In February's Issue:

Editorial Note: We apologize for the delay in posting the February eNewsletter. The Washington, D.C., region was hit with record snow falls the week of February 7 and our offices were closed.

HAP HAPpenings

• Annual State of the SHIPs Report Now Available
• Spotlight on HAP: Looking Ahead in 2010
• SHIPs Share in Spirited Discussions at Health Action 2010
• HAP's Conference Call Roundup
• Newly Developed Medicare Education and Counseling Tools

CMS News

• Update from the OMO, Revised Publications for Your Clients

Interesting Items

• Increasing Demand of Services Needed

HAP's Extra Hand Counseling Guide on Persistent Access to Care Issue Now Available What's Next For Troubleshooting Medicare?

Newly Developed Medicare Education and Counseling Tools
HAP recognizes that SHIP programs have a daunting task to meet the needs of a growing and diverse Medicare population, most of which is done with limited resources and time. This past year, HAP in collaboration with two state SHIP programs — Alabama and Montana — worked closely to develop and pilot a variety of Medicare education and counseling tools to better serve clients' and programs' needs. As the collaboration projects come to close and these tools are complete, HAP is happy to share these resources with the entire SHIP network. We encourage you to customize these tools to meet both your program’s unique needs and the beneficiaries you serve.

Help Train and Retain Counselors
There are many steps to counseling clients on Medicare Advantage (MA) and Part D, from reviewing plan choices, screening for assistance programs, to considering other options such as Medigap plans or retiree coverage, and the list goes on and on. With all these steps to keep in mind, counselors need their game hats on and their handy references within reach. The Alabama SHIP recognized that before they could begin recruiting volunteers to their SCREAM Team they needed to empower counselors with the appropriate counseling skills as well as the substantive knowledge. Under a HAP Collaborative State Project (CSP), the Alabama SHIP and HAP developed a series of counseling tools to empower and equip counselors while also serving the program as a means of quality assurance.

• Task-Based Analyses — These step-by-step instructions (using Washington's task-based analysis on long-term care counseling as a model) help deconstruct the counselors’ experience and make it easier for counselors to keep track of what to review and where to go next. The analyses also offer a program the opportunity to prepare new counselors for what to expect when counseling. HAP and the AL SHIP developed two analyses: Counseling on Medicare Advantage and Counseling on Part D.
• Easy-to-Read Appeals Flowcharts — Need a handy, one-page visual reference that helps explain the appeals process to new and seasoned counselors? HAP in collaboration with the Alabama SHIP created just this tool, to help capture the stages of appeals in both Original Medicare and in the Part D appeals processes. The charts quickly review the main points: who to contact at each stage, length of time allotted for each stage, and if applicable, the maximum amount in controversy.
• Eligibility Screening Tool — Most local programs have developed a handy reference for counselors to use that helps them screen clients for eligibility into assistance programs, such as the Part D low-income subsidy (LIS) and Medicaid. Here's another such tool to equip counselors with during their counseling sessions when screening for program income and asset limits. Customize this eligibility chart with your state's requirements!
• Troubleshooting Directory — Wondering how to help empower your counselors on where to go and who to contact on any given client inquiry? Consider our Troubleshooting Directory — a handy compilation of common Medicare topics and their appropriate contacts, similar to a Numbers to Know you'd post on your refrigerator! This directory captures common counselor questions, such as secondary payer issues to Plan Finder problems, and offers a follow-up person or place to go to for help. SHIP programs can use this directory as a model and customize your own unique contact list to getting help in your area.

Introducing Medicare Advantage (MA) into Your Training Program
It's no secret that the words Medicare Advantage (MA) can send Medicare beneficiaries into a state of confusion and panic. Many counselors can be overwhelmed at the thought of educating beneficiaries on the various types of MA plans. As part of a Collaborative State Project (CSP), HAP helped the Montana SHIP become more comfortable with counseling their clients on Medicare Advantage by working with them to design and implement a comprehensive Medicare Advantage (MA) training and certification program that meets the needs of SHIP counselors, beneficiaries, and volunteers. Together, HAP and the Montana SHIP developed a set of innovative tools that deliver information in a variety of ways and build knowledge, skills, and counselor confidence.

