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I. Conference Call Information
II. In the News
Private Fee-for-Service (PFFS) Update
Medicare Will Not Pay Hospitals for Advoidable Errors
III. Helpful Information
Guide to CMS, SSA, and Plan Mailings
Updated Procedures for Low-Income Subsidy Redetermination
Higher Premiums for Part D in 2008
More Low-Income Beneficiaries Will Be Reassigned for 2008
CMS Announced Payment Changes for Medicare Home Health Services
Tip Sheets: PDP and MA Complaints and Appeals
2008 Part D Marketing Model Material Updates
Final 2008 Model Evidence of Coverage (EOC) Issued
Premium Withholding Payment Reconciliation
IV. HAP News and Resources
I. Conference Call Information
HAP's next monthly conference call will be held on September 19, 2007 at 3:00 PM ET. More information about the call will be on the HAP homepage shortly.
II. In the News
Private Fee-for-Service (PFFS) Update
This year has seen many changes to the marketing and enrollment practices of Medicare Advantage plans. The Limited Open Enrollment Period was created and then terminated. Then, the marketing of PFFS plans was temporarily halted until Medicare Advantage Organizations (MAOs) could prove to CMS that they followed certain marketing rules. In response to the changes, HAP has created a Private Fee-for-Service Resource Center where you can find up-to-date information on PFFS plans, the revised marketing rules, and a timeline of events.
Medicare Will Not Pay Hospitals for Avoidable Errors
Starting in October 2008, Medicare will stop paying hospitals to treat preventable infections and injuries that occur in the hospital. Medicare will soon stop payment for at least eight conditions, including common hospital-acquired infections, blatant surgical errors, and injuries that result from a fall. Hospitals are prohibited from passing the additional costs on to patients. Medicare describes this as a payment policy that supports quality and safety. Hospitals are concerned that factors outside of their control, such as fall prevention when individuals do not call a nurse for help despite instruction to do so, are being included. If the new policy proves successful, private insurance companies are also likely to start refusing to pay for medical mistakes. See the New York Times article, Medicare Says It Won’t Cover Hospital Errors, for more information.
III. Helpful Information
Guide to CMS, SSA, and Plan Mailings -- Summer and Fall 2007
CMS has released a chart detailing the various mailings from CMS, SSA, and the plans to be sent to Medicare beneficiaries this fall. The chart includes information on steps that beneficiaries will need to take.
Updated Procedures for Low-Income Subsidy Redetermination
Recipients of the Low-Income Subsidy are currently being reevaluated to determine their eligibility for 2008. Both CMS and SSA are conducting redeterminations. The processes being used by SSA are different from those used last year, and require beneficiaries to take action. Please see our website for more information.
Higher Premiums for Part D in 2008
CMS anticipates that the actual average premium paid by beneficiaries for standard Part D coverage will be roughly $25 in 2008. This is lower than previous projections but higher than the $22 national average premium for 2007.
More Low-Income Beneficiaries Will Be Reassigned for 2008
CMS announced changes to the parameters for Medicare Part D. According to the calculations for benchmark plans, it appears that in 2008, more low-income beneficiaries will be reassigned to new plans, or subject to higher premiums if they do not change plans. Additionally, if a plan’s premium exceeds the benchmark by a “de minimis” amount, the plan does not charge those beneficiaries who qualify for the low-income subsidy a premium. The de minimis amount has been reduced from $2 in 2007 to $1 in 2008. See the press release from Families USA addressing this issue.
CMS Announced Payment Changes for Medicare Home Health Services
Currently, Home Health Agencies (HHAs) are paid prospectively for 60-day episodes of care. HHAs are paid at different rates depending on the care needs of patients, based upon their clinical severity, their level of function, and their usage of rehabilitation services. The CMS final rule implements a case-mix model that replaces the current therapy threshold of 10 visits per episode with three new therapy thresholds at 6, 14, and 20 therapy visits. Payments levels differ with the thresholds.
Tip Sheets: PDP and MA Complaints and Appeals
CMS has released two tip sheets: Medicare Prescription Drug Coverage: How to File a Grievance, Request a Coverage Determination, or File an Appeal and Medicare Advantage Plans and Medicare Cost Plans: How to File a Complaint (Grievance or Appeal).
2008 Part D Marketing Model Material Updates
On August 27, 2007, CMS released updated Part D marketing model materials for 2008. The materials, which are posted on the HAP website, are final and include:
Final 2008 Model Evidence of Coverage (EOC) Issued
On August 17, 2007, CMS released the final model 2008 Evidence of Coverage (EOC) for Medicare Advantage Plans, Prescription Drug Plans, and Medicare Cost Plans. If the mailing of the EOC and Annual Notice of Coverage (ANOC) are combined, individuals will receive the documents by October 31, 2007. If the EOC and ANOC are mailed separately, beneficiaries must receive the EOC by January 31, 2008 and the ANOC by October 31, 2007.
Premium Withholding Payment Reconciliation
In 2006, many people had incorrect amounts deducted from their Social Security payments to pay for Part D premiums. Some errors from 2006 remained in 2007. Medicare recently performed a premium withholding payment reconciliation process for people who had Medicare Advantage Plan or Medicare Prescription Drug Plan premiums withheld from their Social Security payments at any point during 2006. A CMS tip sheet describes those affected by the 2006 premium withholding reconciliation. A letter is being sent to beneficiaries who owe money to their plan.
The America's Health Insurance Plans (AHIP) Medicare Prescription Drug Plan Guide: How to Choose Your 2008 Plan is now available. This interactive online tool is designed to help individuals evaluate their prescription drug plan choices for 2008.
IV. HAP News and Resources
HAP Testifies at NAIC Hearing
The National Association of Insurance Commissioners Medicare Private Plans subgroup held a public hearing on September 11, 2007. HAP’s testimony focused on common problems and issues reported by SHIPs across the country, including the abusive marketing practices of Medicare Advantage plans, systemic issues resulting in delays in the processing of beneficiary disenrollments from Medicare Advantage and Part D plans, and the unprecedented increase in private plan offerings, which makes it difficult for beneficiaries to make informed decisions. Thank you for sharing your insight and experiences with us.
Website Updates
HAP would like to highlight the Volunteer Management section of our website. Within this section are tools that help SHIPs start shaping a volunteer program or enhance an existing program. The Volunteer Program Toolkit contains dozens of tools to build a volunteer program and, the Volunteer Programs page provides a list of potential volunteer partners.
HAP Bids Farewell to Steve DeRosa
HAP is sad to announce the departure of Steve DeRosa, our Web Tools Project Manager, who was responsible for the day-to-day implementations of SHIPTools. SHIPTools is a web-based application developed this year by HAP to assist SHIPs in their capacity building efforts to serve more Medicare beneficiaries. HAP staff extend our warmest wishes to Steve and his wife in their next adventure teaching English in Morocco! HAP expects to fill the position vacated by Steve in early October. In the meantime, should you have any questions regarding SHIPTools, please do not hesitate to contact HAP’s Director of Technology, Rachel Gussett-Williams. | 
