Health Assistance Partnership
Medicare Network
December 18, 2002 Conference Call Minutes

More than 40 participants joined HAP's first Medicare network call held on December 18, 2002 from 3:00PM EST to 4:00 PM EST.  These included those involved with both local and state SHIPs who responded to our roll call from Alaska, Arizona, California, Delaware, Florida, Hawaii, Indiana, Iowa, Maryland, Massachusetts, Michigan, Nebraska, Nevada New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, South Dakota, Tennessee, Texas, and Wisconsin.  Both national and regional CMS staff also responded to our roll call.  HAP staff present for the call included Kevin Simpson, HAP Executive Director, Hilary Dalin, Medicare Coordinator, Cheryl Fish-Parcham, Medicaid Coordinator, Sonya Schwartz, Private Insurance Coordinator, Pat Forsythe, Training Coordinator and Astrid Schmidt, Research Analyst.  

Kevin provided an update on HAP progress since he presented at the SHIP State Directors Conference in May 2002.  HAP is now fully staffed and the coordinator of each of the three networks is in regular contact with health assistance programs all over the country. With this conference call, HAP has initiated conference calls for each of the three networks.  HAP is responding to requests for technical assistance and resource development.  Kevin invited participants to look at HAP's Web site at www.hapnetwork.org and to register in order to receive notification of future conference calls and timely policy updates and other developments of interest to health assistance programs working with Medicare beneficiaries.

Kevin reported that HAP devoted a considerable amount of time to talking with Martha Taylor and Jay Dobbs, representing the SHIP Steering Committee to the SHIP Resource Center and to CMS, exploring how best to integrate and not duplicate efforts already being offered to the SHIPs.  We held off on scheduling conference calls for this network until we were reasonably sure of a growing confidence that HAP offers a resource that SHIPs can rely upon for accuracy, timeliness and responsiveness to SHIP needs.  Now that we have completed the written document of our understandings, we feel we have reached that comfort level and are grateful to Martha and Jay for the time and effort they devoted to the process of arriving at the understandings reflected in the document.  Please check the text on the HAP Web site.

Kevin reviewed HAP's goals, which are to:

1. Promote consumer assistance programs:  We have social marketing expertise with which we can help programs to market their services to key populations as well as to potential volunteers.  We will also, in conjunction with our sponsoring organization, Families USA, promote SHIPs on the federal legislative scene, specifically in the budget process.

2. Facilitate collaboration within and across networks:  Recognizing the value of familiarity with developments across health care sectors, our conference calls and Web site updates are a mechanism for cross-fertilization, with opportunities for professional growth and learning.  HAP offers a perspective reflecting access to many sources of information on pertinent substantive developments.

3. Strengthen programs:  HAP offers technical assistance including substantive and skills-building trainings, issue briefs and responses to individual program requests.  We are interesting in assisting SHIPs in recruiting and retaining and qualified and enthusiastic corps of volunteers.  Additionally HAP's Web site presents updates and data such as the news of the QI-1 extension through March 13, 2003, that was posted on our web site within 48 hours of passage of the Continuing Resolution by Congress.

4. Data collection and use:  HAP is keenly aware of the SHIP's efforts to comply with the national data reporting system.  However, we want to help assure that data being collected is being fully utilized to market the immense value of the services provided by SHIPs.  Moreover, since large numbers of Medicare beneficiaries share their experiences with SHIPS, they are generally in a position to know, sooner than most, how changes are affecting Medicare beneficiaries.  A critical challenge is to use data to marked SHIPs and respond to systemic issues.  HAP is ready to work with SHIPs on the challenge of making data collection and dissemination relevant, easy and useful.

Kevin invited Martha Taylor to respond.  Martha began by noting how far we've come since Kevin first introduced HAP at the SHIP Directors conference in May 2002.  At that time, she said, many SHIP directors did not understand how HAP fit into the larger picture, especially since state SHIPs have the SHIP Resource Center.  Through the process of arriving at the written document and the information HAP has provided to the SHIPs, the SHIPs now understand that HAP is really interested in helping SHIPs.  HAP is able to provide timely information and policy updates.  HAP can give SHIPs timely access to more information.  SHIPs use all kinds of resources and HAP is another potentially valuable resource available to the SHIPs.

Martha continued that she and Jay learned that while HAP's grant from the Robert Wood Johnson Foundation is for a three year period, Families USA is planning for HAP to be a long-term project.

The written document that was developed details how SHIPs can utilize HAP and the SHIP Resource Center.  The process leading up to the document created a clearer picture of HAP's role and as more state SHIP directors work with HAP, they will find it is a resource that can be used by them.

Hilary then facilitated a discussion on how HAP can work with SHIPs.  In response to a question, she described the types of questions or technical assistance requests from SHIPs to which HAP has responded.  HAP was invited to a regional update-training event in Pennsylvania.  We presented a session on the Medicare home health benefit, called "Staying At Home with Medicare."  The interactive session explored in the Medicare coverage criteria and how this benefit can be used to help beneficiaries with dementia remain in their homes and communities, avoiding or deferring unwanted institutionalization.  Hilary was asked if HAP was able to travel to present training session and she enthusiastically responded affirmatively.

