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I. HAP HAPpenings
- Thanks: HAP's Collaborative State Projects
- New Tool: HAP’s MA Counseling Guide
II. Highlights from CMS
- Beneficiaries Receiving Termination Letters Have Special Enrollment Period
- CMS Continues Initiative to Improve Poorest Performing Nursing Homes
- Beneficiaries and Physicians Can Request Prior Determinations
III. Items of Interest
- Seniors Must File Tax Return to Receive Economic Stimulus Check
- Generic Form of Fosamax Now Approved
- Congress to Curb MA Plan Marketing and Sales Abuses
- Congress Busy with Medicare Advantage Hearings
- Commonwealth Fund Special Needs Plans Resources
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Nebraska Creates Comprehensive Medicare Advantage Guide
When Nebraska's Medicare Advantage (MA) plans grew by 100 in just one year, Nebraska invested in the creation of a 43-page MA guide that lists basic information on all 140 plans available in Nebraska. This objective guide helps SHIP counselors, partners, and beneficiaries easily compare MA plans by area and coverage.
Learn more about creating a MA guide for your program at HAP's Celebrating SHIP Successes page.
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I. HAP HAPpenings
Thanks: HAP's Collaborative State Projects
HAP received a number of excellent applications for this year's Collaborative State Projects (CSPs). We appreciate your interest in partnering with HAP.
HAP will announce the four states selected for the 2008-2009 CSPs this Friday, March 14, 2008.
New Tool: HAP’s MA Counseling Guide
Based on your feedback regarding the need for beneficiaries to have reference tools other than sales materials when choosing an MA plan, HAP has created a series of step-by-step Counseling Guides, including the newest addition on Special Needs Plans (SNPs).
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II. Highlights from CMS
Beneficiaries Receiving Termination Letters Have Special Enrollment Period
The week of March 2, a small group of Low-Income Subsidy (LIS) beneficiaries will receive an "SSA Medicare Prescription Drug Assistance Notice of Termination" letter. The Social Security Administration (SSA) has created a fact sheet to answer anticipated questions.
Affected beneficiaries have a three month Special Enrollment Period (SEP), which will allow them to change to a Part D plan that is affordable without the "extra help" provided by LIS. Individuals can reapply for LIS or file an appeal with SSA by calling 1-800-772-1213. Appeals must be made within 10 days of receipt of the letter to ensure that LIS benefits continue during the appeal process. Individuals who get this letter are encouraged to call SSA immediately to file an appeal.
CMS Continues Initiative to Improve Poorest Performing Nursing Homes
CMS announced an additional 27 nursing homes targeted in its Special Focus Facilities program for underperforming nursing homes. The current list expands upon the nursing homes announced in November 2007 and now totals 136 nursing homes nationwide.
Beneficiaries and Physicians Can Request Prior Determinations
On February 22, CMS published a final rule (73 Fed. Reg. 9679) that establishes a process for beneficiaries and physicians to ask Medicare if a service will be covered before it is provided. Medicare only covers services deemed to be “reasonable and necessary.”
Under the new rule, effective March 24, 2008, both physicians and Medicare beneficiaries can discover whether a recommended service will be viewed as reasonable and necessary before the service is provided. The “prior determination” request to the claims contractor must include supporting documentation. The contractor will have up to 45 days to respond to the request. Any determination made by the contractor will be binding unless there is fraud or misrepresentation by the physician or beneficiary when requesting the prior determination of coverage.
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III. Items of Interest
Seniors Must File Tax Return to Receive Economic Stimulus Check
Nearly 20 million Americans who rely primarily on Social Security payments may receive a $300 or $600 check from the federal government as part of an economic stimulus package, but they must file 2007 tax returns to qualify.
Those eligible must have at least $3,000 in annual income from Social Security benefits, Veteran's Affairs benefits, and/or Railroad Retirement benefits. Individuals who receive a check will not experience a loss of, or reduction in, their needs-based benefits (i.e. Medicaid, food stamps).
The Internal Revenue Service has created a fact sheet that can be used by SHIP counselors and other advocates who are in frequent contact with seniors.
Generic Form of Fosamax Now Approved
On February 6, the Federal Drug Administration (FDA) announced approval of a generic version of Fosamax, called alendronate. Fosamax, used to treat osteoporosis, is one of the most frequently prescribed drugs for Medicare beneficiaries.
Congress to Curb MA Plan Marketing and Sales Abuses
Congressional leaders have made it clear that legislation is needed to protect Medicare beneficiaries from abusive Medicare Advantage marketing and sales practices. On March 3, Senators Rockefeller (WV) and Snowe (ME) introduced a bill (S.2687) that, if passed, would prohibit some marketing abuses, such as telemarketing and door-to-door cold call solicitations, both by stand-alone prescription drug plans and Medicare Advantage plans. Plans also would be prohibited from providing beneficiaries incentives to enroll.
The bill would allow beneficiaries more time to make annual enrollment decisions, and it would require plans without provider networks to disclose the names of providers who have refused to serve the plans' enrollees. Read a summary of the bill, provided by Senators Rockefeller and Snowe.
Congress Busy with Medicare Advantage Hearings
On February 13, the House Ways and Means Committee held a hearing on President Bush’s budget proposals for fiscal year 2009 for the U.S. Department of Health and Human Services, with testimony given by Michael Leavitt, Secretary, U.S. Department of Health and Human Services.
In announcing the hearing, Chairman Charles B. Rangel said, “The President’s budget calls for unprecedented deep cuts to traditional Medicare. We should be working together to strengthen Medicare for future generations, not undermining it.” House Democrats accused the Bush administration of attempting to privatize Medicare via its budget proposal in which reimbursements to traditional Medicare providers are reduced but payments to Medicare Advantage plans are left mostly intact.
On February 14, the House Ways and Means Subcommittee on Health held a separate hearing on the Medicare portions of the President’s fiscal year 2009 budget, with testimony given by Kerry Weems, Acting Administrator, Centers for Medicare and Medicaid Services.
In announcing the hearing, Chairman Pete Stark said, “The proposed Medicare cuts exclusively target traditional fee-for-service Medicare providers, while protecting the overpayments to private insurance companies that drain Medicare solvency and raise beneficiary premiums. This budget again reveals the Administration’s agenda to starve traditional Medicare and force beneficiaries and providers to rely on private plans. I look forward to hearing Acting Administrator Weems explain how these budget proposals are in the best interest of beneficiaries, providers and the overall strength of the program.”
Visit HAP’s What’s HAPpening center for summaries of additional hearings, meetings, and policy analyses, including:
- February 28, 2008 House Ways and Means Subcommittee on Health Hearing on Medicare Advantage
- February 7, 2008 Senate Finance Committee Hearing Selling to Seniors: The Need for Accountability and Oversight of Marketing and Sales by Medicare Private Plans
- January 22, 2008 GAO report on Medicare Part D: Plan Sponsors' Processing and CMS Monitoring of Drug Coverage Requests Could Be Improved
New Special Needs Plans Resources from The Commonwealth Fund
The Commonwealth Fund recently released two new issue briefs that provide an overview of Special Needs Plans (SNPs) and discuss different models that states can use to link Medicaid programs to SNPs.
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