Plan Benefit Design – Medicare Part D Sample Clauses

Plan Benefit Design – Medicare Part D. The BHS Program is payer of last resort, however, when it is determined that the client being served does not qualify for the many other programs sponsored by the state and federal agencies (i.e., Medi-Cal, Healthy Families, etc.), services provided by the BHS Program do not exclude persons with other coverage and the BHS Program does xxxx these funding sources for the services it provides. As a result, BHS Program psychiatrists prescribe medications for these persons as well as those for whom the prescription costs are covered in accordance with section B.1 above. With the recent changes in the Medicare Prescription Drug Coverage Benefit, specifically Part D, the BHS Program desires to ensure that its clients with this coverage are not financially deterred from obtaining their medications and decompensating as a result of not maintaining their medication regimens. Therefore, the BHS Program will cover co-pays for clients receiving Medicare benefits as well as deductibles for certain groups. For future discussion, it can be noted that certain subgroups are also responsible for premiums. The BHS Program may want to consider subsidizing those, or subsidizing the difference to change from a basic benefit to an enhanced benefit, depending on cost analyses. This does not affect Contractor considerations discussed below. The following details the desired Plan Benefit Design for these populations, which are subject to change as defined by Medicare regulations, provided, however, in all cases – the cost of the medication should be billed to Medicare or Medi-Cal as appropriate and the County will only be billed for the appropriate co-pay and/or deductible for BHS Program clients. Benefit Packages: