Medicare and Medicaid Issues

Documents Tools Organizations 340B Information

Documents

The CMS Online Manual System
The CMS Online Manual System is a Web site that provides informational manuals on a variety of Medicare topics including, but not limited to, Medicare's Eligibility and Entitlement, Benefits Policy, Claims Processing, Quality Improvement, ESRD Network Organizations, and Managed Care.

The Guide to Medicare Preventive Services for Physicians, Providers, Suppliers, and Other Health Care Professionals
This professional resource has been developed by CMS to meet the need of the provider community for updated information on Medicare preventive services and screenings. This guide contains a variety of information to help providers understand Medicare's coverage and requirements regarding preventive services. It also provides information about filing claims and educating beneficiaries about Medicare benefits for which they may be eligible. This information may be useful for physicians, non-physician practitioners, and front office and billing staff.

Medicaid Treatment of CAHs by State
This excel spreadsheet contains information about Medicaid treatment for critical access hospitals on a state by state basis.

One Year In: Sole Community Rural Independent Pharmacies and Medicare Part D
Author(s): Andrea Radford, Michelle Mason, Indira Richardson, Stephan Rutledge, Stephanie Poley, Keith Meuller, Rebecca Slifkin
This brief describes the experiences of a random sample of 51 rural independently-owned pharmacies one year after program implementation to determine whether initial financial and administrative problems were resolved over time, focusing on pharmacies that are the sole providers in their community.

State Profiles of Medicaid and SCHIP in Rural and Urban Areas - A New Final Report from the NCRHR&PAC
To address this information gap for state officials and others interested in how Medicaid and SCHIP are operating in different geographic areas of a state, we collected data from a number of sources with an emphasis on program characteristics relevant to rural areas. This final report is one component of a larger project that includes the development of web-based State Profiles of Medicaid and SCHIP in Rural and Urban Areas.

Medicare Guide to Rural Health Services Information for Providers, Suppliers and Physicians
The "Medicare Guide to Rural Health Services Information Providers, Suppliers and Physicians," which was developed by the Division of Provider Information Planning & Development at the Centers for Medicare & Medicaid Services (CMS) is now available online and in print and CD-Rom formats. This publication offers rural health information and resources in a single source and can be ordered free of charge from the Medicare Learning Network's web page on the CMS website.

Organizations

Medicare Learning Network
CMS Education Information for Fee-For-Service Providers - Highlights include Medicare Modernization Act, Information for Health Care and Pharmacy Professionals on Medicare-Approved Prescription Drug Discount Cards and Transitional Assistance Program, and Medicare Modernization Update.

Medpac - Advising the Congress on Medicare Issues
The Medicare Payment Advisory Commission (MedPAC) is an independant federal body established by the balanced budget act of 1997 (P.L. 105-33) to advise the U.S. Congress on issues affecting the Medicare Program.

Centers for Medicare & Medicaid Services (CMS)
CMS administers the Medicare program, and works in partnership with the States to administer Medicaid, the State Children's Health Insurance Program (SCHIP), and health insurance portability standards. CMS is responsible for the administrative simplification standard from the Health Insurance Portability and Accountability Act of 1996 (HIPPA) and quality standard in health care facilities through its survey and certification activity.

340B Information

HRSA's Introduction to 340B Drug Pricing Program
The 340B Drug Pricing Program resulted from enactment of Public Law 102-585, the Veterans Health Care Act of 1992, which is codified as Section 340B of the Public Health Service Act. Section 340B limits the cost of covered outpatient drugs to certain federal grantees, federally-qualified health center look-alikes and qualified disproportionate share hospitals. Significant savings on pharmaceuticals may be seen by those entities that participate in this program.

340B Drug Pricing Program Questions
The HRSA Pharmacy Services Support Center (PSSC) is a resource that was established in 2002 to assist HRSA grantees and eligible health care sites optimize the value of the 340B Program and provide clinically and cost effective pharmacy services that improve medication use and advance patient care. The PSSC operates under a contract between the American Pharmacists Association (APhA) and the Office of Pharmacy Affairs (OPA), in the HRSA Healthcare Systems Bureau.

340B Drug Pricing Program: Results of a Survey of Eligible but Non-participating Rural Hospitals
Results of a 2006 survey of pharmacy directors at rural hosptials eligible to participate in the 340B drug program but identified as not participating at the time of the survey.

CMS 340B and Safety Net Pharmacy Information
Medicare beneficiaries with limited incomes and resources can receive extra help with their prescription drug costs. Those who qualify for the extra help will have reduced cost-sharing. For example, people with Medicare and Medicaid will have no premium or deductible and nominal co-pays of no more than $1 or $3 per prescription. An individual with an income less than $12,600 per year and limited assets will also have no premium or deductible and will pay $2 or $5 per prescription. For more information, please visit the web site.

Establish 340B Pharmacy Services in a Rural Community Health Center
The journey of implementing pharmacy services in a rural community health center.