Coordination of Benefits between Part D Plans and Other Prescription Coverage Providers

The SPAP/ADAP Attestations page (Figure 2) displays.

Figure 2: SPAP/ADAP Attestations

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HOW TO ENTER DATA FOR AN INITIAL ADAP OR SPAP ATTESTATION
1. On the SPAP/ADAP Attestations Page, click Add New Attestation option.
2. The New Attestation page displays (Figure 3).
NOTES:
The data-entry process is the same for ADAP and SPAP.
All the following sections are expanded by default on the New Attestation page.
-

Program Details

-

Contact Information for CMS

-

Eligibility

-

Enrollment

-

Assurances

To collapse a section click on the corresponding section name.
Required fields are marked with an asterisk (*) in each section.

Figure 3: New Attestation

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3. Enter the applicable data in the Program Information section (Figure 4).

Figure 4: Program Information Section

NOTES:

You can choose to continue entering data in all sections and confirm the entries to add
new attestation. Or you can choose to save the data entered in Program Information
section and return later to complete data entry.
To save the data entered in Program Information section, click Save. A save
confirmation message displays indicating that data has been saved with the Attestation
Number (Figure 5). Note down the Attestation Number for future reference.
After the save, the New Attestation page becomes the Edit Attestation page. The user
can select Close to exit the Edit Attestation page and return later to complete data
entry.
To resume data entry, refer to “How to Edit an Attestation” in this guide.
To continue data entry in all sections and confirm the entries to add new attestation,
continue from Step 4.

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Figure 5: Program Information Saved

4. In the Contact Information for CMS section (Figure 6):
If data fields are populated: A state user from the same state has already entered
the contact data. This contact data applies for all SPAP/ADAP programs in that
state. Users can update the data on this page.
If data fields are blank: Enter the required data and proceed to Eligibility section.

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Figure 6: Contact Information for CMS

5. In the Eligibility section (Figure 7), select/enter the applicable data:
If entering an SPAP/ADAP, users may select “N/A” for all those yes values for the
“Is SPAP/ADAP eligibility determined by Income?” question.
If entering an SPAP/ADAP, users may select “N/A” for all those yes values for the
“Is SPAP/ADAP eligibility determined by Age?” question.
If entering an SPAP/ADAP, users may select “N/A” for all those yes values for the
“Is SPAP/ADAP eligibility determined by Asset level?” question.
If entering an ADAP, users must select “Yes” for the “Is SPAP/ADAP eligibility
disease/condition dependent?” question and must click the related “HIV/AIDs”
checkbox.
To access the Medicare & You Handbook, click the LIS link in the question “Is
SPAP/ADAP eligibility conditioned upon LIS application?”.

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Figure 7: Eligibility

6. After selecting/entering data in the Eligibility section, proceed to Enrollment section.
7. In the Enrollment page (Figure 8), select/ enter applicable data.
8. You will be required to upload an Algorithm document if “Non-random assignment” for
the state’s enrollment/assignment process is selected.

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Figure 8: Enrollment Section

9. After selecting/ entering data in the Enrollment section, proceed to Assurances section.
10. In the Assurances section (Figure 9), select all the checkboxes.
NOTE: The Data Sharing Agreement is disabled for a State Regulator User with State
Data Entry access. It is enabled for a State Regulator User with State Signature access.

Figure 9: Assurances Section

11. If applicable, enter additional information in the Additional Information textbox (Figure
10).

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Figure 10: Confirm Attestation

12. Click Confirm.

13. A notification banner displays (Figure 11) indicating that the new attestation has been
saved. The Attestation Number displays in the notification banner.

Figure 11: Attestation Confirmation

HOW TO DELETE AN INITIAL ADAP OR SPAP ATTESTATION BEFORE IT HAS
BEEN SUBMITTED
After an attestation has been created, a state user can delete the attestation prior to its being
submitted.
1. On the SPAP/ADAP Attestations page (Figure 12), click the Delete (trashcan) icon for a
specific attestation that is in “Open” status.

Figure 12: Delete Attestation
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2. The delete Confirm message dialog box for displays (Figure 13).

Figure 13: Confirm Delete Attestation

3. Click OK.
4. A successful attestation deletion message banner displays (Figure 14). The deleted
attestation is removed from the grid.

Figure 14: Successful Attestation Deletion

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