• Get Your Feet Wet — This tool provides an overview of SHIP and the Medicare program to new counselors. While the information can be shared during an initial training to provide a foundation, it can also be used as a tool to screen prospective volunteers who may find that the SHIP volunteer experience does not match their expectations or preferences. By providing Get Your Feet Wet before an initial training, some may decide that SHIP is not the right volunteer opportunity for them before attending a training — saving your program both time and resources!
• Make More of Your Mileage: Medicare Advantage Counseling Scenarios — This audio training allows counselors in Montana to make the most of their windshield time. It includes two counseling scenarios, follow-up questions, and counseling tips. The audio training, relevant in all areas of the country, can be used by an individual as a self-study tool or in group setting that allows for role-play and discussion. Download the audio training scenarios to get started.
• Medicare Advantage Overview — This slideshow (which includes speaker notes) provides a comprehensive overview of the Medicare Advantage (MA) program including types of plans, eligibility and enrollment, costs, marketing, and grievances and appeals as well as counseling activities for training participants.
• Mining the Manuals: Build Your Skills to Find Answers — This slideshow is designed to build counseling skills, including issue spotting and researching an answer, so that counselors are empowered and equipped to provide timely and accurate information. It includes a step-by-step process and group activities that allow participants to practice their skills.
• Medicare Advantage Manual — This training manual provides an introduction to the Medicare Advantage (MA) program, including eligibility, enrollment, coverage and cost issues. It includes counseling tips, referred to as SHIP Tips, counseling scenarios or examples, and references to additional resources. The manual can be used as a self-study tool and also as a reference guide during or after a counseling session. (Access our other SHIP Resource Guides here.)
• Medicare Advantage Review — This review, available online in SHIPTools, can be used to gain a better understanding of a counselor's knowledge of the Medicare Advantage program. Used alone or as part of a comprehensive certification program, this review can build counselor confidence while also identifying areas where additional training is needed.

Please look for volunteer recruitment and training tools developed under Collaborative State Projects (CSPs) with the Colorado SHIP and the Virginia SHIP in our March eNewsletter.

2009 FPL Guidelines to Remain in Effect

On January 22, the Department of Health and Human Services (HHS) released a notice in the Federal Register to announce that 2009 Federal Poverty Level (FPL) guidelines would remain in effect until at least March 1, 2010. Poverty levels affect access to needs-based programs for millions of Medicare beneficiaries. HHS will issue updated levels for 2010 no sooner than March 1.

HAP's Extra Hand

Counseling Guide on Persistent Access to Care Issue Now Available
HAP launched the Troubleshooting Medicare project to help identify the persistent and systemic issues negatively affecting beneficiaries and to help improve the Medicare program as a whole.

HAP alerted the SHIP network last summer to a persistent care coordination issue affecting people enrolled in the Qualified Medicare Beneficiary (QMB) program. The QMB program is designed to assist Medicare beneficiaries with low incomes and assets with Medicare Part A and B premiums, deductibles, and coinsurance. People who qualify for the QMB program are also automatically eligible for the low-income subsidy (LIS, also known as “Extra Help”) which helps to pay for the premium, deductible, and copayments for a Part D prescription drug plan.

SHIPs in a number of states reported that their QMB clients were being improperly billed for Medicare cost-sharing amounts by health care providers even though beneficiaries in the QMB program are entitled to full relief from Medicare cost-sharing under the law. As a result of the feedback we received from the SHIP network, it became clear that the problem of people enrolled in QMB having to absorb Medicare cost-sharing charges was emerging as an important access to care issue that affects the most vulnerable of beneficiaries in both Original Medicare and Medicare Advantage (MA) plans. This is particularly true in those states that haven’t established a system for processing billing claims from Medicare-only or non-Medicaid participating providers, and in states where the Medicaid reimbursement rate is significantly lower than the Medicare reimbursement rate. In response, HAP developed the following resources and information tools to support SHIPs when working with QMB clients:

• Getting Started: What SHIPs Need to Know
• Moving Forward: A Guide to CMS Policy on Cost-Sharing for Qualified Medicare Beneficiaries
• Key Terms: QMB and Medicare Cost-Sharing

After many months of listening to your feedback and hearing your stories, we're ready to release the next set of practical counseling tools – Putting It into Practice: Tools to Help QMB Clients. The counseling tools range from topics on how to help QMB clients in Original Medicare or Medicare Advantage (MA), to screening questions that help ensure clients can fully access the QMB benefit.

In the meantime, HAP continues to make informed recommendations to policymakers on improving coordination of care for the QMB program as a whole. Please e-mail us to learn how you can report your experiences with this issue. You can also visit our Troubleshooting Medicare Web page to learn more about this project.

What's Next For Troubleshooting Medicare?
Next up in the Troubleshooting Medicare project, HAP will examine the issue of Medicare coverage notices and due process. It's an important beneficiary protection issue that not only affects access to care, but also influences a beneficiary's ability to understand coverage decisions. As you know, Medicare, its payment contractors, and health care providers give written notices to beneficiaries in order to provide information about coverage, payment, and claims — including decisions to deny payment, or to reduce or discontinue services.

HAP is interested in hearing from you about any issues your clients are experiencing around Medicare Summary Notices (MSNs), Advance Beneficiary Notices (ABNs), or Coverage Termination notices. In particular, we want to know if beneficiaries are receiving incomplete or inappropriate coverage decision notices given to them by Medicare's payment contractors, health care providers, or Medicare Advantage (MA) plans. The information you provide will help HAP to determine the scope of the problem and its impact on SHIP clients and counselors alike. Share your feedback now, and stay tuned for further updates.