HAP’s eNewsletter: May 2008
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I. HAP HAPpenings
- Listen to HAP Conference Calls at Your Convenience
- Visit HAP’s New Medigap Resource Center
- HAP’s FAQ Center Features Concise Answers to Complicated Questions
- Updated Materials on Disenrollment
II. Highlights from CMS
- Comment on Proposed Regulations Intended to Protect Beneficiaries
- Fewer LIS Reassignments Expected Due to CMS Rule Changes
o Background on CMS Benchmark Calculation Method
- E-Prescribing: The Future is Near
- Clarification to EOB Notice on Benefit or Formulary Changes
- Updated Guidance on Creditable Drug Coverage Determinations
o Creditable Coverage
o Late Enrollment Penalty
- New CMS Policy Extends Service Areas for Retiree Groups
III. Items of Interest
- Five SHIPs Highlighted for Successful Low-Income Outreach
o California
o Maine
o Nebraska
o New Mexico
o Washington
- SHIP Counselors' Experiences Reinforce the Value of Personal Assistance
- Limited Knowledge of Part D Cost-Sharing Tied to Financial Hardship
- New Information Clarifying Low-Income Beneficiary Protections
- Kaiser Examines Trends in Medicare Drug Program
- Updated Hospital Compare Website Now Offers Patient Satisfaction Data
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Florida’s State Outreach and Publicity Team Supports Local Promotional Efforts
In order to reach 3.3 million Medicare beneficiaries, local liaisons and volunteers must be on the lookout for free and low-cost opportunities to promote Florida’s SHIP program, Serving Health Insurance Needs for Elders (SHINE).
The state level Outreach and Publicity Team are tasked with supporting those promotional efforts. By creating cohesive messages for all beneficiary materials, helping to get free and “earned” media coverage of SHINE, producing community education presentations and talking points, and providing presentation trainings for liaisons and volunteers, the SHINE program connects with nearly half a million beneficiaries each year.
Learn more about what you can do to further promote your SHIP by visiting HAP's Celebrating SHIP Successes page. | | |
I. HAP HAPpenings
Listen to HAP Conference Calls at Your Convenience
We know how difficult it can be to join HAP’s conference call every third Wednesday at 3:00 pm ET. That’s why we are excited to announce that you can now listen to HAP’s conference calls online. Calls will be posted on our Web site the Monday following the live call. No special software is required. Simply go to HAP’s Conference Calls page, click on the topic that interests you, and listen to HAP staff and your SHIP colleagues discuss timely topics and clever solutions—all at your convenience.
Visit HAP’s New Medigap Resource Center
HAP’s new Medigap Resource Center contains background information on Medigap polices, as well as information on the relationship between Medigap and Part D. When counseling a beneficiary on Medigap, look to HAP for resources that can help, such as:
HAP’s FAQ Center Features Concise Answers to Complicated Questions
We continue to expand our Frequently Asked Questions (FAQs), which are based on technical assistance requests from local and state SHIP staff and volunteers around the country. Recent updates include answers to questions about Medigap and Medicare Savings Accounts.
Updated Materials on Disenrollment
HAP’s April conference call, Let's Talk Disenrollment: Resolving Enrollment Issues highlighted many challenges SHIP counselors continue to face when trying to disenroll beneficiaries from inappropriate plans. Visit HAP’s conference call page for disenrollment counseling resources and to listen to HAP’s April conference call, which includes information from your colleagues about their successes and struggles with disenrollment.
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II. Highlights from CMS
Comment on Proposed Regulations Intended to Protect Beneficiaries
On May 8, CMS proposed new low-income subsidy (LIS) and Medicare Advantage (MA) regulations intended to provide greater protections to beneficiaries. The proposed rule streamlines eligibility determinations for LIS and limits beneficiary cost-sharing liability, establishes stricter MA marketing and sales standards, and provides new protections for beneficiaries enrolled in Special Needs Plans.
We encourage all SHIPs to submit comments on this regulation to CMS by 5:00 pm, Tuesday, July 8. There are four ways to submit comments, one of which is electronically at http://www.regulations.gov. Enter the code 4131-P under the "Comment or Submission" icon. Once the page loads, click the link to the document. Hit the icon next to “Add Comments” and type your comments into the form.
Fewer LIS Reassignments Expected Due to CMS Rule Changes
CMS issued a final rule April 3 that changes the method used to calculate the low-income premium benchmark. The changes will weight the benchmarks on the basis of each plan’s share of LIS enrollees rather than their share of total Part D enrollment. Had the rule been in effect for the 2008 plan year, CMS estimates that the number of reassignments would have been reduced by 850,000. The new rule takes effect on May 31, 2008.
Background on CMS Benchmark Calculation Method
In January 2008, CMS proposed a solution to the problem of high turnover of plans below the benchmark. Based on public comments to the proposed rule, CMS issued the April 3 final rule to improve upon some of the concerns within the January 2008 proposal. The final rule requires CMS to calculate the benchmark premium by weighing each plan’s premium by its LIS enrollment, rather than by each plan’s total Part D enrollment.
