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2010 Patient Assistance

On September 16, 2010, the U.S. Census Bureau published, Income, Poverty, and Health Insurance Coverage in the United States: 2009, reporting an increase in the number of people without health insurance to 50.7 million in 2009 from 46.3 million in 2008. In addition, the number of people covered by Medicaid is the highest since 1987 with 47.8 million people in 2009 up from 42.6 million in 2008.

Of those Americans who do have health insurance, more than 25 million are considered “underinsured” meaning they cannot afford to cover the difference between what their insurance covers and their actual medical bills. Moreover, healthcare experts warn of a coming surge in the numbers of underinsured as employers react to rapidly rising health care costs by increasing their employees share of premiums and moving to policies with higher deductibles and co-payments.

What does this mean for your clinic? More patients will be in need of assistance. This issue provides an updated listing of patient assistance services and resources that may be available to your patients.

Federal Poverty GuidelinesThe poverty guidelines are issued by the Department of Health and Human Services (HHS) each year and are generally published in the Federal Register in late January. In 2010, Congress froze the poverty guidelines to the 2009 level to avoid a reduction in eligibility that would have occurred due to an annual average decrease in the Consumer Price Index for All Urban Consumers (CPI-U).

The HHS poverty guidelines, or percentage multiples of them, are used as an eligibility criterion by a number of federal and state programs.
The 2010 poverty guidelines listed below are effective until the new 2011 poverty guidelines are published in the Federal Register. The poverty guidelines can be found on the HHS website at: http://aspe.hhs.gov/poverty/.

The 2011 Poverty Guidelines for the
48 Contiguous States and the District of Columbia

Persons in family

Poverty guideline

1

$10,890

2

14,710

3

18,530

4

22,350

5

26,170

6

29,990

7

33,810

8

37,630

For families with more than 8 persons, add $3,820 for each additional person.

2011 Poverty Guidelines for Alaska

Persons in family

Poverty guideline

1

$13,600

2

18,380

3

23,160

4

27,940

5

32,720

6

37,500

7

42,280

8

47,060

For families with more than 8 persons, add $4,780 for each additional person.

2011 Poverty Guidelines for Hawaii

Persons in family

Poverty guideline

1

$12,540

2

16,930

3

21,320

4

25,710

5

30,100

6

34,490

7

38,880

8

43,270

For families with more than 8 persons, add $4,390 for each additional person.

