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I. HAP HAPpenings
II. Highlights from CMS
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CMS Releases Part D and Low Income Subsidy Data by State
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CMS Releases New Model Explanation of Benefits for Part D Plan Usage
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CMS Announces Moratorium on New Special Needs Plans (SNPs)
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HAP’s Resources Reflect 2008 LIS Income and Resource Limits
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Part D Costs Less Than Expected
III. Items of Interest
- HAP’s Comments Focus on CMS Beneficiary Protections and SHIP Counseling
- Senate Finance Committee Holds Two Hearings on Medicare Advantage
- Kaiser’s 2008 Medicare Part D Resources
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Missouri SHIP Site Empowers Caregivers with Medicare 101 Training
Westport Cooperate Services (WCS), a SHIP sponsor site in Missouri, provides a Medicare 101 workshop for caregivers and beneficiaries to expose them to the range of services available through the Medicare program. By providing a basic understanding of what should be covered, caregivers are better able to see “red flags” and know that the local SHIP is there to help.
Learn more about how an education campaign might work for your SHIP program by visiting HAP's Celebrating SHIP Successes page. | |
I. HAP HAPpenings
Apply Now: HAP's Collaborative State Projects
HAP is seeking four states for its 2008-2009 Collaborative State Projects (CSPs), a 12-month engagement in which HAP provides customized assistance to help SHIPs expand upon and strengthen existing practices and/or planned initiatives.
The goal of a CSP is to develop innovative and replicable models that can be shared throughout the SHIP network. This year's projects are designed to meet two of SHIPs' expressed needs—volunteer program development and Medicare Advantage counseling challenges. More specifically, HAP would like to work with SHIPs in the following areas:
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Medicare Advantage Training and Counseling: Design and implement a customized program that effectively prepares a SHIP for the challenges associated with educating and counseling beneficiaries about Medicare Advantage plans. This CSP aims to explore new methods of preparing a SHIP team to manage the complex array of beneficiary requests regarding the Medicare Advantage program.
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Volunteer Recruitment Strategies: Design and implement a customized volunteer recruitment plan based on work undertaken in HAP's 2007-2008 Alabama CSP, including the development and testing of a volunteer recruitment toolkit. The final products of this CSP will include volunteer recruitment materials and methods that are practical and replicable in many communities.
| If your program is interested in partnering with HAP for the coming year, we invite State Directors to complete our online application by Friday, February 22, 2008. |
For more information, please visit the CSP Resource Center or contact Lee Thompson at 202-737-6340 or infohap@hapnetwork.org.
New Tool: HAP's PFFS Counseling Guide
Based on the feedback you give us about our HMO counseling tool, HAP has created a new step-by-step PFFS Counseling Guide.
We will check in with you about how this tool is working. In the meantime, please don’t hesitate to contact Kristi at infohap@hapnetwork.org with suggestions about how we can improve this or other tools for you and your team.
II. Highlights from CMS
CMS Releases Part D and Low Income Subsidy Data by State
According to CMS, about 90 percent of Medicare beneficiaries have some type of prescription drug coverage, such as Part D, Veteran's benefits, and retiree plans. Of those with Part D coverage, 68 percent have original Medicare and are enrolled in a PDP.
Additional data shows that of the 12.5 million Medicare beneficiaries eligible for the Low-Income Subsidy only 2.6 million are not enrolled (20 percent).
- HAP has links to this newly released CMS Part D and LIS enrollment data.
CMS Releases New Model Explanation of Benefits for Part D Plan Usage
Part D enrollees will receive new Explanation of Benefits (EOBs) from their plans in August 2008, in accordance with CMS deadlines. However, some plans may start using the new EOBs earlier. A revision to the model EOB removes the names of the previous plans from which True Out-Of-Pocket (TrOOP) balance transfers had been received by a beneficiary's current plan.
CMS provided the plans with a model cover letter and explanation of benefits framework, although the plans do not necessarily have to use this format.
CMS Announces Moratorium on New Special Needs Plans (SNPs)
A recent CMS memo describes a freeze on the "enrollment of a beneficiary in any SNP in an area in which that SNP was not available for enrollment on January 1, 2008." Medicare Advantage Organizations may continue to offer existing CMS approved SNPs through December 31, 2009.
Enrollment and Marketing Suspended: Health Net Orange PDP Plans
Beginning January 16, 2008, CMS suspended marketing and further enrollments in Health Net's stand-alone PDPs Health Net Orange Plans until troublesome enrollment processing and member notification issues are corrected. Those enrolled prior to January 16, 2008 may be able to use their previous 2007 plan, or pay out of pocket and seek reimbursement from Health Net while enrollment backlogs are cleared.
All impacted plans contain the contract number S5678. These plans are:
- Health Net Orange Option 1
- Health Net Orange Option 2
- Health Net Value Orange Option 2
- Health Net Orange
CMS is taking this action due to enrollment processing violations by these plans.
HAP's Resources Reflect 2008 LIS Income and Resource Limits
CMS released the 2008 LIS income and resource levels, which are based on the 2008 federal poverty guidelines. HAP's materials reflect these new limits and are ready to use:
Part D Costs Less Than Expected
CMS announced lower projected costs for Part D than previously reported. CMS attributes the decrease to the slowing of drug cost trends, lower estimates of plan spending, and higher rebates from drug manufacturers.
III. Items of Interest
HAP’s Comments Focus on CMS Beneficiary Protections and SHIP Counseling
HAP submitted comments to CMS on the 2009 Medicare Advantage, Medicare Advantage-Prescription Drug, Cost-Based Plan, and Prescription Drug Plan sponsors draft call letter. Our comments focus on beneficiary protections and facilitating effective counseling and education of Medicare beneficiaries by SHIPs.
Senate Finance Committee Holds Two Hearings on Medicare Advantage
Elyse Politi, a SHIP Coordinator for 13 years, testified for the Senate Finance Committee on Private Fee-for-Service Plans on January 30, 2008. The following week, the Senate Finance Committee held another hearing on “The Need for Accountability and Oversight of Marketing by Medicare Private Plans.” CQ Healthbeat has an analysis of the testimony on MA marketing abuses.
Visit HAP’s What’s HAPpening Center for more information about the effect of these hearings on your work. Also, summaries of additional meetings and policy analyzes include:
- Joint American Medical Association/CMS workgroup meeting
- Kaiser analysis of Medicare Advantage Special Needs Plans
- MedPAC meeting on increasing participation in the Low Income Subsidy
Kaiser’s 2008 Medicare Part D Resources
The Kaiser Family Foundation has created a series of 2008 Medicare Part D data spotlights. These short documents identify trends, analyze key policy issues, and detail practical implications for beneficiaries. The newest data spotlights focus on formularies and utilization management. | 
