Nebraska Department of Insurance
THE NEBRASKA HEALTH INSURANCE INFORMATION, COUNSELING, AND ASSISTANCE (NICA) PROGRAM
MARCH 2003 NICA NEWS
ISSUES
Certificate of Medical Necessity for Oxygen
Medicare requires a Certificate of Medical Necessity (CMN) be completed for a Medicare beneficiary to receive coverage for oxygen through their Durable Medical Equipment Regional Carrier (DMERC). Beneficiaries should be aware of this requirement, as the dates of treatment and testing are critical in determining coverage. For example, the initial date of need for home oxygen coverage cannot precede the date of the order or the date of the test(s), the results of which establish that the coverage criteria are met. In addition, the date of oxygen testing, and the physician's completion of the CMN, must be within 30 days prior to the date of initial certification for Medicare coverage. This can affect beneficiaries who were on oxygen before becoming eligible for Medicare. If this is the case, the doctor will need to complete a new CMN within 30 days of Medicare entitlement, in order for the DMERC to pay for the supplies. If you do not obtain the CMN prior to Medicare eligibility, you can still obtain a CMN at any time, if your health conditions meet criteria, however Medicare payment of claims will not be in effect until the date of the CMN. If claims are denied due to not having a CMN on file, you can file an appeal with DMERC requesting payment due to circumstances.QI-1 Extension
The Qualified Individual-1 Program, commonly referred to as the Medicaid QMB or Buy-In program, has been extended until September 30, 2003. QI-1 pays the $58.70 Medicare Part B premium for people with Medicare whose incomes are between 120% and 135% of the federal poverty limit. Benefits for these persons had been scheduled to expire on December 31, 2002, however, a Continuing Resolution has been enacted that extends the QI-1 benefit through September.Incorrect phone number in Medicare Enrollment Information
The Initial Enrollment Package that was mailed from CMS to beneficiaries during the second week of January, 2003, has an incorrect phone number for the Social Security Administration. The phone number appears as 1-800-772-1213.The correct number is 1-800-772-1213. This information went out to beneficiaries who will be entitled to Medicare beginning May 1, 2003.Prescription Drug Card Initiative
On January 29th, 2003, a federal judge stopped CMS from proceeding with the prescription drug card assistance initiative. The ruling indicates that the Federal government by law does not have the legal authority to implement such an initiative. CMS is currently reviewing the court's decisions and available options, and is continuing to pursue appropriate avenues for improving access to affordable prescription drugs. The agency continues to work with the President and Congress to push for a comprehensive prescription drug benefit for the nation's seniors.
Did you know?? According to a study published February 9, 2003,
in the Journal of the American Medical Association, one out of three
senior citizens does not have the health literacy skills necessary to understand
instructions for prescriptions, medical forms and doctors' directions on self-care.
This shows how important NICA volunteers can be!!