Performance Improvement 2009. How Can We Best Move Poor Health Care Beneficiaries into the Prescription Drug Payment Program?


This study examined whether the administrative state-to-plan (S2P) process was more efficient than the point-of-sale facilitated enrollment process in moving low-income subsidy beneficiaries to Part D.

The study compared the administrative efficiency of the S2P demonstration to the contractor-based point-of-sale facilitated enrollment (POS FE) process, explored the characteristics of beneficiaries utilizing the two programs, and examined the feasibility of alternative models for transitioning new dual eligible beneficiaries into Part D. Study results were based on key informant interviews and secondary data analysis.

The study documented gains in administrative efficiency within the ongoing POS FE process due, in part, to edits put in place that led to significant reductions in inappropriate claims submissions and served as a valuable safety net for the enrollment of low income subsidy beneficiaries into a Part D plan. The S2P demonstration laid the groundwork for future endeavors moving these beneficiaries into drug coverage, but there remain pitfalls to avoid and options to pursue.

Report Title: Easing the Part D Transition: An Evaluation of Federal and State Efforts to Ensure Dual Eligibles and Other Low-Income Beneficiaries Maintain Prescription Drug Coverage;

Agency Sponsor: CMS-ORDI, Office of Research, Development, and Information
Federal Contact: Iris Wei, 410-786-6539
Performer: Acumen
PIC ID: 9010

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"PerformanceImprovement2009.pdf" (pdf, 1.26Mb)

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