SOURCE: Federal Register, Vol. 76, No. 13, January 20, 2011

Helpful Resources
Access To Benefits Coalition
Website www.accesstobenefits.org
Phone 202-479-6670
Fax 202-479-0735
Email info@accesstobenefits.org
The Access to Benefits Coalition is a national program dedicated to helping Medicare beneficiaries with limited means identify and apply for all available resources for accessing prescription drugs and reducing their costs.
The Air Care Alliance
Website www.aircareall.org
Phone 888-260-97
Fax 915-572-9192
Email mail@aircareall.org
The Air Care Alliance website provides a comprehensive list of free air transportation services for qualified patients and their families to specialized medical treatment facilities.
Air Charity Network
Website http://aircharitynetwork.org/
Phone 877-621-7177
Air Charity Network is comprised of 7 independent member organizations identified by specific geographical service areas. Airlift Hope NC-TN, Angel Flight Central, Angel Flight Mid-Atlantic, Angel Flight Northeast, Angel Flight™ Southeast, Angel Flight West and Mercy Flight™ Southeast coordinate volunteer pilot missions in the continental United States as well as Alaska and Hawaii.
American Cancer Society
Website www.cancer.org
Phone 866-228-4327
The American Cancer Society operates offices throughout the nation. The ACS can help patients locate various types of support and financial assistance.
Andre Sobel River of Life Foundation
Website www.andreriveroflife.org/
Phone 310-276-7111
Email Info@AndreRiverOfLife.org
The Andre Sobel River of Life Foundation is a tax-exempt non-profit organization that provides financial assistance to single parents so that they can remain by their child's side throughout a life-threatening illness. The Andre Sobel River of Life Foundation also has two funds to provide emergency assistance, The Everyday Needs Assistance Fund, funded by the Genentech Foundation, meets urgent financial needs of single parent families whose children are undergoing treatment for cancer and the Compassion Can't Wait Fund assists single parent families of children with any catastrophic diagnosis who have exhausted all other resources.
Association of Community Cancer Centers
Website www.accc-cancer.org
ACCC maintains a comprehensive list of reimbursement assistance programs for oncology-related drugs and services. The companies listed have programs for physicians and in some cases patients.
BENEFITS.gov
Website www.benefits.gov
Phone 1-800-333-4636
Email email directly from website
BENEFITS.gov is a partnership of 17 Federal agencies providing improved, personalized access to government assistance programs. The online screening tool is free, easy-to-use, and confidential. The user answers a series of questions, then the website generates a list of government benefit programs that the user may be eligible to receive, along with information about how the user can apply.
Cancer Financial Assistance Coalition (CFAC)
Website www.cancerfac.org
The CFAC is a coalition of 14 member organizations helping cancer patients manage their financial challenges. The CFAC website includes an online database through which cancer patients and their caregivers can find assistance by type of assistance, diagnosis and zip code.
Cancer Legal Resources Center
Website www.lls.edu/academics/candp/clrc.html
Phone 866-843-2572
Email clrc@lls.edu
The Cancer Legal Resource Center provides free and confidential information and resources on cancer-related legal issues to people with cancer, their families, friends, employers, health care professionals, and others coping with cancer. Callers can receive information about relevant laws and resources for their particular situation.
CancerCare
Website www.cancercare.org
Phone 800-813-4673
Fax 212-712-8495
Email info@cancercare.org
CancerCare is a national non-profit organization. They provide free professional support services for people affected by cancer. They also provide financial assistance for certain expenses related to cancer treatment.
CancerCare Copayment Assistance Foundation
Website www.cancercarecopay.org
Phone 866-552-6729
Email information@cancercarecopay.org
CancerCare Copayment Assistance Foundation is a national non-profit organization affiliated with CancerCare. The foundation provides co-payment assistance for certain oral and IV cancer drugs. The foundation website maintains a list of covered diseases and medications.
Catholic Charities USA
Website www.catholiccharitiesusa.org
Phone 703-549-1390
Catholic Charities offers financial assistance for practical needs including rent, utilities, food or transportation.
Center for Medicare Advocacy, Inc.
Website www.medicareadvocacy.org
Phone 860-456-7790
The Center for Medicare Advocacy is a national non-profit advocacy group that provides education, advocacy, and legal assistance to help elders and people with disabilities obtain Medicare and necessary health care. The Center focuses on Medicare patients with chronic conditions, and those in need of long-term care.
Centers for Disease Control & Prevention
Website www.cdc.gov/cancer/nbccedp/guidance.htm
Phone 800-232-4636
Fax 770-488-4760
Email cdcinfo@cdc.gov
The CDC provides low-income, uninsured, and underserved women access to screening and diagnostic services, to detect breast and cervical cancer, through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). The Breast and Cervical Cancer Prevention and Treatment Act of 2000 gives states the option to provide medical assistance through Medicaid to eligible women who were screened through the CDCs National Breast and Cervical Cancer Early Detection Program (NBCCEDP).
Chronic Disease Fund
Website www.cdfund.org
Phone 877-968-7233
Email info@cdfund.org
The Chronic Disease Fund provides assistance to underinsured patients with chronic or life altering diseases, including many types of cancer, that require the use of expensive, specialty therapeutics. Provides co-pay assistance, administers PAP programs on behalf of the manufacturer.
Colorectal CareLine
Website www.colorectalcareline.org
Phone 866-657-8634
Fax 757-952-2031
Email CCL@patientadvocate.org
The Colorectal CareLine Financial Aid Fund provides financial assistance through a small grant program for colorectal patients in need of debt crisis assistance. Financial assistance is available to colorectal cancer patients with specific treatment related expenses and a family income less than $75,000.00 annually. As part of the Patient Advocate Foundation (PAF) the organization also supplies various patient resources and direct appeal assistance.
Co-Pay Relief
Website www.copays.org
Phone 866-512-3861
Fax (757) 952-0119
Email pap@patientadvocate.org
Part of PAF, The Co-Pay Relief (CPR) program provides co-pay assistance to insured patients who qualify financially & medically to access pharmaceutical co-payment assistance. CPR can provide co-pay assistance for patients with certain diagnoses. Physicians and patients can initiate a request for assistance.
