Resource Center for Demonstration Projects of the
Medicare Modernization Act
The Medicare Modernization Act (MMA) requires the Centers for Medicare and Medicaid Services (CMS) to establish various demonstration projects. CMS is now beginning to implement several of these demonstration projects that directly affect beneficiaries.
The Health Assistance Partnership has developed information to equip consumer health assistance programs to handle questions about the demonstration projects from Medicare beneficiaries. We encourage programs to use the information to educate beneficiaries, conduct outreach, and train staff and volunteers. Please email Hilary Dalin (hdalin@healthassistancepartnership.org) with questions and to let us know when and how you are using the material. By doing this, you will help us keep you updated as well as help direct our efforts to develop material that your programs can use.
I. Medicare Replacement Drug Demonstration Project
This demonstration project offers thousands of Medicare beneficiaries an opportunity to save significant money on the cost of certain very expensive medications prescribed for specified medical conditions. As of October 1, 2004, enrollment in this project is on a "rolling basis." Applications will be accepted until enrollment has reached its maximum of 50,000 Medicare beneficiaries. As of February 6, 2005, more than 19,600 beneficiaries were enrolled in the project.
HAP Resources
Other Resources
II. Demonstration Project to Clarify the Definition of Homebound
Beginning on October 4, 2004, up to 15,000 Medicare beneficiaries with a permanent and severe disability who reside in Massachusetts, Missouri, or Colorado will be able to enroll in this two-year demonstration project. This project will expand the current definition of "homebound" to allow Medicare beneficiaries who are receiving Medicare home health benefits to leave their home more frequently and for longer periods of time without risking losing their home health benefits.
Currently, beneficiaries who are receiving Medicare coverage for home health services can leave home only "infrequently or for a short duration," with the exception of attending a religious service and adult day care, without risking the loss of their Medicare-covered home health care. Under this demonstration project, a less restrictive definition of "homebound" will be used, thereby allowing Medicare beneficiaries who are enrolled in this project to live fuller lives.
Enrollment in this project will be open until the 15,000 enrollee limit is reached. For more information, please visit the Centers for Medicare & Medicaid Services.
III. Voluntary Chronic Care Improvement Program (CCIP)
On December 8, 2004, CMS announced the organizations that will participate in the pilot program to improve the quality of care and quality of life for Medicare beneficiaries with multiple chronic illnesses. Please see the CMS website for more information about the program, including eligible beneficiaries and the participating organizations.
IV. CMS Demonstration Allows Medicare Part D Plans to Fill in the Doughnut Hole
Under the Medicare Modernization Act of 2003 (MMA), a five-year demonstration project, called "Part D Reinsurance Payment Demonstration," will allow private Part D plans to offer supplemental drug coverage through an option that would fill in some or all of the gaps in coverage for beneficiaries in the "doughnut hole." Under the standard Medicare prescription drug benefit, after beneficiaries have met the annual deductible ($250 in 2006) on covered drugs, Medicare will pay 75 percent of their prescriptions that are covered by the Part D plan until the beneficiaries have spent another $500 out-of-pocket (in 2006) on their covered drugs. After that, beneficiaries are required to pay 100 percent of their drug costs until they spend another $2,850 out-of-pocket on their covered drugs. This period in which they are responsible for all of their drug costs is called the "doughnut hole."
Private plans that wish to participate in the project, including both stand-alone prescription drug plans (PDPs) and Medicare Advantage plans with a prescription drug plan (MA-PDs), must submit their applications to CMS by March 23, 2005. For more information on the types of Part D plans and cost-sharing, see HAP's documents on the types of Medicare Part D Plans and on standard Medicare Part D cost-sharing. (back to top)