Prior to the April 3 rule, CMS calculated the low-income benchmark premium using an average plan premium weighted by the total enrollment of each plan, including Prescription Drug Plans (PDPs) and Medicare Advantage plans with prescription drug coverage (MA-PDs). Since total enrollment in a plan is not always reflective of LIS enrollment, a benchmark premium calculated this way is rather low. When the benchmark is lowered, fewer plans have premiums below that level, leaving LIS beneficiaries with decreased options for premium-free enrollment.
Calculating the benchmark using this new method will likely contribute to more plans being available premium-free to LIS beneficiaries in each region. However, this regulation will probably not affect the stability of which plans fall below the benchmark.
E-Prescribing: The Future is Near
The Medicare Modernization Act of 2003 (MMA) required sponsors offering PDPs and/or MA-PDs to implement electronic programs that transmit information to the prescribing provider, the dispensing pharmacy, and the dispenser. Currently, plan sponsors only transmit information on formularies, cost-sharing, and enrollment status to pharmacies.
The MMA does not require prescribers or dispensers to e-prescribe, but if they choose to, CMS final rule from early April establishes the procedures for prescribers and dispensers who electronically transmit prescription information for Medicare beneficiaries. For those who utilize e-prescribing, the compliance date is April 7, 2009.
The final rule describes three new Part D e-prescribing tools:
- Formulary and benefit transactions: Prescribers can receive information about the drugs covered by a patient’s Part D plan at the point of care.
- Medication history transactions: Prescribers and payers can access the list of drugs dispensed to a patient.
- Fill status notifications (or RxFill): Prescribers can receive an electronic notification from the pharmacy if a patient's prescription has been picked up, or if the prescription was only partially filled.
Clarification to EOB Notice on Benefit or Formulary Changes
CMS issued a clarification on the implementation of new Explanation of Benefits (EOB) notices for plan sponsors to use when conveying information to enrollees regarding any benefit or formulary changes. CMS expects plans to begin using the model notice in July so that Medicare beneficiaries begin to receive new EOB notices in August 2008 (for the month of July). One helpful change for SHIP counselors and beneficiaries: Within this notice is additional information regarding whether or not secondary payer or other sources count toward True Out-Of-Pocket (TrOOP) costs. A copy of the new 2008 model EOB can be found at HAP’s new EOB page.
Updated Guidance on Creditable Drug Coverage Determinations
In an updated guidance on creditable coverage determinations and related late enrollment penalty issues, CMS announced simplified steps that beneficiaries must take to verify prior creditable coverage. Below are some of the key changes:
- Creditable Coverage
- To determine the number of uncovered months, plans no longer need to look back to a beneficiary’s Initial Enrollment Period (IEP), and instead should determine the number of months since a beneficiary disenrolled from a Part D plan or a retiree drug subsidy plan (p. 1).
- To increase the number of beneficiaries who complete the attestation form in a timely manner, CMS has simplified it and has included a beneficiary checklist. The attestation form is sent to beneficiaries who have recently enrolled in a plan and may owe a late enrollment penalty (p. 3, Exhibit 1A).
- CMS also released a new model notice for plans to remind enrollees about the importance of submitting an attestation form if they had prior creditable drug coverage (p. 3, Exhibit 1B).
- Plans have an additional 7 days (for at total of 28 days) to obtain missing attestation information from beneficiaries (p. 5).
- Late Enrollment Penalty
- To help with the reconsideration process, in the event that a beneficiary requests a reconsideration, plans must retain copies of the late enrollment period (LEP) notice sent to enrollees (p. 7-8).
- CMS has revised the LEP Reconsideration Request form (p. 8).
- CMS has extended the timeframe to process a reconsideration request from 30 to 90 days (p. 8).
- As a reminder, Medicare beneficiaries who qualify for the low-income subsidy and enroll in a drug plan by December 31, 2008 will not have a LEP (p. 18, Appendix 1).
New CMS Policy Extends Service Areas for Retiree Groups
On April 11, CMS’s Center for Beneficiary Choices issued a memo with a policy change that allows local Medicare Advantage HMOs and PPOs to extend their service areas beyond county and state lines starting in 2009. The modification to Medicare’s Employer Group Waiver Policy will help local coordinated care plans serve retirees who move outside of a plan’s service area, typically the state or metropolitan area where an employer or union is based. The change will also make local coordinated care plans more competitive with private-fee-for-service (PFFS) plans in the MA employer group market.
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III. Items of Interest
Five SHIPs Highlighted for Successful Low-Income Outreach
An April 2008 issue brief released by The Commonwealth Fund illustrates state and local organizations that have successfully helped low-income beneficiaries and other vulnerable populations access and use Medicare prescription drug coverage and the low-income subsidy. The issue brief recognizes that SHIPs play a critical role in developing and sustaining efforts to reach vulnerable beneficiaries, and highlights some successful SHIP strategies, including:
- California: Local Health Insurance and Assistance Program (HICAP) in California worked closely with the Southeast Asian California Healthy Elders Leadership Project to assist dual eligibles in the Cambodian, Laotian, and Vietnamese communities with Part D.
