|
In February's Issue:
HAP HAPpenings
CMS News
-
2009 Federal Poverty Levels Guidelines Released
-
CMS Issues Rule on Part D Protected Drug Classes
-
Suspension of WellPoint Enrollment and Marketing
-
Best Available Evidence Policy
-
Medicare Expands Coverage of Off-Label Cancer Drugs
Interesting Items
- Engaging Boomers: A New Webinar Series
- MIPPA Funding Opportunities Now Available
- Improving Access to Care for Limited English Proficient Beneficiaries
- Health Affairs Examines Medicare Payment Policies
|
Best Practices
Michigan's Strategies for Success: Motivating Local SHIP Sites
- This Best Practice package describes strategies you can use to motivate your local SHIP sites for success.
| |
|
|
|
HAP HAPpenings
HAP’s February Call Is a Webinar
This month, HAP is hosting a webinar in response to your requests for more interaction during our monthly calls. The topic is SHIP Certification. Check the website for information about how to participate.
Learn More about the State of the SHIPs
HAP recently released a summary of state SHIP program priorities and needs collected from a survey of state SHIP directors last fall. The survey covered topics ranging from training, certification, volunteer program development, and reporting, to issues that most commonly affect Medicare beneficiaries.
The summary provides an interesting snapshot of the SHIP community from a state-level perspective. We plan to share it widely with key decision-maker audiences in Washington, D.C. and beyond in order to reinforce the critical role SHIPs play in helping millions of beneficiaries obtain and navigate Medicare. We also encourage SHIP programs to think of the summary as a communication tool that they can use to help inform and educate important local stakeholders about the value of SHIPs in the community.
|
|
| We welcome your comments and suggestions. Email us at SHIPhelp@hapnetwork.org. |
Apply Now:
Collaborative
State Projects
HAP is pleased to offer its Collaborative State Projects for 2009/10. For the 2009 SHIP Grant Year, we will work collaboratively with three SHIPs on volunteer recruitment and management. For more information, please refer to the CSP Resource Center. | |
Back to the Top
CMS News
2009 Federal Poverty Levels Guidelines Released
On January 23, the Federal Register published the Federal Poverty Levels for 2009. Many means-tested programs, including Part D Extra Help and the Medicare Savings Programs, use these income thresholds to calculate eligibility for assistance. The following HAP tools are updated to reflect the latest figures:
CMS Issues Rule on Part D Protected Drug Classes
On January 16, CMS published a final interim rule in the Federal Register that changes the Part D regulations to comply with a provision from the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. This provision directs CMS to identify and cover new protected drug categories and classes to ensure beneficiaries can obtain drugs used to treat depression, epilepsy, cancer, and HIV. In its background discussion, CMS said that it will conduct an extensive examination of widely used treatment guidelines before it establishes the protected drug categories and classes.
Current policy already requires Part D formularies to include all, or substantially all, drugs in the following six classes: antidepressants, antipsychotics, anticonvulsants, immunosuppressants, antiretrovirals, and antineoplastics. Any changes that CMS makes to these protected classes would take effect for contract years 2011 and beyond. CMS said that it could not complete its analysis of the protected drug classes before the April 2009 due date for 2010 formulary submissions.
The rule also requires, for the first time, that Part D plan sponsors use the same definition for a “medically accepted indication” for anti-cancer drugs that is used in Medicare Part B. Thus, Part D plan sponsors will use Part B compendia and potentially use peer-reviewed medical literature to determine off-label uses for anti-cancer drugs. This change took effect Jan. 1, 2009.
Suspension of WellPoint Enrollment and Marketing
On January 12, CMS notified WellPoint, the sponsor of many Medicare plans, of sanctions against it. These sanctions prohibit WellPoint from marketing and enrolling people in their Part D and Medicare Advantage plans. CMS cited that the suspension was due to systemic issues that WellPoint had in a variety of areas, including issues related to enrollment, low-income subsidy benefits, premiums, marketing, appeals, and grievances. Essentially, WellPoint failed to provide coverage and service as required by CMS.
Additionally, the pharmacy Point of Sale (POS) system allows dual-eligible beneficiaries who are not enrolled in a plan to have safety-net Part D coverage through WellPoint. However, until CMS lifts sanctions on WellPoint, the POS system will not assign these beneficiaries to any WellPoint benchmark plans. The POS process provides immediate coverage of drugs and then enrolls the dual-eligible beneficiary into a random Part D plan below the low-income benchmark. SHIPs can access more information about the POS system on CMS's website.
Further, while these sanctions may protect more beneficiaries from the poor compliance of WellPoint, many Medicare beneficiaries already are enrolled in WellPoint plans. Since CMS did not impose the sanctions until after the end of the Annual Enrollment Period, WellPoint likely has new enrollees. All WellPoint enrollees, including new enrollees, may experience issues with their plans, and SHIP counselors should be aware that these enrollees may require special assistance navigating the plans. CMS has notified SHIPs that WellPoint enrollees who have had trouble obtaining services through their plans should contact 1-800-Medicare for assistance with addressing the issues.
Best Available Evidence Policy
As a reminder to SHIP counselors, all plans must allow low-income beneficiaries whose LIS status is entered incorrectly in the computer systems to provide evidence to the plans about their correct status. If such evidence is not available, plans must work with these beneficiaries to obtain the evidence and also to correct the computer systems. More information about this Best Available Evidence (BAE) policy is available on CMS's website.
