This training module was developed and approved by the Centers for Medicare & Medicaid Services (CMS), the federal agency that administers Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the Federally-facilitated Health Insurance Marketplace and is brought to you by Relias Learning. The information in this module was correct as of May 2016. To check for an updated version, visit https://www.cms.gov/outreach-and-education/training/cmsnationaltrainingprogram/.The CMS National Training Program provides this as an informational resource for our partners. It’s not a legal document or intended for press purposes. The press can contact the CMS Press Office at [email protected] Official Medicare program legal guidance is contained in the relevant statutes, regulations, and rulings.
Section 1: Introduction A. About This Course B. Learning Objectives Section 2: The Basics A. The 4 Parts of Medicare B. Medicare Prescription Drug Coverage C. Part A Prescription Drug Coverage D. Part B Prescription Drug Coverage E. Part B Immunization Coverage F. Self-Administered Drugs in Hospital Outpatient Settings G. Review H. Summary Section 3: Medicare Part D Benefits and Costs A. Part D Medicare Prescription Drug Coverage B. Medicare Drug Plans C. Medicare Drug Plan Costs D. Standard Structure E. Improved Coverage in the Coverage Gap F. True Out-of-Pocket (TrOOP) Costs G. What Payments Count Toward TrOOP? H. What Payments Don’t Count Toward TrOOP? I. Part D Monthly Premium and Income-Related Monthly Adjustment Amounts (IMRAA) J. Income Related Monthly Adjustment Amount (IRMAA) K. Review L. Summary Section 4: Medicare Part D Drug Coverage A. Part D Covered Drugs B. Required Coverage C. Drugs Excluded by Law Under Part D D. Formulary E. Formulary Changes F. How Plans Manage to Access Drugs G. Requirement for Prescribers H. If Your Prescription Changes I. Medication Therapy Management J. Medicare Therapy Management Conditions K. Review L. Summary Section 5: Part D Eligibility and Enrollment A. Part D Eligibility Requirements B. Credible Drug Coverage C. Initial Enrollment Period D. When You Can Join or Switch Plans E. Special Enrollment Period (SEP) F. 5-Star Special Enrollment Period G. Low Performing Plan H. Part D Late Enrollment Penalty I. Part D Penalty Example: Ann J. Review K. Summary Section 6: Extra Help with Part D Drug Costs A. What is Extra Help? B. Extra Help and Income Resource Limits C. Qualifying for Extra Help D. Automatic and Facilitated Enrollment E. 2016 Extra Help Copayments F. Reassignment Notices G. Changes in Qualifying for Extra Help H. Redetermination Process I. Medicare’s Limited Income Newly Eligible Transition (NET) Program J. How Do You Access Medicare’s Limited Income Newly Eligible Transition (NET) Program? K. Review L. Summary Section 7: Comparing and Choosing Plans A. Things to Consider Before Joining a Plan B. Steps in Choosing a Medicare Drug Plan C. Step One: Prepare D. Step Two: Compare Plans on Medicare Plan Finder E. Step Three: Decide and Join F. What New Members Can Expect G. Annual Notice of Change (ANOC) H. Review I. Summary Section 8: Coverage Determinations and Appeals A. Coverage Determination Request B. Exception Requests C. Requesting Appeals D. Key Points to Remember E. Review F. Summary Section 9: Conclusion A. Summary B. Course Contributor C. Resources D. This Training is Provided By E. Congratulations!
Jessica has almost 15 years of experience in nursing and 10 years in MDS/PAC working with organizations for the purposes of assessment, reimbursement, training, organizational, and leadership development. In these roles, she has acted as a consultant and auditor. Jessica has written content for diverse healthcare topics, including health and human services, compliance and more. Disclosure: Jessica Cairns, RN, RAC-CT, CMAC has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
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