- Maine: The Maine State Health Insurance Assistance Program (SHIP) hired a full-time Part D Specialist for each Area Agency on Aging. The specialists provide counseling and enrollment assistance for the low-income subsidy, Medicare Savings Programs, and the Maine State Pharmacy Assistance Program (SPAP). The Maine SHIP also works very closely with a Part D Appeals Unit for low-income beneficiaries, which is operated by Legal Services for the Elderly.
- Nebraska: As a member of Nebraska’s Medicare Prescription Drug Coalition, the Nebraska State Health Insurance Information Program (SHIIP) provided expertise for a series of Medicare Part D training videoconferences that reached more than 800 people, including counselors and eligibility workers.
- New Mexico: The New Mexico Health Insurance and Benefits Assistance Corps (HIBAC) partners with the state’s Medicaid agency to ensure that dual eligible beneficiaries, particularly those with limited English proficiency and low-literacy rates, retain their benefits. The Medicaid agency notifies HIBAC managers when dual eligibles do not respond to a redetermination notice, and in turn lose their Medicaid benefits. HIBAC managers and volunteers then engage in an “intensive, ‘outdoor’ face-to-face case management,” which is a “hallmark of New Mexico SHIP’s outreach to hard-to-reach Medicare beneficiaries.”
- Washington: The Washington Statewide Health Insurance Benefits Advisors (SHIBA) program translates key materials on Medicare Part D into five languages—Chinese, Korean, Russian, Spanish, and Vietnamese—and posts the materials on its Web site. SHIBA also recruits and trains bilingual volunteer counselors.
SHIP Counselors' Experiences Reinforce the Value of Personal Assistance
In the fall of 2006, researchers writing a report for the Commonwealth Fund asked HAP to send a survey to SHIP counselors so they could learn more about the challenges that beneficiaries, particularly those who are low-income, face in choosing and using a drug plan that meets their needs. Thank you to those who responded!
The information helped shape a May 1 issue brief from the Commonwealth Fund on confusion and disruption facing low-income beneficiaries in Medicare Part D drug plans.
Limited Knowledge of Part D Cost-Sharing Tied to Financial Hardship
A study published in the April 13 issue of the Journal of the American Medical Association (JAMA) estimated that only 40 percent of beneficiaries surveyed were aware of the Part D coverage gap. Researchers interviewed 1,040 enrollees of a Kaiser Permanente MA plan in northern California. They concluded that limited knowledge about cost-sharing details, such as the start and end point of the coverage gap, is associated with more reports of financial burden evidenced in borrowing money or going without necessities.
New Information Clarifying Low-Income Beneficiary Protections
A recent update from the Center for Medicare Advocacy (CMA) answers questions raised by many SHIPs about low-income beneficiary protections, including whether a provider may balance bill Qualified Medicare Beneficiaries (QMBs). CMA also explains the rules about cost-sharing for dual eligible beneficiaries enrolled in MA plans, a complex subject with answers that vary by state. The information provided in this alert can help SHIPs provide assistance to low-income beneficiaries who are balance billed or charged improper cost-sharing. More tools to assist low-income beneficiaries may be found in the Medicaid and Low-income Benefits section of HAP’s Web site.
Kaiser Examines Trends in Medicare Drug Program
HAP has been highlighting the Kaiser Family Foundation’s series on Medicare Part D 2008 Data Spotlights, which are excellent and concise policy resources. Recently, Kaiser synthesized the key findings from all eight pieces, including:
- Part D plan formularies for 2008 are relatively the same as they were in 2006 when the Medicare prescription drug benefit began, but beneficiary cost-sharing has increased, as have utilization management tools that restrict access to drugs.
- While the overall number of PDPs rose from more than 1,400 in 2006 to more than 1,800 in 2008, the percentage of qualified plans that offer coverage to low-income beneficiaries remained almost the same across all three plan years.
Researchers concluded that the variations among plan offerings, benefit designs, coverage, and out-of-pocket costs highlight the need for beneficiaries to compare plans each year to determine which package best meets their needs.
Updated Hospital Compare Website Now Offers Patient Satisfaction Data
CMS has posted patient satisfaction data on its hospital compare Web site. Drawn from the Consumer Assessment of Healthcare Providers and Systems hospital survey (HCAHPS), the survey data compare ten aspects of the inpatient experience at more than 2,500 acute care hospitals. This tool allows you to explore a range a patient responses around issues such as the percentage of patients who reported that their nurses always communicated well, and the number of people who reported their pain was always controlled. In a press release, HHS Secretary Leavitt said that the new resources are designed to help consumers choose hospitals based on “quality and value.”
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