Long Term Care Cards: Nursing Home Facility Benefits
CMS Approval Date: mm/yyyy Date of last update: 08/2004
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THE LTC CARD:
NURSING FACILITIES' FREQUENTLY ASKED QUESTIONS
The Long Term Care Pharmacy Alliance (LTCPA) is offering the Medicare-approved LTC Card as a part of a new government program to improve access to the many medications required by low-income nursing facility residents. Congress recently passed the Medicare Prescription Drug Improvement and Modernization Act (MMA) of 2003, and the full benefit doesn't start until 2006. The LTC Card supplements the specialized services currently provided by LTCPA member pharmacies to 60 percent of all residents of skilled nursing facilities nationwide. Following are answers to common questions that nursing facilities may ask about the LTC Card.
What is the LTC Card?
- The LTC Card is a temporary (transitional) assistance card sponsored by the LTCPA in association with ACS State Healthcare that provides low-income nursing facility residents with access to a $600 prescription drug benefit provided by the government.
Do I have to pay a fee to receive the card?
- The card's annual enrollment fee of $30 will be paid by the federal government through the Centers for Medicare and Medicaid Services (CMS).
How does the LTC Card benefit nursing facilities?
- Nursing facilities can offer low-income residents quality, dependable pharmacy services from LTCPA companies, including round-the-clock availability and regular resident safety and drug regimen reviews.
- By enrolling residents in the LTC Card, nursing facility administrators can enjoy a streamlined process to provide these benefits by working with pharmacies that they know and trust. These pharmacies include Omnicare, PharMerica, NeighborCare and Kindred Pharmacy Services. Other pharmacy providers can easily become out-of-network providers through the LTCPA so that nursing facilities can offer the LTC Card.
What are the advantages of the LTC Card for nursing facility administrators and billing departments?
- The LTC Card is simple to incorporate into existing administrative practices.
- The pharmacy does all the billing, coordinates non-covered drugs and co-pays, and informs the facility when the $600 is depleted. The payer status notification process between the pharmacy and nursing center remains the same.
- In the typical nursing facility, the LTC Card is available to a small, yet substantial portion of the facility's low-income residents, providing a much-needed benefit to residents and only minimally affecting the workload of nursing facility employees.
How can nursing facilities determine a resident's eligibility for the LTC Card?
- Eligibility is based solely on a resident's annual income, which must be less than 135 percent of the federal poverty level (no more than $12,569 if single or no more than $16,862 if married).
- Residents are NOT eligible if they:
" Are enrolled in TRICARE
" Are enrolled in a Federal Employees Health Benefits Program
" Are a member of an exclusive Medicare+Choice or Medicare cost plan-sponsored card
" Have outpatient prescription drug coverage under Medicaid (sometimes called Medical Assistance)
" Have other health coverage that includes outpatient prescription drugs
- A resident can still be eligible for the LTC Card if he/she has drug coverage through a Medicare Managed Care plan or Medigap plan.
How can nursing facilities enroll their residents in the LTC Card?
- The process is streamlined for the nursing facility resident or provider, with a one-page enrollment form that has been designed to be user-friendly. A toll-free support line (1-866-490-1863) and Web site are available for any questions about the enrollment process ( ltcpa.org/ltccard ).
- The enrollment form can be immediately downloaded from the Web site, along with other training and outreach materials at ltcpa.org/ltccard . Hard copies of the enrollment forms will be available to facilities in late May.
How should admissions staff answer residents' questions regarding their freedom of choice when selecting Medicare-approved cards?
- According to CMS, the resident has already exercised freedom of choice in selecting the nursing facility.
- Federal regulations state that long-term care facilities have the right to choose the pharmacy or pharmacies they use for their residents, and facilities can select the pharmacies that meet all their requirements for ensuring residents' safety.
Why use an LTC pharmacy to meet your nursing facilities' needs?
- 24-hour, 7-day-a-week, 365-day-a-year emergency service is provided to meet residents' round-the-clock needs.
- Medicines are delivered directly to nursing facilities.
- Special packaging is provided to aid nursing staff in safely administering medications and tracking controlled substance medicines, such as morphine.
- A small emergency supply of medicines for last-minute immediate needs is maintained, checked and periodically replaced.
- Extensive pharmacy services are provided, such as frequent safety reviews (to determine if a medication should change) because residents' conditions change often.
- All residents of a nursing facility are served, including low-income residents, regardless of their ability to pay.
While waiting for enrollment materials, what can nursing facility employees do to prepare for the launch of the card?
- Nursing facilities interested in offering the LTC Card may begin evaluating which residents could be eligible for the LTC Card, based on their residents' annual incomes (no asset test).
- Consult the LTC Card Web site ( ltcpa.org/ltccard ) for the latest and most up-to-date information and materials.
- Consult your local pharmacy provider with any questions about the LTC Card. If the pharmacy provider cannot answer your questions, call 1-866-490-1863.