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Case
Study Medicare
Part D Legislative Changes
Situation:
A leading national patient advocacy and legal assistance organization is
pursuing regulatory appeals, legal resolutions, and legislative corrections to
address Medicare’s denial of coverage for medically necessary treatments
because of an unusual provision in the Medicare Part D outpatient prescription
drug benefit law.
Actions:
Provided pro-bono research, insight and guidance about the legislative
situation and history to help inform their legal arguments and legislative
strategy.
Contacted leading Medicaid legislative experts about the Federal legal provisions that are the basis for the
Medicare Part D plans denying patients coverage for medically necessary treatments.
Recommended legislative approaches, strategies, and drafted legislative
language for improving the Medicare law.
Outcome:
Legal and legislative advocacy staff developed better arguments
and strategies for creating better access for Medicare patients to medically
necessary treatments. (Legal and
legislative activities are still ongoing as of April 2008.)
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