Weekly Email: Week of June 13
I. Conference Call Information (Wednesday, June 15 and Thursday, June 23)
II. In the News
NGA's Statement on Medicaid
AHIP Study on Health Savings Accounts
BCBSA Report on Association Health Plans
Department of Justice Ruling on HIPAA
Families USA's Report on the Cost of Care for the Uninsured Borne by the Insured
III. HAP Resources
Medicaid and Portability
IV. Helpful Information
CMS State Medicaid Directors' Letter on MMA
Two New Medicaid Reports from the Kaiser Family Foundation
New Commonwealth Fund Report on External Quality Review Organizations
Kaiser Family Foundation Webcast: Low-Income Medicare Drug Assistance Workshop
Free Vision Screening Program for Infants
Follow-Up on CMS State Medicaid Directors' Letter on Sex Offenders
I. Conference Call Information (Wednesday, June 15 and Thursday, June 23)
Working with Younger Medicare Beneficiaries
The next Medicare conference call will be on Wednesday, June 15 at 3:00 PM Eastern time. We will continue our theme of working with younger Medicare beneficiaries by discussing access to needed prescriptions through Part D plans. During this call we will focus on a variety of issues, including:
special factors in selecting a Part D plan,
beneficiaries who rely upon particular medication regimes for medical stability,
coordinating Part D coverage with other drug coverage, and
working with alternative decision-makers for beneficiaries with either temporary or long-lasting cognitive impairments.
We will also have an opportunity to share ideas with advocates from diverse disability communities regarding ways that SHIPs and other consumer health ombudsman programs (that often have more experience in working with aging populations) can expand and improve their efforts to reach this generally younger population of people with disabilities.
In addition, we will take time during this call to address the Part D low-income subsidies (called "extra help" by the Center for Medicare & Medicaid Services [CMS] and the Social Security Administration). We will talk about response to the letters sent to those deemed eligible for the extra help as well as about the needs of those who must apply for the subsidies. Please note that HAP's Medicaid conference call for June will also deal with the important issues of the low-income subsidies and will be coordinated with the Medicare call. Both of these calls are very important, and we look forward to your participation. Please contact Hilary Sohmer Dalin at hdalin@healthassistancepartnership.org with information, ideas, and suggestions about HAP's Medicare conference calls and Cheryl Fish-Parcham at cparcham@healthassistancepartnership.org to discuss HAP's Medicaid conference calls. You can also reach them by telephone at 202-737-6340.
(Back to the top)
Medicaid and MMA
The next Medicaid conference call will be on Thursday, June 23rd at 1:00 PM Eastern time. Given that in July Medicaid agencies must begin to accept the low-income subsidy applications and to screen for Medicare Savings Programs (MSPs) when people come to the Medicaid agency to apply for the subsidy, we would like to talk about the application processes your states are using and about counseling consumers to use the Medicaid application process (especially if they may be eligible for an MSP).
Also, as you know, CMS recently sent letters to people dually eligible for Medicaid and Medicare, to people on MSPs, and to SSI (Supplement Security Income) beneficiaries informing them that they will automatically get "extra help" with their prescription drug plan costs and do not need to apply for the subsidy. We are interested in hearing whether these letters have been received and understood by consumers in your area and whether you see any further counseling needs about that letter or automatic-enrollment process this summer. Have you or any of your Medicaid agencies done any checking to make sure that the mailings reached most or all dual eligibles in your communities? CMS and the media reported that perhaps 6,000 people erroneously received empty envelopes, but did the mailings otherwise go smoothly?
In addition to the individual counseling that you provide to the low-income population, we are interested in talking about appropriate community outreach in senior centers and other locations that would reach both the population automatically eligible for the subsidies and those who need to apply. Please let us know how you are approaching such presentations: what has worked and what help do you need? If you have materials to share for this call or other suggestions for the agenda, please contact Cheryl Fish-Parcham at cparcham@healthassistancepartnership.org. Both Cheryl and Hilary Dalin (who can be contacted at hdalin@healthassistancepartnership.org) will participate in the discussion on the 23rd.
(Back to the top)
The information about participating in the HAP conference calls is limited to staff members (paid or volunteer) of consumer health insurance assistance programs because of HAP's funding restrictions. If you are a staff member of a consumer health insurance assistance program and should be getting the conference call information, please email Avis Hall at awise@healthassistancepartnership.orgwith your request and information about your program.
II. In the News
NGA's Statement on Medicaid
The National Governors' Association (NGA) issued its interim Statement on Medicaid in which the bi-partisan organization takes the position that Medicaid should be reformed and that other forms of health insurance and long-term care should be strengthened as well. NGA's proposal for reforming Medicaid includes the following ideas:
prescription drug pricing changes,
further restrictions on Medicaid eligibility for people who have transferred assets in the past,
increased cost-sharing for beneficiaries,
more flexibility for states in determining what benefits to provide, and
lessening the role of the judicial system when states cut Medicaid programs or implement questioned waivers, among other changes.
