• New Staff Member Joins HAP Communications Team
• SHIP Directors Conference: HAP Reception Roundup
• What’s New with HAP’s Project to Help Medicare Beneficiaries?
• Ready Your SHIP: What You Need to Know about MIPPA for 2010
• Comments on CMS’s Draft PDP and MA Enrollment Guidance
• Want to Make Your SHIP More Buoyant?

• Helping SHIPs Prepare for Upcoming Plan Non-Renewals
• CMS Releases 2009 Corrective Action Plan
• CMS Releases Proposed 2010 Budget

Interesting Items

• Social Security Trustees Release Annual Report
• Quick-Look-at-States Fact Sheets

HAP's Extra Hand HAP Advisory Alert: Providers and MA Plans Cannot Bill QMBs for Medicare Cost-Sharing

New Staff Member Joins HAP Communications Team
HAP is excited to welcome Monica Garreau to the communications team. Monica will serve as HAP’s Communications and Web Associate. Her responsibilities will include developing communications tools and products, coordinating and preparing updates to the SHIP network, and managing the HAP website.

Prior to joining HAP, Monica served seven years in the U.S. Army as a Public Affairs specialist in photojournalism, community relations, and media relations. She also brings experience in corporate and nonprofit web design.

Welcome aboard, Monica!

SHIP Directors Conference: HAP Reception Roundup

Thank you again to all of you who stopped by the May 27 HAP reception at the SHIP Directors Conference. Attendees included state and local SHIPs, members of the Medicare advocacy community, and CMS and AoA staff. Terrific musical talent was generously provided by the CMS Sensations, a group that includes Mark Manfredi (CMS San Francisco Regional Office), John Manfredi (Mark’s brother), and David Sayen (CMS San Francisco Regional Office). The performance included the song “We Are Family,” customized especially for the SHIPs. Also much appreciated was the impromptu trio of state directors that joined the band for a few medleys!

We loved having a chance to salute the SHIP community in person, and we hope you’ll join us again next year!

HAP Resources from the SHIP Directors Conference:

• HAPSavers:
  • Webinar Overview
  • Picking a Webinar Vendor
  • Hosting a Good Webinar
• SHIPTools: Online Tour
• Presentations:
  • Successful Volunteer Training Programs: Going for the Gold with a Role-Based Model
  • SHIP Certification - Strategies for Ensuring Competence and Confidence
• Make More of Your Mileage: Medicare Advantage Counseling Scenarios CD
• SHIP Resource Guides:
  • Medicare Basics
  • Medicare Advantage
  • Medicare Part D

What’s New with HAP’s Project to Help Medicare Beneficiaries?
The Health Assistance Partnership (HAP) is continuing to work on its new project to identify and address persistent issues that affect beneficiaries across the Medicare program. In our April eNewsletter, we introduced our plans to capture the systemic issues frequently encountered by Medicare beneficiaries. We intend to use the findings to develop system-change policy recommendations that will help improve the Medicare program as a whole for all Medicare consumers.

SHIPs are a local access point to the Medicare program and are among the first to spot issues and trends that adversely affect beneficiaries. The information and perspective you provide will drive this project, and we want to hear from you.

Stay tuned for more news on the data collection module we will be launching for the SHIP network in July. The data collection module will allow SHIPs to capture and share information on the specific issues they’re seeing in the field. HAP will use the information provided by the SHIP network to develop a series of system-level Medicare program improvements to policy makers in the coming year.

In the meantime, feel free to contact us directly with questions and suggestions at SHIPhelp@hapnetwork.org.

Ready Your SHIP: What You Need to Know about MIPPA for 2010
The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 made notable changes to the Medicare program. Several of these key changes are specific to the Part D low-income subsidy (LIS) program and become effective in 2010.

We know SHIPs are making preparations now - whether it’s updating fall counselor trainings or building partnerships with state Medicaid offices - in anticipation of stepped up Medicare Savings Program enrollment. HAP encourages you to join our June 17 conference call to learn more about how your program can prepare for the MIPPA provisions scheduled to take effect in 2010.

