MIPPA Act:
Changes Effective January 2010
The Medicare Improvements for Patients and Providers Act (MIPPA), signed into law on July 15, 2008, encompasses significant changes and opportunities for Medicare beneficiaries, particularly those who are low-income. The following MIPPA changes take effect Jan. 1, 2010. For more information about additional MIPPA changes, please see HAP's MIPPA Changes Effective in 2009 fact sheet.
Asset Test for LIS and MSPs
- All resource (asset) limits for the Medicare Savings Programs (MSPs) — QMB, SLMB, and QI-1 — increase to match the full low-income subsidy (LIS) asset limits. The MSP resource limits for 2010 are $6,600 for an individual and $9,910 for a couple*. The asset tests for LIS and MSPs will be indexed each year. Note that the resource amounts for MSPs do not include the burial fund allowance ($1,500 and $3,000 respectively). The burial fund allowance is typically added automatically to the LIS asset amounts in many published tools, creating a total asset limit in 2010 of $8,100 for an individual and $12,910 for a couple.
* Some state Medicaid programs may allow higher resource limits or eliminate resource tests entirely. Check your state's rules for official guidelines.
LIS, Medicaid, and MSP Applications
- With the consent of applicants, Social Security transmits LIS application data to states for consideration of Medicaid and MSP eligibility. States must act on these transmissions as they do with all other such applications.
Estate Recovery
- States are prohibited from recovering the value of Medicare cost-sharing paid under MSPs.
LIS Income and Resources
- SSA will not consider in-kind support and maintenance as income for LIS applicants.
- SSA will not consider the cash surrender value of life-insurance policies as a resource for LIS applicants.
Model Forms
- The model MSP application is available in the 10 non-English languages spoken by Medicare beneficiaries.
Special Needs Plans (SNPs)
- All SNPs (including those for dual-eligible, institutionalized, and chronic condition beneficiaries) may enroll only individuals who meet the special need requirement of the plan.
- All SNPs meet new care management requirements, including an evidence-based model of care, appropriate networks of providers, initial and annual assessments of enrollees, and an interdisciplinary team.
- All SNPs meet new data collection and reporting requirements.
- Institutional SNPs (I-SNPs) use an assessment tool that determines need for institutional level of care for potential enrollees living in the community.
- Dual SNPs (D-SNPs) must have contracts with State Medicaid agencies to provide appropriate Medicaid benefits for enrollees. States are not required to enter into contracts with SNPs.
- D-SNPs are prohibited from charging enrollees any costs that exceed the amounts permitted under Medicaid for duals not enrolled in a D-SNP.
- Chronic Condition SNPs (C-SNPs) must abide by a new definition of people eligible for C-SNPs.
All Medicare Advantage Plans
- The names of all MA plans must include the type of plan, using standardized abbreviations.
PFFS and MSA Plans
- All PFFS and MSA plans have quality improvement programs.
Formulary Requirements
- The classes of clinical concern (immunosuppressants, antidepressants, antipsychotics, anticonvulsants, antiretrovirals and antineoplastics) may be expanded upon the recommendation of the Secretary.
Psychiatric Services
- Medicare coverage of psychiatric services increases from 50 percent to 55 percent.
Medigap
- Medigap (Medicare supplement) plans must meet certain changes recommended by the National Association of Insurance Commissioners (NAIC) by June 1, 2010.
The changes noted above take effect January 1, 2010. There are additional changes from MIPPA that have taken effect in the past and some that will take effect at later dates. For a complete list of other MIPPA changes, visit HAP's September Conference Call page.