NGA will be testifying about its proposal in Congress this week, and the full National Governors' Association will decide whether to finalize and to ratify this interim policy in about a month.
The Center on Budget and Policy Priorities and Families USA have also jointly issued Principles to Guide Medicaid Action that differs from the NGA proposal.
(Back to the top)
AHIP Study on Health Savings Accounts
Last month, America’s Health Insurance Plans (AHIP) issued its study Number of HSA Plans Exceeded One Million in March 2005, which reflects an increase of more than 50 percent in six months. Because health savings accounts, or HSAs, first established by the Medicare Modernization Act (MMA) which was signed into law in December of 2003, are so new and differ from standard health insurance plans in many ways, this study is a call to private insurance ombudsman to educate consumers about HSAs and determining what choice is best for them.
HSAs are accounts to which people (and their employers if they choose) can contribute pre-tax dollars up to a certain amount each year to be used for specific medical expenses. Available to individuals (and their families) as well as to groups, HSAs must be paired with a high-deductible health insurance plan, or HDHP (a premium which employers may or may not cover) and must be housed in a bank or other financial institution (which will charge fees for managing the account, fees which employers may or may not cover, just as there are charges for 401(k) and 403(b) retirement accounts). In addition, like a PPO plan, an HDHP typically has a network of health care providers through which charges are generally more favorable to the consumer but which of course is not unlimited.
At the end of a plan year, unlike a flexible spending account, all unused contributions in an HSA are rolled over into succeeding years, along with any interest money in the account may have earned as well, although the return may not be significant. HSA funds always stay with the individual. Hence, while those who do not have many medical expenses may find an HSA/HDHP to be a good choice, those with greater medical expenses, especially expenses not covered by the HDHP, may do better with different coverage. It is thus crucial that consumers understand the pros and cons of HSAs, especially if they have other insurance options, before they get an HSA/HDHP.
AHIP's study found that, contrary to expectations, "nearly half of people covered by HSA-eligible insurance are over the age of 40" and that more than half of those with an HSA/HDHP are in the individual market. However, according to the study, "much of the recent growth (comes) from employers offering HSAs to their employees." AHIP also found that more health insurance plans now offer HSA-eligible HDHPs: "(t)here are now 71 health insurers offering high deductible plans to large employers, compared with 15 in September; 68 insurance companies providing plans to small employers, up from 20 at the time of the earlier report; and 56 companies have HSA-eligible plans for individuals, contrasted with 11 six months ago."
Programs that are interested in learning about consumer education material on HSAs--or in sharing their own--should contact Christin Engelhardt, Outreach and Publications Coordinator, at cle@healthassistancepartnership.org.
(Back to the top)
BCBSA Report on Association Health Plans
The Blue Cross and Blue Shield Association (BCBSA) recently issued a report Association Health Plans: No State Regulation Means Loss of Protections for Consumers, Small Employers and Providers that explains which consumer protections enacted by states and the District of Columbia would disappear if Congress passes the federal association health plan (AHP) legislation examined in the report and now being debated. AHPs have existed for many years, but proponents of AHPs say they have not been as popular as they should be because AHPs are subject to state regulation, just as states traditionally have regulated insurance companies and their products (although not most corporate and union health plans). If enacted, this legislation now before Congress would permit AHPs that would not be subject to state law and oversight, including state solvency and benefit mandates. Hence, according to the BCBSA report, AHPs can allow, for example, insurers to drop coverage for certain medical services. BCBSA also finds that AHPs do little to expand health care coverage.
(Back to the top)
Department of Justice Ruling on HIPAA
On June 1, the U.S. Department of Justice issued a ruling that significantly limits enforcement of privacy rules under the Health Insurance Portability and Accountability Act (HIPAA).
Written by Steven Bradbury, the Principal Deputy Assistant Attorney General in the Office of Legal Counsel, for the General Counsel at the Department of Health and Human Services, the ruling states "We conclude that health plans, health care clearinghouses, those health care providers specified in the (HIPAA) statute, and Medicare prescription drug card sponsors may be prosecuted for violations of section 1320d-6. In addition, depending on the facts of a given case, certain directors, officers, and employees of these entities may be liable directly under section 1320d-6, in accordance with general principles of corporate criminal liability, as these principles are developed in the course of particular prosecutions. Other persons (e.g., employees of the covered entities such as clerks or consultants for the covered entities) may not be liable directly under this provision. The liability of persons for conduct that may not be prosecuted directly under section 1320d-6 will be determined by principles of aiding and abetting liability and of conspiracy liability." In other words, if doctors violate a patient's privacy under HIPAA, they are subject to prosecution under HIPAA but not necessarily their secretaries.
Under this ruling, the one criminal HIPAA conviction (out of 13,000+ complaints of privacy violations filed during the past two years) would not have been possible: In that case, an employee of a hospital was sentenced to sixteen months in prisons after pleading guilty nearly a year ago to improperly disclosing a patient's personal health information. No civil fines have been imposed by the government yet.
