Specifications include, but are not limited to:The purpose of this Request for Proposals (RFP) is to secure services which would result in identification of Medicare entitlement or potential eligibility for Commonwealth of Virginia Health Benefits Program participants, The Local Choice (TLC) program participants, and participants in any new health benefits programs that are implemented by the Department of Human Resource Management (the Department) during the period of this contract. This information will be used to comply with the requirements of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 to provide disclosure of creditable drug coverage to Medicare Part D Eligible Individuals by entitles that provide prescription drug coverage to Medicare beneficiaries and to facilitate identification of participants in any of the Department’s health benefits programs who should have Medicare as their primary health plan coverage based on Medicare Secondary Payer guidance. This would include: Retirees, long-term disability participants, survivors, and their covered family members who are no longer covered under the program based on current employment; Active employees and their covered family members who are eligible for Medicare (and, therefore, eligible for Medicare Part D), including those eligible due to End Stage Renal Disease who have exhausted their coordination period; Extended Coverage/COBRA qualified beneficiaries who are entitled to Medicare prior to their Extended Coverage election or become entitled after their COBRA election. The cost containment and avoidance objective of obtaining these services is to ensure that the Department’s health benefits programs do not make primary payment for any health plan claims that should be paid by Medicare. In turn, this will ensure appropriate primary payment in order to avoid or resolve any Medicare Secondary Payer demands and associated interest liabilities, all to the benefit of the Programs and their participants.