In the meantime, stay tuned for our eAlert on how to join the call, and don’t forget to try our special MIPPA: 2010 edition of Check Your Skills to see how much you already know about MIPPA.

HAP looks forward to helping your SHIP prepare for the opportunities and challenges in the coming AEP!

Comments on CMS’s Draft PDP and MA Enrollment Guidance
Each year, CMS updates chapters within its Medicare manuals to include additional language for clarification or relevance. In May, it released draft versions for comments on two specific chapters - Chapter 3 of the Medicare Prescription Drug Benefit Manual and Chapter 2 of the Medicare Managed Care Manual. As SHIPs know, these chapters provide important enrollment guidance that is essential when it comes to counseling Medicare beneficiaries. The chapters cover eligibility; enrollment periods, such as Annual Enrollment Period (AEP) and SEPs (Special Enrollment Periods); as well as procedures for enrolling and disenrolling beneficiaries.

HAP understands that the information addressed in the two chapters needs to reflect the important questions and issues that SHIPs encounter when they are assisting beneficiaries. As a result, our recommendations to CMS on the MA Enrollment Guidance and the PDP Enrollment Guidance emphasized making both chapters as user-friendly as possible and included specific suggestions on clarifying information and improving readability.

We will continue to make your needs and concerns known to CMS. If you have questions about HAP’s comments, or if you have suggestions for further improvements to CMS’s manuals, please contact us.

Want to Make Your SHIP More Buoyant?
Here are tools to help you do just that. Use and customize these materials to your SHIP program to get valuable feedback from your clients and volunteers:

• SHIP Client Satisfaction Survey
• SHIP Volunteer Evaluation Form

Take a few minutes to use these tools to get your SHIP crew on board for the next AEP!

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Quick-Look-at-States Fact Sheets
A useful new resource provides a snapshot of Social Security’s role in lifting retirees out of poverty. The fact sheets provide an overview of each state including information on the state's older population, average personal income, and Social Security's income percentages among older residents' income.

HAP's Extra Hand

What the Law Says: It is against the law for providers or MA plans to bill QMBs for Medicare cost-sharing costs. The law that established the QMB program does not require states to pay Medicare’s deductibles, coinsurance, or copayment charges if the Medicare payment (including an MA plan payment) for a given service or procedure is greater than the Medicaid payment rate. In most cases, this means that physicians and other providers who serve QMBs must accept the Medicare payment as payment in full and write off the cost-sharing charge. In addition, states have the option of paying an MA plan’s monthly premium on behalf of a QMB.

Despite the fact that Medicaid may not cover the full amount of a coinsurance or copayment charge, Medicare law states that a Qualified Medicare Beneficiary has no legal liability for payment to a provider or to a Medicare Advantage plan for these charges. In other words, providers cannot balance bill QMBs for any Medicare cost-sharing charges including MA plan copayments for office visits, consultations with specialists, and Durable Medical Equipment (DME).

The Providers’ Role: Some providers justify their balance billing practices by claiming they do not participate in the Medicaid program. It is important to know that, for purposes of providing services to QMBs, providers can enter an agreement with their state Medicaid agencies simply by submitting a claim for Medicare cost-sharing charges on behalf of a QMB.

Providers who balance bill QMBs are subject to penalties, including civil monetary penalties, under Medicare or Medicaid law. It’s unlikely that most physicians know about the rules and the sanctions they could face for violating them.

What SHIPs Can Do: SHIP counselors are in a good position to educate providers about their responsibilities to QMB patients. When providers repeatedly balance bill, SHIPs should report the problem to their CMS Regional Office. For more information on these rules, see CMS’s memo on the subject of Medicaid Obligations for Cost-Sharing in Medicare Part C Plans.

Has a QMB-eligible client reported this problem to your SHIP? Let us know, and HAP will continue to work with other Medicare advocates to make sure providers are aware that they cannot balance bill Qualified Medicare Beneficiaries (QMBs) and QMBs with full Medicaid benefits (QMB Plus).