(Back to the top)
Families USA's Report on the Cost of Care for the Uninsured Borne by the Insured
Last Wednesday, Families USA released a new report Paying a Premium: The Added Cost of Care for the Uninsured that is the first to calculate the price the insured pay for the millions of uninsured Americans. According to the study, "premiums for employer-provided family health insurance will cost, on average, an extra $922 in 2005 to cover the unpaid expenses of health care for the uninsured. That figure will increase to $1,502 by the year 2010."
(Back to the top)
III. HAP Resources
Medicaid and Portability
When people lose Medicaid, they do at least have some protections when obtaining other insurance. The Health Insurance Portability and Accountability Act (HIPAA) requires Medicaid agencies to issue a “notice of creditable coverage” to people losing Medicaid benefits. This notice can reduce or eliminate a person’s pre-existing-condition exclusion period with a new insurer: that is, if the new insurer normally imposes a waiting period before care related to a pre-existing condition is covered, this wait may be reduced or eliminated depending on how long the person previously had creditable coverage. However, if you want to be sure that former Medicaid beneficiaries have a right to enroll in an employer-based plan outside of normal enrollment periods, or if you want to be sure that they have rights to coverage on the individual market, your state may need to take action. For more information, read HAP's publication Medicaid and Portability.
(Back to the top)
IV. Helpful Information
CMS State Medicaid Directors' Letter on MMA
CMS sent a letter to state Medicaid directors on June 3 explaining rules for Medicaid coverage of drugs that are excluded under Part D, including barbiturates and benzodiazepines. The letter explains that if states cover these drugs for non-dual eligibles, they must continue to cover them for dual eligibles as well. Conversely, if states decide to cover the drugs for full duals, they must cover them for other Medicaid beneficiaries as well.
Two New Medicaid Reports from the Kaiser Family Foundation
The Kaiser Family Foundation released an issue paper and a background report on Medicaid spending for "mandatory" and "optional" populations and services. One conclusion is that more than 60% of state Medicaid spending is for services or populations currently considered "optional" under federal law but that these services are essential to Medicaid's role and are particularly relevant given the shift away from institutional care.
New Commonwealth Fund Report on External Quality Review Organizations
The Commonwealth Fund recently issued a report, Using External Quality Review Organizations to Improve the Quality of Preventive and Developmental Services for Children, that mentions several states' success in using External Quality Review Organizations to examine preventive and developmental services provided by Medicaid managed care plans. It recommends that other states similarly focus on the quality of well-child visits.
(Back to the top)
Kaiser Family Foundation Webcast: Low-Income Medicare Drug Assistance Workshop
Last Wednesday, June 8, the Kaiser Family Foundation held a workshop entitled Low-Income Medicare Drug Assistance which focused on how to reach those low-income beneficiaries eligible for the Part D subsidies and to get them enrolled in an appropriate Part D prescription drug plan. Panelists included Beatrice Disman, New York Regional Commissioner and Chair, Medicare Taskforce, Social Security Administration; James Firman, President and CEO, National Council on the Aging and Chair, Access to Benefits Coalition (ABCRx); Vicki Gottlich, Senior Policy Attorney, Center for Medicare Advocacy, Inc.; and Michael McMullan, Deputy Director for Beneficiary Services, Centers for Medicare & Medicaid Services. Tricia Neuman, ScD, Vice-President, Kaiser Family Foundation and Director, Medicare Policy Project, provided an overview of the help available to low-income Medicare beneficiaries. During their presentations, the speakers also considered lessons learned from the Medicare-approved drug discount card program, which had a significant benefit for low-income Medicare beneficiaries who were not in Medicaid.
(Back to the top)
Free Vision Screening Program for Infants
A new public health program has been developed by the American Optometric Association, in partnership with The Vision Care Institute of Johnson & Johnson Vision Care. This program, InfantSEE, provides a free eye exam by an optometrist to help detect potential vision problems, such as lazy eye (amblyopia) and retinoblastoma (a type of eye cancer), at an early stage. These types of conditions are not commonly identified this early by pediatricians and family practitioners during regular exams. During the InfantSEE exam, which is available for children between the ages of six and twelve months, the eye doctor uses techniques and instruments (such as penlights and finger puppets) that comprehensively assess eye health; if eye problems are detected, early treatment often leads to full correction. The exams are available at no cost regardless of income and thus may be of particular interest to parents of infants without vision insurance. More than 6000 certified optometrists who have volunteered their services for this program perform the exams. A physician locator can be used to find providers across the country.
Follow-Up on CMS State Medicaid Directors' Letter on Sex Offenders
Last week, we told you of a letter that CMS sent to states informing states that they could deny Medicaid coverage for impotence drugs for sex offenders. We subsequently heard concerns about how this would be implemented in a way that would protect privacy rights, target the appropriate people, and protect others' access to proper treament. If your state is either developing good procedures or grappling with problems, please contact Cheryl Fish-Parcham at cparcham@healthassistancepartnership.org or at 202-737-6340.
(Back to the top)