HAP has also been asked to explore:

1. The relationship of COBRA to Medicare, especially as it relates to those Medicare beneficiaries whose entitlement is based on disability, rather than age.  Timing of COBRA election, notification requirements and decisions regarding Medicare Part B enrollment are topics HAP has been asked to analyze and explain.
2. Traditional Medicare appeals and the many questions regarding the piece-meal implementation of the changes enacted in the Beneficiary Improvement and Protection Act, (BIPA.)  (See the summary of the current status of implementation posted on the HAP Web site.)  Proposed regulations have recently been promulgated and they raise troubling questions, particularly for un-represented Medicare beneficiaries seeking to appeal adverse Medicare determinations with which they disagree.  Our summary will provide convenient links to the actual proposed regulation and the CMS preamble that explains its rationale for the proposed changes, as well as links to the comments and analyses of many consumer advocacy programs.  HAP has been asked specifically about the rules for establishing good cause for late filing of a Medicare appeal.  Our response will also address re-opening Medicare determinations, as a potential alternate means by which to reverse an erroneous decision.  The new rules found in the proposed regulation will also be reviewed.
3. Dual-eligibility for Medicare and Medicaid and the Medicare Savings Programs have been the source of a number of technical assistance requests including the relationship of QMB to Medigap policies, the status of QI-1 and QI-2, and how dually eligible individuals can obtain access to various medical services.
4. Medicaid long term care issues including how SHIPs can better understand Medicaid spousal impoverishment prevention rules and what role SHIPs should undertake in advising those contemplating the need for long term care.

Next, questions from the participants were answered.  Much of HAP's research in response to technical assistance requests will be posted on the HAP Web site and some may well become the subjects of conference calls, training workshops and conference sessions at the HAP conference and other national or regional conferences.  Web site postings will often contain links to original sources such as statutes, regulations, and policy issuances, proposed legislation and model SHIP materials, so that HAP is both a resource for information and a conduit to material produced by others working on the same matters.  We will send e-mail notifications about our web updates and enhancements periodically.  Please be sure to register on our Web site to assure receiving HAP e-mails.  Martha Taylor added that in the future www.SHIPtalk.org will contain a link to HAP's Web site.  Once HAP is again connected to www.SHIPtalk.org, we will also be able to link from HAP's Web site to SHIPtalk.

Hilary proceeded to solicit topics for future conference calls.  She outlined her list, which included:

1. Medicare prescription drug discount cards and the issues SHIPs will need to grapple with in order to counsel Medicare beneficiaries.  (Hilary noted that HAP would be posting on the HAP Web site a bibliography of recently published studies of prescription drug coverage for Medicare beneficiaries.  The posting was made on Friday, December 20, 2002.)
2. The PPO demonstration pilot.  A conference call for SHIPs in the 23 demonstration states could provide a setting in which questions and issues might be freely discussed.
3. Long term care issues including Long Term Care Insurance and how to obtain reliable and understandable information and materials; spending down resources for Medicaid eligibility; Home and Community-Based Services waivers, etc.  Hilary noted that we could spend many hours reviewing these topics!

All of these topics were endorsed as of interest and conference call participants raised others:

1. HIPAA privacy rules and the implications for SHIPs.  Sonya noted that HAP is completing an issue brief on HIPAA that will be posted on our Web site soon.
2. Medicare services and End Stage Renal Disease (ESRD.)
3. Physician shortages and access to physician services for Medicare beneficiaries.
4. Prescription drug formularies and generic versus brand name drugs in Medicare HMOs.  HAP is monitoring developments on this critical issue and will report on developments including the Maine case, called Concannon, which will be argued before the US Supreme Court on January 22, 2003.  (If the date sounds familiar, that's because it is the second day of HAP's national conference.)
5. Congressional proposals and developments that may affect Medicare beneficiaries.  We will include legislative updates and policy announcements as a regular component of the conference calls.

Conference calls will be scheduled monthly on the third Wednesday of each month at 3:00PM EST or EDT and are expected to last one hour.  We understand the time demands on SHIPs!  We will announce the Web site shortly after each call.  Martha announced that the SHIP Steering Committee is urging CMS to schedule another CMS-sponsored national conference in January 2003 on the QI-1 situation.  She emphasized that HAP calls are not intended to replace CMS calls.

Kevin added that we at HAP are the SHIPs' biggest fans.  Through our relationship to Families USA we have opportunities to remind Congress of the importance of the SHIPs.  SHIPs mean real people helping real people.  Real people can't be dealt with through Web sites or phone operators reading from scripts.  We are stating the value of SHIPs loudly in all possible forums.  We carry this message to every CMS meeting open to us.  Hilary or other HAP staff attends with one assignment: to put the SHIPs in front of the meeting and to ask about the role of the SHIPs.  We are also working to promote the good work of the SHIPs on the state level, through relationship building with the National Conference of State Legislators.  Our social marketer attended a recent conference of the National Black Caucus of State Legislators and secured passage of a resolution in support of consumer health assistance programs, including SHIPs.

Kevin added that the interests listed by participants closely match the workshop topics scheduled for HAP's national conference.  We are glad that our conference is responsive to the interests of SHIPs.  We will bring information from our other networks to the SHIPs and assist in state-level networking between SHIPs and health assistance programs from our other two networks.

HAP works closely with many advocacy organizations including the National Council on Aging Organizations. Medicare Rights Center, Center for Medicare Advocacy, Center for Medicare Education, ABA Commission on Law and Aging, National Academy of Elder Law Attorneys and many others.  HAP staffers have opportunities to attend and present at many national conferences and Kevin has emphasized that staff must return with something that can be brought to the SHIPs.  Likewise, Hilary mentioned that, in recognition that only approximately 20 SHIP staffers are able to attend the HAP conference, those in attendance have been told they will be expected to help HAP bring the conference back home to those SHIPs unable to come this year.

We intend to be here for the SHIPs; to follow SHIP lead in offering what SHIPs are looking for.  Please do not hesitate to offer suggestions, feedback, either positive or negative, and your ideas for us.  We are energized by our connection to you.

HAP's NEXT MEDICARE NETWORK CONFERENCE CALL WILL BE HELD ON FEBRUARY 19, 2003 AT 3:00PM EST. 

Call-in details will follow at the end of January 2003, after the HAP national conference.