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Top Official: State Will Get Medicare Costs Back; The Health and Human Services Chief Pledges to Require Insurers to Pay for Drug-Benefit Coverage.

Posted on: Sunday, 22 January 2006, 18:00 CST

By BART JANSEN Washington D.C. Correspondent

The federal secretary of Health and Human Services promised Maine's senators Friday that insurers would reimburse the state for costs related to the Medicare prescription drug program. Maine's payments are at $5 million and rising.

Secretary Mike Leavitt pledged to force insurers to reimburse states that cover exorbitant copayments or pay for prescriptions that should be covered. But that's a different strategy than simply forcing the federal government to cover the costs, as some lawmakers have proposed.

Sens. Susan Collins and Olympia Snowe, both R-Maine, each praised Leavitt's commitment.

"I am pleased that Secretary Leavitt recognizes the unfairness of this situation," Collins said. "This isn't a matter of going to the insurers and pleading with them to pay - he will order them to pay."

Gov. John Baldacci said he stood with the congressional delegation in trying to get the state's money back.

"It will be equally exciting when it becomes a reality and Maine is paid all the money it is owed," Baldacci said.

But concerns linger about how Medicare will assure reimbursement to states, when the agency can't even keep track of its own participants.

Another uncertainty is whether the state will recoup its costs in cases where it simply overpaid for a prescription, rather than paying for a recipient expected to be eligible for the drug benefit.

Snowe introduced legislation Friday to force the federal government to pay for mistakes from computer errors and other problems enrolling the elderly in the drug program that began Jan. 1. She vowed to pursue her legislation if insurers resist paying as Leavitt described.

Rep. Tom Allen, D-Maine, plans to introduce legislation like Snowe's as early as Monday to force federal reimbursement rather than have the state fight billing disputes with 18 companies that offer 41 prescription plans.

Allen would also allow pharmacists to bill the Center for Medicare Services directly after providing drugs for people eligible for Medicaid and Medicare but whose records are confusing.

"I would have to say I'm skeptical about whether or not they'll really reimburse the states," Allen said. "They will try to pass the responsibility off on the plans and then the plans will make individual arguments about why they shouldn't have to pay one charge or another. It'll get lost in a morass of details."

Roseanne Pawelec, a federal Medicare spokeswoman, released a statement saying the agency "is committed to resolving each and every issue."

Despite skepticism, Collins maintained confidence that the insurers would pay in a timely manner.

"I do think it will happen relatively quickly," Collins said. Leavitt "recognizes that the state should not have to use their own resources and step in to bail out the federal mistakes that were made."

Jude Walsh, the governor's director of pharmacy affairs, who handles the Medicare program, described problems facing the state to a U.S. House briefing that Democrats on the Government Reform Committee held Friday in Washington.

At one point on New Year's Day, a pharmacist had 13 phone lines on hold because insurers were slow or didn't answer their phones, Walsh said.

Among the 18,000 frantic calls on Jan. 3 were ones from a woman threatening to burn down her home for lack of mental-health medication and a man who said he was charged $100 for what are typically $1 to $3 copayments.

"It was chaos," Walsh said. "The federal drug benefit was not ready Jan. 1 and is still not ready today."

Bart Jansen can be contacted at 202-488-1119 or at:

bjansen@pressherald.com

Source: Portland Press Herald

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