Kaiser Foundation:  SHIPs Not Assisting Nursing Home Residents with Part D

LTCPA and other groups which represent long term care providers have repeatedly asked the Centers for Medicare and Medicaid Services (CMS) to lift its prohibition on physicians, nursing homes and pharmacists being allowed to provide counseling, advice and assistance to nursing home residents in choosing and enrolling in a Medicare Part D drug plan that best meets their needs.  

Because the average nursing home resident is over 80 years old, is on over eight medications, and in most cases is cognitively impaired, they generally lack the ability to analyze and select a Part D plan on their own.   As dual-eligibles who have not selected a plan on their own, most nursing home residents have been and continue to be automatically – and randomly – assigned a Part D plan by CMS, regardless of whether the plan covers their prescribed medications.   This has created enormous problems in the nursing home setting.  

Most people recognize nursing home residents require and deserve assistance in selecting and enrolling in a Part D plan that covers their medications.  Some have suggested that Medicare State Health Insurance Assistance Programs (SHIPs) are available to provide this assistance.  However, this week the Kaiser Foundation released a report entitled “Early Experiences of Medicare Beneficiaries in Prescription Drug Plans: Insights from Medicare State Health Insurance Assistance Program (SHIP) Directors.”  The report is based on findings from a focus group of state SHIP directors.  It finds SHIPs are not generally assisting nursing home residents.  Here’s the relevant section from the Kaiser report:

Nursing Home Residents

The Medicare law requires that all PDPs and MA-PDs have the capability of serving the nursing home resident population, and must include long-term care pharmacies in their networks. Nursing home residents with physical and cognitive limitations are especially challenged by the complexity of Medicare Part D.

SHIPs generally do not counsel nursing home residents. Many nursing home residents are physically and cognitively disabled and not able to seek counseling on their own behalf. For the most part the participants noted that their SHIPs did not have much interaction with beneficiaries residing in nursing homes. They noted that nursing home patients have a separate pharmacy system and a network of patient advocates that focus solely on the nursing home population.

Clearly, nursing home residents are not receiving the assistance they need.   LTCPA continues to urge CMS to lift the ban on health care professionals assisting the nursing home residents they serve.