Corporate Angel Network
Website www.corpangelnetwork.org
Phone 914-328-1313
Fax 914-328-3938
Email info@corpangelnetwork.org
Corporate Angel Network provides free flights transporting qualified cancer patients and their families to treatment facilities. Eligibility is open to all cancer patients, bone marrow donors, and bone marrow recipients who are not in need of medical support while traveling.
Healthwell Foundation
Website www.healthwellfoundation.org
Phone 800-675-8416
Fax 800-282-7692
Email info@healthwellfoundation.org
Healthwell Foundation is a non-profit, charitable organization that helps individuals afford prescription medications they are taking for specific illnesses. The Foundation provides financial assistance to eligible patients to cover certain out-of-pocket health care costs, including prescription drug co-insurance, co-payments & deductibles, and health insurance premiums. Lists of disease states & medications covered are available on their website. An on-line application is also available.
Hope Lodge
Website http://www5.cancer.org/docroot/subsite/
hopelodge/index.asp
Phone 1-800-227-2345
Hope Lodge and the American Cancer Society offers cancer patients and their families a free, temporary place to stay when their best hope for effective treatment may be in another city. Currently, there are 30 Hope Lodge locations throughout the United States. Accommodations and eligibility requirements may vary by location. Find local lodging resources at www.cancer.org's Find Local Resources page by selecting the category Housing.
HRSA Bureau of Primary Health Care
Website http://findahealthcenter.hrsa.gov/
The Health Resources and Services Administration (HRSA) helps patients find federally-funded health centers to care for them, even if they have no health insurance. Patients pay what they can afford, based on income. An on-line health services locator is available on the HRSA website to identify local health centers.
IRS
Website www.irs.gov/
Phone 1-800-829-1040
The Internal Revenue Service (IRS) can provide information about tax deductions for medical costs that are not covered by insurance policies. For example, tax deductible expenses might include mileage for trips to and from medical appointments, out-of-pocket costs for treatment, prescription drugs or equipment, and the cost of meals during lengthy medical visits.
Joe's House
Website www.joeshouse.org
Phone 877-563-7468
Email info@joeshouse.org
Joe's House website lists accommodations that cater to cancer patients, their families, and caregivers and provides a centralized list of appropriate housing.
LawHelp
Website www.lawhelp.org
Email info@lawhelp.org
Pro Bono Net is a national non-profit organization that works with non-profit legal organizations across the country to help people with low and moderate incomes find low-cost and free legal aid. The LawHelp website also includes interactive links to state-by-state legal aid referrals and information.
The Leukemia & Lymphoma Society
Website www.leukemia-lymphoma.org
Phone 800-955-4572
The Leukemia & Lymphoma Society provides supplementary financial assistance to patients in significant financial need. The Patient Financial Aid program covers specific drugs related to the treatment/control of leukemia, Hodgkin and non-Hodgkin lymphoma and myeloma.
The Leukemia & Lymphoma Society Copay Assistance Program
Website www.lls.org/copay
Phone 877-557-2672
The Leukemia & Lymphoma Society Copay Assistance Program provides financial assistance (for certain diagnoses) for cancer treatment related co-pays, private health insurance premiums and co-pay obligations, Medicare Part B, Medicare Plan D, Medicare Supplementary Health Insurance and Medicare Advantage premium or co-pay obligations.
The Lymphoma Research Foundation
Website www.lymphoma.org
Phone 1-800-500-9976
Fax 212-349-2886
Email Helpline@lymphoma.org
The Lymphoma Research Fund (LRF) offers two financial assistance programs for people currently undergoing treatment for lymphoma. Through these programs, LRF may be able to pay a portion of a patient's medical bills or assist with quality of life expenses.
Myriad Financial Assistance Program
Website www.myriadtests.com
Phone 800-469-7423
Fax 801-584-3615
Myriad offers testing at no charge to uninsured patients that meet specific financial and medical criteria. Patients who are recipients of government funded programs (i.e. Medicaid, Medicare) or those that have any third-party insurance are not eligible to apply for MFAP. Qualification requirements and application forms are available on the MFAP website.
National Association of Hospital Hospitality Houses
Website www.nahhh.org/
Phone 800-542-9730
Email helpinghomes@nahhh.org
The National Association of Hospital Hospitality Houses (NAHHH), Inc. is an association of over 150 non-profit organizations located throughout the U.S. that provide family-centered lodging and support services to patients and their families who are receiving medical treatment far from home. The NAHHH website features an on-line lodging locator.
National Association of State Comprehensive Health Insurance Plans
Website http://naschip.org
The National Association of State Comprehensive Health Insurance Plans (NASCHIP) website provides a database of states offering Risk Pool Coverage. These state programs provide health insurance options for high risk individuals and those with pre-existing health conditions.
National Conference of State Legislators
Website www.ncsl.org/programs/health/drugaid.htm#IL
Phone 202-624-5400
Email ncslnet-admin@ncsl.org
The National Conference of State Legislators (NCSL) maintains a database of State Pharmaceutical Assistance programs providing details on each of the individual state programs, including citations and web links to state laws where available, year of creation, basic eligibility requirements and contact telephone numbers within each state for further details.
National Foundation for Transplants
Website www.transplants.org/
Phone 800-489-3863
Fax 901-684-1128
Email info@transplants.org
The National Foundation for Transplants (NFT) provides fundraising assistance to bone marrow and solid organ transplant patients in all 50 states and U.S. territories. Through their fundraising program the NFT endeavors to help patients with their transplant, pre-transplant treatment, follow-up care and medications.
National Organization for Rare Disorders
Website www.rarediseases.org
Phone 203-744-0100
Fax 203-798-2291
Email RN@rarediseases.org
The National Organization for Rare Disorders is a non-profit organization, comprised of a federation of voluntary health organizations dedicated to helping people with rare "orphan" diseases and assisting the organizations that serve them. NORD provides co-pay assistance for a limited number of conditions including Advanced Renal Cell Carcinoma, Peripheral T-cell Lymphoma and Hodgkin's Lymphoma and medication assistance for Hodgkin's disease (stage III & IV) and certain other lymphomas, and early or expanded access to investigational drugs.
