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Legislation Reintroduced in Senate To Eliminate Medicare Part D Co-Pays

Sen. Gordon Smith (R-Ore.) and seven co-sponsors introduced the Home and Community Services Copayment Equity Act of 2007 (S. 1107). Similar to a bill that Smith sponsored during the last session of Congress, this legislation would provide dual eligibles—those covered by both Medicare and Medicaid—in assisted living residences and other home- and community-based settings (HCBS) the same co-pay coverage under Medicare Part D as dual eligibles residing in nursing facilities.

The American Health Care Association and the National Center for Assisted Living praised Sen. Smith and the bill’s bi-partisan cosponsors, which include Sens. Jeff Bingaman (D-NM), Barbara Boxer (D-CA), Hillary Clinton (D-NY), Susan Collins (R-ME), Blanche Lincoln (D-AR), John Kerry (D-MA), and Bill Nelson (D-FL), for taking the initiative on this issue.

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According to research, assisted living residents take eight to 10 medications, about the same number as residents of nursing homes. Under current law, dual eligibles living in nursing homes have no cost sharing under Part D, while other dual eligibles must pay co-pays ranging from $1.00-$5.35 in 2007. These co-pays are updated annually for inflation. There is concern that, given this population’s high use of prescription drugs and very low income, many may not be able to afford needed medications. Under current law, pharmacies are under no obligation to provide prescription drugs under Part D if beneficiaries cannot afford required cost sharing.

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NCAL has led efforts to develop support for this legislation and has organized a coalition of more than 35 national organizations representing consumers, geriatric care professionals, health care and long term care providers, pharmacists, and state officials in support of its passage.

As more states opt to use Medicaid to cover assisted living services and long term care services at home, this population of beneficiaries is expected to increase. Analysis prepared for AHCA/NCAL by the Lewin Group estimates that by 2008, the HCB dual eligible population will be larger than the number of dual eligible beneficiaries living in nursing facilities and other institutions.

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