Kyllo’s statement. “Ultimately, however, the most important reason to pass the Home and Community Services Co-payment Equity Act is to help frail, elderly seniors afford needed medications.”

The American Health Care Association and the National Center For Assisted Living are the nation's leading long term care organizations. AHCA/NCAL and their membership are committed to performance excellence and Quality First, a covenant for healthy, affordable and ethical long term care. AHCA/NCAL represent nearly 11,000 non-profit and proprietary facilities dedicated to continuous improvement in the delivery of professional and compassionate care provided daily by millions of caring employees to more than 1.5 million of our nation's frail, elderly and disabled citizens who live in nursing facilities, assisted living residences, subacute centers and homes for persons with mental retardation and developmental disabilities.