National Patient Advocate Foundation
Website www.patientadvocate.org
Phone (800) 532-5274
Fax (757) 873-8999
Email help@patientadvocate.org
Patient Advocate Foundation (PAF) provides patients with arbitration, mediation and negotiation to settle issues with access to care, medical debt, and job retention related to their chronic/debilitating or life-threatening illness. Their website contains links to many helpful resources for patients and caregivers including a National Financial Resources Guidebook providing an interactive state-by-state database of available financial assistance and resources.
National Patient Travel Helpline
Website www.patienttravel.org/
Phone 1-800-296-1217
Fax 1-800-550-1767
Email info@nationalpatienttravelcenter.org
The NPTC provides a single-point of contact to facilitate patient access to appropriate charitable or discounted airline tickets for patients and patient escorts. The NPTC serves in association with numerous national and state level charitable medical air transportation programs providing maximum efficiency and minimum costs.
NeedyMeds
Website www.needymeds.com
Email info@needymeds.com
NeedyMeds.Com does not supply medications or financial assistance. They provide a comprehensive listing of drugs and dosages that are available through patient assistance programs. They provide detailed information about the patient assistance program including, the program name, contact information, application forms, eligibility guidelines and the application process and requirements.
Partnership for Prescription Assistance
Website www.pparx.org
Phone 888-477-2669
Fax 419-858-7221
Email info@needymeds.com
The Partnership for Prescription Assistance offers a single point of access to more than 475 public and private patient assistance programs, including nearly 200 programs offered by pharmaceutical companies.
Patient Access Network Foundation
Website www.panfoundation.org
Phone 866-316-7263
Email contact@patientaccessnetwork.org
The Patient Access Network Foundation is an independent, national organization dedicated to assisting underinsured patients with copayment assistance. Applicants must meet certain financial, medical and insurance criteria. A list of covered disease states is available on their website.
Patient Services Incorporated
Website www.patientservicesinc.org
Phone 800-366-7741
Email uneedpsi@uneedpsi.org
Patient Services Inc., provides premium and co-pay assistance programs for qualified patients with certain diseases.
PatientAssistance.com
Phone 888-788-7921
Fax 225-273-2652
Email email directly from website
PatientAssistance is a non-profit organization providing a patient assistance program database and online enrollment forms (when available through the manufacturer).
Road to Recovery
Website http://www.cancer.org/Treatment/
SupportProgramsServices/Programs/road-to-recovery
Phone 1-800-227-2345
Email email directly from website
Road to Recovery is an American Cancer Society service program that provides transportation for cancer patients to their treatments and home again. Transportation is provided according to the needs and available resources in the community.
Rx Outreach
Website www.rxoutreach.org
Phone 800-769-3880
Email questions@rxoutreach.org
Rx Outreach is an independent, non-profit charitable organization that offers prescription medicines to uninsured individuals and families, as well as those who have limited prescription drug coverage. Individuals can use Rx Outreach regardless of their age or if they use another discount medicine program or patient assistance program. Financial qualifications and applications are available on the website.
RxAssist
Website www.rxassist.org
Phone 401-729-3284
Fax 401-729-2955
Email info@rxassist.org
RxAssist is a national non-profit resource center containing a comprehensive database of patient assistance programs.
RXHope
Website www.RxHope.com
Phone 877-267-0517
Email CustomerService@RXHope.com
RxHope contracts directly with the Pharmaceutical companies to provide an electronic application process for their patient assistance programs. RxHope provides this service to physicians and patients free of charge. Physicians or their staff members can go online to complete the application. Some applications can be transmitted electronically through the site and others must be printed and mailed or faxed.
State Health Insurance Assistance Programs
Website www.shiptalk.org
The State Health Insurance Assistance Program (SHIP) is a national program that offers one-on-one counseling and assistance to people with Medicare and their families. Patients can be referred to their state’s SHIP by contacting 1-800-Medicare and asking for health insurance counseling. Patients & others can get state specific information through the SHIP website.
Supplemental Security Income
Website www.socialsecurity.gov
Phone 1-800-772-1213
Email email directly from website
Supplemental Security Income (SSI) is administered by the SSA and supplements Social Security payments for aged, blind, and disabled people with little or no income. It provides cash to meet basic needs for food, clothing, and shelter. Information on eligibility, coverage, and how to file a claim is available from the SSA. The Benefit Eligibility Screening Tool is available on the website. Individuals who are disabled for 6 months or longer may qualify for benefits. Certain cancer diagnoses qualify.
Taking Charge of Money Matters
Website www.cancer.org/Treatment/
FindingandPayingforTreatment
Phone 1-800-227-2345.
Email email directly from website
The American Cancer Society provides interactive tools dealing with financial and insurance issues that may come up during or after a person's cancer treatment.
Together RX Access Card
Website www.togetherrxaccess.com
Phone 1-800-444-4106
The Together Rx Access™ Card was created as a public service by a group of some of the world's largest pharmaceutical companies, in order to provide savings on prescriptions to eligible residents of the US and Puerto Rico who have no prescription drug coverage.
The United Way
Website www.unitedway.org
Phone 703-836-7112
Fax 703-519-0097
Email worldwide@unitedway.org
The United Way is an international organization that can help patients locate various types of assistance.
UnitedHealthcare Children's Foundation
Website www.uhccf.org
Phone 952-992-4459
The UnitedHealthcare Children's Foundation is a nonprofit charity providing financial assistance in the form of medical grants to be used for medical services for children (16 years and younger) with cancer who are not covered or not completely covered by commercial health benefit plans.

