Rural Networks

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Rural Networks Medicare Advantage

• Medicare Advantage
• Medicare Prescription Drug Plans

Tom Morris Deputy Director Office of Rural
Health Policy Health Resources and Services
Administration U.S. Department of Health and
Human Services
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Rural Networks Medicare Advantage

• Most Significant Changes to Medicare Since Its
  Inception
• HHS-Wide Team, including ORHP, Reviewed
  Regulations
• Rural Access A Consideration Attracting Plans
  also a Key Consideration

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Rural Networks Medicare Advantage

• Most Significant Changes to Medicare Since Its
  Inception
• Opportunities for Increased Access and Services
• But, Big Changes in the Past Hit Rural Hard

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Rural Networks Medicare Advantage

• Medicare Advantage
• HMOs
• PSOs
• Private FFS
• Cost Plans
• And Medicare FFS Always a Fall Back

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Rural Networks Medicare Advantage

• Determining the Impact
• Rural Health Research Center Reports
• ORHP Staff Monitoring
• Regular Meetings with CMS and ORHP
• Rural Open Door Meetings

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Rural Networks Medicare Advantage

• Medicare Advantage Regional PPO Map

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Rural Networks Medicare Advantage

• Key Issues with Regional PPOs
• Network Adequacy
• Negotiating Payment Rates both In and Out of
  Network
• Educating Beneficiaries

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Rural Networks Medicare Advantage

• Prescription Drug Coverage
• Offered through Medicare Advantage Plans (MA) or
  Medicare Prescription Drug Plans (PDPs)
• Enrollment Begins 2006

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Rural Networks Medicare Advantage

• The Basics for Beneficiaries
• 250 deductible
• 75 Coverage up to 2,250 and then 95 coverage
  after 3,600
• Starts January 1, 2006
• Enrollment Begins Nov. 15, 2006

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Rural Networks Medicare Advantage
This information was reprinted with permission of
the Henry J. Kaiser Family Foundation. The Kaiser
Family Foundation, based in Menlo Park,
California, is a nonprofit, independent national
health care philanthropy and is not associated
with Kaiser Permanente or Kaiser Industries.
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Rural Networks Medicare Advantage

• Opportunities for Increased Access to Drugs but
  
• Delivery Mechanism Post Office Boxes or a
  Friendly Neighborhood Pharmacist?
• Some Protections
• Enrollees supposed to have at least two options
  in plans
• Plans cant rely solely on mail order

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Rural Networks Medicare Advantage

• Primary Rural Concerns
• Impact of the Tri-Care Access Standard

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Rural Networks Medicare Advantage
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Rural Networks Medicare Advantage

• Impact on Rural Pharmacists
• Rural more reliant on community-based pharmacies
• Cash-Paying Customers Key Part of Pay Base
• Key Questions
• Will volume offset cash revenue loss?
• Will chain drug stores have more of a financial
  cushion?

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Rural Networks Medicare Advantage

• CMS Resources
• Medicare Prescription Drug, Improvement and
  Modernization Act of 2003 Information
  www.cms.hhs.gov/medicarereform
• Medicare Prescription Drug, Improvement and
  Modernization Act of 2003 Update
• www.cms.hhs.gov/mmu
• Medicare Learning Network
• www.cms.hhs.gov/medlearn

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• Tom Morris
• Deputy Director
• Office of Rural Health Policy
• 301-443-4269
• tmorris_at_hrsa.gov