Finally, if you have trouble with utilizing best available evidence with a plan or with CMS, please contact us at SHIPhelp@hapnetwork.org.
Medicare Expands Coverage of Off-Label Cancer Drugs
A number of recent news stories are focusing on the Medicare rule issued this past November that will significantly expand the program’s coverage of off-label drugs for cancer treatment. Proponents say that using off-label drugs that are not yet approved by the Food and Drug Administration (FDA) to treat cancer will allow patients access to the most up-to-date care and also give health care providers greater flexibility in prescribing cancer treatment regimens, especially with some rare types of the disease.
Critics of the rule cite concerns about the limited clinical evidence of drug effectiveness in off-label treatments. They have also raised questions about the influence of drug manufacturers on the new guides Medicare uses to authorize drug use for certain types of cancers. No estimate is available on how much the new rule will increase federal drug spending beyond the $2.4 billion Medicare paid for cancer drugs in 2007.
More information is available in the following articles:
Back to the Top
Interesting Items
|
MIPPA Funding Opportunities Now Available
The U.S. Administration on Aging (AoA) and the Centers for Medicare & Medicaid Services (CMS) announced that they are accepting applications for $25 million in grants from SHIPs, AAAs, and ADRCs for grant funding. This funding was made available due to provisions in the Medicare Improvement for Patients and Providers Act (MIPPA) of 2008.
Improving Access to Care for Limited English Proficient Beneficiaries
A series of recently released reports found that beneficiaries with limited English proficiency (LEP) face general challenges in obtaining both information and care from the Medicare program.
1-800-Medicare is the most common way for beneficiaries and other members of the public to get information on Medicare, and CMS currently provides information to both English-speaking and LEP beneficiaries. CMS has made efforts to better serve these populations. A Government Accountability Office (GAO) study, Callers Can Access 1-800-Medicare Services, but Responsibility within CMS for Limited English Proficiency Plan Unclear, reported that CMS’s efforts to provide Spanish-speaking callers with access to 1-800-Medicare have led to, on average, shorter wait times for service. However, the effort does not link consistently to the larger LEP plan at the Department of Health and Human Services (HHS). The study says CMS is lacking guidance from HHS on how to better align their LEP efforts with the HHS LEP plan on issues such as the need for complaint mechanisms for language issues.
A recent bulletin issued by the AARP Public Policy Institute, Improving Access to Care among Medicare Beneficiaries with Limited English Proficiency: Can Medicare Do More? found that language barriers prevent many thousands of Medicare beneficiaries from obtaining the care they need, and that communication failures in health care settings between patient and provider often lead to poor health outcomes, medical errors, and increased costs. CMS currently addresses the language access issue through a number of demonstration projects to test new methods and potential program changes.
Other policy options CMS should consider to improve language services for Medicare beneficiaries include:
- Extending reimbursement for interpreter services in fee-for-service Medicare
- Increasing the language options on the CMS web site
- Improving the collection of race and ethnicity data on Medicare beneficiaries
- Approaching language and cultural access as important quality measures at every level of care
Reducing language barriers in Medicare not only helps reduce racial and ethnic disparities in health care, but also helps to improve the quality of care that Medicare beneficiaries receive.
For more information on how to tackle racial and ethnic health disparities within the Medicare population and the recent MIPPA provisions on addressing cultural competency standards, see the report released by Families USA, Medicare Improvements for Patients and Providers Act of 2008: Addressing Racial and Ethnic Health Disparities. |
|
|
Engaging Boomers: A New Webinar Series
Your organization may be using volunteers to help fulfill its mission already — but is it ready to harness the skills, experience, and passions of the baby boomer generation?
If not, a new webinar series from VolunteerMatch is the answer! Each webinar in the series explores a different aspect of a process proven to help nonprofits successfully engage baby boomers as high-impact volunteers. You can take the webinars in sequence or individually.
Please note you must participate in these webinars live. Part I has already occurred and is no longer available. However, you can join the other three sessions as stand-alone trainings.
Part I: Introduction and Overview
1/29 | 3 p.m. EST
Part II: Structuring for Innovation
2/26 | 3 p.m. EST | Register
Part III: Creating Positions, Networking, and Cultivation
3/26 | 3 p.m. EST | Register
Part IV: Sustaining the Collaboration
4/23 | 3 p.m. EST | Register
| |
Health Affairs Examines Medicare Payment Policies
On January 27, Health Affairs published a web exclusive article about Medicare payment reform. The article explores a potential update to the structure of the system Medicare uses to pay providers. In the new structure, Medicare would use payment incentives for providers to coordinate care more effectively, to reward high-quality care and high performance, and to follow evidence-based medicine.
While some may say that Medicare spending contributes to the ever-expanding costs of health care, many others argue that Medicare’s costs are rising along with the rest of health care system. The payment systems proposed in this article may very well improve the value for each health care dollar Medicare spends and, at the same time, serve as a model for health system fixes on a larger scale.
At Families USA's Health Action 2009 conference, one of the authors of this article, Stuart Guterman, along with Patricia Nemore from the Center for Medicare Advocacy, and Juliette Cubanski from Kaiser Family Foundation spoke about the sustainability of Medicare. The take-home message from this workshop is Medicare is a critical and necessary component of the U.S. health care system, and making the Medicare program more effective in terms of quality and cost would help to better serve the needs of Medicare beneficiaries. These presentations and more are available at the Families USA website. |
Back to the Top | Back to HAP's Homepage