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Published by Rise Marie Cleland. Sponsored by Lilly Oncology

 

HEALTH CARE REFORM
The Patient Protection and Affordable Care Act (PPACA) was signed into law on March 23, 2010 and the Health Care and Education Reconciliation Act (HCERA), which amends the PPACA on March 30, 2010. Together, the PPACA and HCERA form the massive health care reform legislation that is now known as The Affordable Care Act (ACA).

ACA Consumer Protections Effective in 2010:

  • Prohibits denying coverage of children based on pre-existing conditions effective for health plan years beginning on or after September 23, 2010 for new plans and existing group plans. 
  • Prohibits insurance companies from rescinding coverage based on an error, or other technical mistake, on a customer’s application. Effective for health plan years beginning on or after September 23, 2010. 
  • Eliminates lifetime limits on insurance coverage. Insurance companies will be prohibited from imposing lifetime dollar limits on essential benefits, like hospital stays.  Effective for health plan years beginning on or after September 23, 2010.
  • Regulates annual limits on insurance coverage. Insurance companies’ use of annual dollar limits on the amount of insurance coverage a patient may receive will be restricted for new plans in the individual market and all group plans. Effective for health plan years beginning on or after September 23, 2010.
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ACA Consumer Protections Effective January 1, 2014:

  • Creation of state-based and state-administered health insurance exchanges for the individual and small group market.
  • Insurers can no longer deny coverage to people with pre-existing conditions.
  • Insurers are prohibited from imposing annual or lifetime monetary coverage limitations.
  • Insurers, with the exception of grandfathered plans, are prohibited from denying routine care or dropping coverage if an enrollee participates in certain clinical trials.
  • All qualified plans, with the exception of grandfathered plans, must provide essential health benefits package.
  • Group health plans and health insurance issuers offering individual or group coverage can no longer utilize a waiting period that is longer than ninety days.

