HAP’s eNewsletter: July 2008
|
Mark Your Calendar
..........
HAP Conference Call:
Prepare for Long-term Care!
July 23, 2008
3:00 pm ET
Ideas for Future Topics?
shiphelp@hapnetwork.org
Listen Online to Past Conference Calls |
I. HAP HAPpenings
- Welcome Stacey and Becky!
- New LTC Center and Conference Call
- SHIP Directors Enjoy the Opportunity to Shape CMS Policy
- HAP's Conference Call Will Be on Vacation in August
- Sharing Successful LIS Outreach Strategies
II. Highlights from CMS
- Duals: On Their Way to Faster Identification
- Advise Beneficiaries to Check Their Mailboxes
- New CMS Rule Targets Abuse of Billing Privileges
III. Items of Interest
|
I. HAP HAPpenings
Welcome Stacey and Becky!
HAP is excited to welcome two new members to our team.
Stacey Platte is a Senior Program Associate of Program Development and joins us from the state Michigan SHIP (Medicare/Medicaid Assistance Program) where she was a Program Manager. Stacey also brings local experience to this new program development role.
Rebecca “Becky” Scheckelhoff comes to HAP as the Program Associate of Medicare with experience as the Training Coordinator for the Massachusetts SHIP (Serving Health Information Needs of Elders) office.
New LTC Center and Conference Call
In response to the increased demand SHIPs are experiencing for long-term care (LTC) information and counseling, HAP has created a new LTC Center, which covers topics such as: What Is Long-Term Care?, How Do You Pay for Long-Term Care?, What Is Long-Term Care Insurance?, and What Is the Partnership for Long-Term Care?
Since the SHIP grant requires SHIPs to counsel beneficiaries on LTC and LTC insurance, the LTC Center provides basic information in the form of easy-to-read facts sheets designed specifically for beneficiaries. Be on the lookout for our training presentations containing engaging case studies and exercises that assess participant knowledge of covered material.
We want to hear from you! Please take a moment to take our 5-question survey. This survey will give us information about your LTC counseling activities and what additional materials would be helpful to your SHIP.
SHIP Directors Enjoy the Opportunity to Shape CMS Policy
We are delighted to share the comments with CMS on Revisions to the Medicare Advantage and Prescription Drug Benefit Programs that HAP compiled based, in large part, on the lively conversation during HAP’s first SHIP Directors' Comments Call on July 25. Thank you for taking the time to join us for this important policy-shaping call.
HAP’s Conference Call Will Be on Vacation in August
HAP will not be having a SHIP-to-SHIP conference call in August. If you start to miss our voice, don’t despair, you can listen to past calls online at your convenience.
We hope you, your staff and volunteers, and your families are having a wonderful summer. We look forward to talking with you in September! In the meantime, if you have suggestion for a call, please email us at SHIPHelp@hapnetwork.org.
Sharing Successful LIS Outreach Strategies
If you missed June’s call on Low-Income Subsidy (LIS) Outreach planning, you can listen online to your colleagues share strategies for LIS outreach at your convenience.
In part 5 of the call, Kevin Simpson of CMS mentioned that CMS has partnered with the Health Resources and Services Administration (HRSA) to provide SHIPs with contact information for Community Health Centers (CHC) in the 100 counties with the highest LIS populations. In addition, the article Community Health Centers Offer Opportunity to Reach LIS Population in the June 16 edition of the SHIP Weekly Digest provides background information about partnering with a CHC to reach LIS eligible beneficiaries. This is the second article in a series on this topic. The SHIP Weekly Digest from June 30 has more information about CMS’s efforts to help SHIPs conduct LIS outreach.
Are you partnering with a CHC in your area? What other partnerships have helped your SHIP reach LIS eligible beneficiaries? We want to highlight innovative LIS outreach strategies, so let us know what has worked for your program. Email us at shiphelp@hapnetwork.org to be featured online in HAP’s Best Practices section.
Back to the Top
II. Highlights from CMS
Duals: On Their Way to Faster Identification
CMS recently announced that they will now be able to receive and process data from State Medicaid Agencies more than just once a month. This means that CMS will be able to identify dual eligibles sooner and get them into Prescription Drug Plans (PDPs). This new process will allow identified duals to get any retroactive drug coverage faster.
As these newly recognized duals are auto-enrolled or facilitated into PDPs, CMS will be mailing notification letters. Calls from these new dual eligibles to SHIPs may now be spread throughout the month instead of in one smaller time period.
For a concise description of Medicaid’s assistance with cost-sharing, check out HAP’s chart: Cost-sharing for Dual Eligible Beneficiaries.
Advise Beneficiaries to Check Their Mailboxes
As you gear up for the Annual Enrollment Period, consider using CMS’s bi-annual Guide to Mailings from CMS, Social Security and Plans as a counseling tool. This guide identifies dates when notices are scheduled to be mailed to beneficiaries for the remainder of the year.
Counselors can encourage beneficiaries to check their mailboxes and save anything they receive from CMS, SSA, and the plans. In addition, counselors can ask beneficiaries which mailings they have recently received from CMS, particularly around the dates in this guide.
New CMS Rule Targets Abuse of Billing Privileges
CMS published a final rule in the June 27 Federal Register that allows carriers, fiscal intermediaries, and Medicare Administrative Contractors (MAC) to revoke a provider’s or supplier’s billing privileges for submitting claims that could not have been furnished to a beneficiary. This final rule will take effect on August 26.
The regulation at 42 CFR §424.535 specifically addresses “abuse of billing privileges” and states that “these instances include but are not limited to when the beneficiary is deceased, the directing physician or beneficiary is not in the country…or when the equipment necessary for testing is not present.”
The final rule also gives providers and suppliers expanded appeal rights when a Medicare claims contractor denies an application for billing privileges or revokes those privileges.
Back to the Top
III. Items of Interest
Medicare Improvements for Patients and Providers Act Becomes Law
You have likely heard media coverage about the recent debate over a bill that will affect Medicare. On July 15, the Congress overrode the President’s veto of the Medicare Improvements for Patients and Providers Act (HR 6331).
This new law contains quite a few provisions that will affect Medicare beneficiaries and SHIPs including an additional $7.5 million for SHIPs to conduct outreach to those potentially eligible for the Low-Income Subsidy and Medicare Savings Programs. HAP's SHIP Funding Resource Center has a concise breakdown of the legislation and the What's HAPpening section contains a summary of the political process leading up to this new law.
CMS Agrees to Ease Access to Part D Drugs for Duals
On June 19, the National Senior Citizen Law Center and the Center for Medicare Advocacy announced a settlement agreement with CMS in the Medicare Part D class action lawsuit, Situ v. Leavitt, brought on behalf of 6.2 million dually eligible Medicare beneficiaries.
Under the agreement, CMS will do the following:
- Process files it receives from states identifying new duals within one day of receipt, instead of waiting several weeks.
- Allow states to submit the files more often.
- Require drug plans and CMS Regional Offices to assist beneficiaries whose names are mistakenly missing from pharmacy or plan computer systems.
- Educate pharmacy organizations about new protections for duals that are not automatically enrolled in a plan and thus are unable to obtain medications.
At the same time, new procedures will shift the burden of proof away from the beneficiary to providers when eligibility is in question. The federal court for California’s Northern District will retain jurisdiction over the case for three years to monitor CMS’s implementation of the agreement.
Back to the Top | Back to HAP's Homepage
