The Medicare Helpline’s Reference Center is CMS’ core team of Medicare experts who resolve the beneficiaries’ and general public’s most challenging inquiries and customer service issues. It responds to these complex caller inquiries by phone, email, and letter. Responses are based on researching the beneficiary’s question or issue using information from CMS approved scripts, CMS publications, www.medicare.gov frequently asked questions, and customized information from Subject Matter Experts (SME) regarding complex, hot topic, and previously unresolved issues.
The creation of Medicare drug benefits brought challenges of a new scale to the Reference Center. The Medicare Prescription Drug, Improvement and Modernization Act of 2003 was signed in December 2003 with the new drug benefits available beginning January 2005. While the new benefit’s implementation plans were being established, CMS instituted the Medicare Approved Drug Discount Card. This was a temporary program to help its 42 million beneficiaries during the interim period by lowering their current prescription drug costs.
The discount card program officially began just four months after the President signed the new Medicare legislation, on May 1, 2004. In the six months from April to September 2004, call volume zoomed to 59,088 calls, an average of about 10,000 per month. During the month immediately before that period, the number had been 5,770.
In response to the spike CSC, management moved aggressively to fill customer service representative and training positions with permanent and temporary employees, acquire additional space and equipment and conduct an intensive training effort. During this period beneficiaries continued to receive timely and accurate information from the Reference Center. Staff researched inquiries and made an initial contact attempt within two business days. They used new Medicare.gov website tools to provide callers with information about the various Drug Discount Cards and to enroll online.
During this period CSC also worked with CMS to prepare for the even more crucial implementation of the Prescription Drug Benefit itself. The initial enrollment period was November 15, 2005 through May 15, 2006. To meet the anticipated surge in inquiries, the Reference Center again increased staff and provided them additional focused training.
Of necessity, enrollment was conducted with systems and interagency data exchanges that hadn’t been extensively tested. The potential for problems existed and, indeed, they emerged. One of the Reference Center’s main functions during the initial period was to assist beneficiaries who experienced complex problems enrolling in plans or who had unique issues that couldn’t be addressed by regular customer service staff. CMS created a tool, the Prescription Drug Plan Finder (PDPF), on the Medicare.gov website to compare the features, benefits and costs of selected drug plans. Reference Center specialists used the PDPF tool to assist beneficiaries in assessing and enrolling in drug plans in their communities. The Reference Center also assisted many beneficiaries with complex issues regarding enrollment/disenrollment and switching between plans.
During the initial Drug Benefit Plan enrollment period, the Reference Center responded to 146,056 telephone inquiries and 48,950 emails, helping tens of thousands of Medicare beneficiaries make crucial decisions about their health care coverage. According to CSC quality metrics for the period from November 2005 through May 2006, 97.37 percent of Reference Center responses were accurate and met CMS customer service standards.
In the summer and fall of 2006, the Reference Center continued to address inquiries relating to the new drug benefit. As a reporting entity, the Reference Center has provided CMS with information about trends and problems, particularly regarding enrollment into the drug plans and drug plan premium withholding. Further, the Reference Center provides beneficiaries who have reached the “coverage gap” with information and referrals to other sources of financial help with prescription drugs.