The ACA creates the Pre-Existing Condition Insurance Plan (PCIP) to make health coverage available to individuals who have been denied health insurance by private insurance companies because of a pre-existing condition.  The Department of Health and Human Services HealthCare.gov website contains an interactive PCIP Map that describes the available PCIP program in each state.

To be eligible for the Pre-Existing Condition Insurance Plan:

  • You must be a citizen or national of the United States or residing in the U.S. legally.
  • You must have been uninsured for at least the last six months. Please note that if you currently have insurance coverage that does not cover your medical condition or are enrolled in a state high-risk pool, you are not eligible for the Pre-Existing Condition Insurance Plan.
  • You must have a pre-existing condition or have been denied coverage because of your health condition.

More information about eligibility and benefits of the PCIP are available at www.pcip.gov.

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FEDERAL LAWS PROTECTING MEDICAL INSURANCE COVERAGE
The American Cancer Society provides information on federal laws that may protect medical insurance coverage when a person changes or loses a job, or loses benefits as a result of a reduction in the hours worked:

The Family and Medical Leave Act of 1993 (FMLA) requires employers (with at least 50 employees) to provide up to 12 weeks of unpaid, job-protected leave to eligible employees for certain family and medical reasons. Employees are eligible if they have worked for a covered employer for at least 1250 hours in the previous 12 months.

For the time period of the FMLA leave, the employer must maintain the employee's medical insurance coverage under any company group health plan. This act is regulated by the U.S. Department of Labor's Wage and Hour Division.

The Americans with Disabilities Act of 1990 (ADA) offers protection against discrimination in the workplace to anyone who has, or has had, certain disabilities, including any diagnosis of cancer. Parents of dependent children with cancer are also protected under this law. It requires private employers who employ 15 or more people, labor unions, employment agencies, and government agencies to treat employees equally, including the benefits offered them, without regard to their disabling condition or medical history.

It also does not allow employers to screen out potential employees who have children with disabilities. This law is administered by the U.S. Equal Employment Opportunity Commission (EEOC).

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) This bill has several clauses that can possibly benefit cancer patients:

  • Individuals who have had group medical insurance for at least 12 months prior to changing jobs are guaranteed coverage with a new employer who also offers group insurance. There is no waiting period and a dependent cannot be denied coverage because of a preexisting health problem.
  • If a cancer patient was previously uninsured and takes a job with an employer offering group insurance, the waiting period for preexisting conditions cannot be longer than 12 months.
  • Insurers are required to renew coverage for all employers and individuals when premiums are paid.
  • Guarantees the availability of group insurance coverage for employers of small businesses of 2 to 50 people.
  • HIPAA also helps protect anyone left out of group health coverage after COBRA has run out. If you are eligible and act within 63 days of losing COBRA coverage, HIPAA guarantees that you can buy some type of coverage and that you will have a choice of at least two options.

The Secretary of Labor enforces the health care portability requirements on group health plans under ERISA, including self-insured arrangements. In addition, participants and beneficiaries can file suit to enforce their rights under ERISA, as amended by HIPAA.

The Secretary of the Treasury enforces the health care portability requirements on group health plans, including self-insured arrangements. For more information about HIPAA, contact your state department or commission of insurance.

COBRA (Consolidated Omnibus Budget and Reconciliation Act of 1986) COBRA gives qualified employees and their families the right to temporarily continue health insurance coverage at group rates when coverage is lost due to certain specific events or qualifying events. Patients should be advised that the cost of the COBRA premium is usually far less than the cost of treatment should they let their health policy lapse. COBRA is administered by the U.S. Department of Labor, COBRA information & FAQs are available on their Web site. Department of Labor – COBRA page

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OTHER LAWS PROTECTING CANCER PATIENTS

Women’s Health and Cancer Rights Act of 1998
Under the Women’s Health and Cancer Rights Act (WHCRA) of 1998 health insurance plans must cover breast reconstruction in connection with a mastectomy if the patient decides to have reconstruction and received insurance benefits from her plan for the mastectomy.

