Pro Bono Medicare D Network
Article Date: Tuesday, January 17, 2006
Written By: Russell Rawlings
Pro Bono Medicare D Network
Sponsored by the North Carolina Bar Association Health Law and Elder Law Sections, Legal Aid of North Carolina (LANC) and the N.C. Division of Aging and Adult Services
Program participants, from left, Lynne Berry of the N.C. Division of Aging, Angeleigh Dorsey of LANC-Asheville, Patricia Nemore of the Center for Medicare Advocacy, Elder Law Section Chair Walt Sheffield and Health Law Section Chair Dean McCord. |
Regardless of whether you're dealing w/ Medicare Part D appeals or helping a loved one choose their Medicare Part D plan, the NCBA CLE is offering statewide video replays of Medicare Part D Pro Bono Training Featuring Patricia Nemore, Center for Medicare Advocacy.
Medicare Part D enrollment for this first year ends May 15, 2006, after which the annual enrollment periods are anticipated to run from Nov. 15 to Dec. 31 of the preceding year (ex. Nov. 15-Dec. 31, 2006 for 2007 enrollment year). Choose from 10 locations statewide including a Feb. 28 replay at the N.C. Bar Center in Cary.
For a location near you, visit /{localLink:1779} and sort by title, location and date.
Who can be a Pro Bono Medicare D Network member?
Any attorney who wants to help can be a member. There are 1 million Medicare beneficiaries in NC and many of them may need our help. Some Medicare beneficiaries will have difficulty with enrollment or getting necessary medications covered. Other beneficiaries will require help applying for the Low Income Subsidy they may be entitled to.
What commitment is involved in joining the Pro Bono Medicare D Network?
You must agree to accept only one case (although taking on more cases would be desirable) to help a Medicare beneficiary with a problem related to one of the three subject areas described below. These cases are limited in scope and duration, and local offices of Legal Aid of NC will screen and place beneficiaries with the attorneys in the Pro Bono Medicare D Network. The information and tools needed to represent these individuals will be provided at the CLE training. If you find yourself in need of assistance, ongoing support will be provided by Legal Aid of North Carolina and other members of the Medicare D Pro Bono Network.
To ensure that members of the Network are sufficiently educated to provide assistance to eligible beneficiaries, we have limited the subject area of representation to three particular issues:
1.) Coverage of a Prescribed Medication
Certain patients require specific medications, but prescription programs may put up barriers to some drugs. You would work with the client to file a request for an exception with the client’s drug program, which involves up to 3 levels of internal review and then one level of external review. If the client's objectives have not been obtained at that point (it is likely that many if not most cases will resolve before reaching this level), your responsibility to the client ends and the case may be forwarded to Legal Aid of North Carolina or you may keep the case for evaluation for further appeal to Administrative Law Judge Hearing, Appeals Council and ultimately federal court. Your advocacy will involve working with the client, the prescribing physician and the drug program via written, fax and telephonic communications to ensure that the drug program has the documentation it requires to allow coverage for the medication in question.
2.) Denial by the Social Security Administration on Eligibility for the Low Income Subsidy
Many low income Medicare beneficiaries are eligible for subsidies to assist with payment of co-pays and other costs of the prescription drugs. If an individual feels they have been wrongly denied eligibility for the Medicare D Low Income Subsidy, they may appeal to the Social Security Administration. You will interview the client to determine they meet all income and asset eligibility requirements and complete the Appeal of Determination for Help with Medicare Prescription Drug Plan Costs (form SSA -1021); including any additional information that is needed to determine that the client meets all SSA eligibility requirements. If the denial is not reversed upon SSA receiving corrected or additional information, the client has a right to a hearing via telephone and you would represent the client at the telephone hearing. After the hearing and once a decision is rendered by the SSA, your responsibility to the client ends and you may forward the case to Legal Aid of North Carolina or keep the case for evaluation of further appeal.
3.) Proper Enrollment
A denial for coverage may be related to problems with the client’s enrollment into a particular program. With millions of beneficiaries signing up within a few short weeks of each other, problems are sure to arise. If someone delays enrollment, a late fee is assessed for every month they delay and the premium costs permanently go up. Individuals may need assistance in straightening out their enrollment application or getting penalties waived for late enrollment that was not due to their own error.
For additional information on the Pro Bono Medicare D Network, please contact Michelle Cofield, director of public service and pro bono activities at the North Carolina Bar Association, via e-mail at mcofield@ncbar.org