WHCRA does not require health plans or issuers to pay for mastectomies. However, if a group health plan or health insurance issuer does cover mastectomies the plan or issuer is generally subject to WHCRA requirements.
WHCRA does not apply to Medicare and Medicaid as they are public health plans not issuers of health insurance.

The WHCRA is administered by the U.S. Department of Labor and the U.S. Department of Health and Human Services. Both of these agencies have Web pages with information about WHRCA including a list of frequently asked questions. 

Department of Health and Human Services

Department of Labor 

Breast and Cervical Cancer Prevention and Treatment Act
On October 24, 2000, the Breast and Cervical Cancer Prevention and Treatment Act (BCCPT) of 2000 was signed into law. The Act, which became effective October 1, 2000, gives states the option to provide medical assistance through Medicaid to eligible women who were screened through the Centers for Disease Control and Prevention's (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and found to have breast or cervical cancer, including pre-cancerous conditions.

In 2002, Congress passed a technical amendment to the BCCPT Act. The Native American Breast and Cervical Cancer Treatment Technical Amendment Act of 2001, extends benefits of the BCCPT Act to American Indian and Alaska Native women.

To be eligible for Medicaid under this option, the woman must:

  • Have been screened for and found to have breast or cervical cancer, including precancerous conditions, through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP)
  • Be under age 65; and
  • Be uninsured and otherwise not eligible for Medicaid

Participation in the BCCPT is optional for States. States that do participate receive an enhanced matching rate for women who enroll. Under the BCCPT law, women whose cancers were found through the CDC’s NBCCEDP may be eligible for Medicaid benefits for the duration of their cancer treatment.

Resources:
National Breast and Cervical Cancer Early Detection Program

The Older Americans Act
The Older Americans Act provides Federal funds for state and local social service programs that help frail and disabled people age 60 and older remain independent in their community. This funding covers home care aide, personal care, meal delivery, and escort and shopping services. The U.S. Administration on Aging maintains the Eldercare Locator, which provides information about assistance for older people.

Resources:
Eldercare Locator

 

 

 

2010 Newsletter Archives

Volume 5, Issue 5
Volume 5, Issue 4
Volume 5, Issue 3
Volume 5, Issue 2
Volume 5, Issue 1

 

 

CONTACT US
Risë Marie Cleland
Rise@Oplinc.com

Oplinc, Inc.
113 W. 7th Street
Suite 205
Vancouver, WA 98660
360.695.1608 office
360.326.1733 fax
www.Oplinc.com
Rise@Oplinc.com

 

UPCOMING ISSUE
Comments and suggestions for future issues are welcome, please forward correspondence to Risë Marie Cleland by email at: Rise@Oplinc.com

 

PAST ISSUES
Access all of our previous newsletters.

 

ABOUT THE EDITOR
Risë Marie Cleland is the Founder and CEO of Oplinc, Inc., a national organization of oncology professionals. Through Oplinc, Inc. Ms. Cleland publishes the weekly Oplinc Fast Facts focusing on the timely dissemination of information pertaining to billing, reimbursement and practice management in the oncology office and Oplinc’s Best Practices Review, which provides a more in-depth look at the issues and challenges facing oncology practices. Ms. Cleland also works as a consultant and advisor for physician practices, pharmaceutical companies and distributors.

 

IMPORTANT NOTICES
Please note that this newsletter is presented for informational purposes only. It is not intended to provide coding, billing or legal advice. Regulations and policies concerning Medicare reimbursement are a rapidly changing area of the law. While we have made every effort to be current as of the issue date, the information may not be as current or comprehensive when you review it. Please consult with your legal counsel for any specific reimbursement information. For Medicare regulations visit: www.cms.gov.

CPT® is a Trademark of the American Medical Association Current Procedural Terminology (CPT) is copyright 2010 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein.

Copyright ©2010
Oplinc, Inc.
Oplinc, Inc., grants permission to distribute this newsletter without prior permission provided that it is forwarded unedited and in its entirety.

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