Three Key Events Since 1995 White House Conference on Aging

1. ResolutionOnMental Health & Substance AbuseServices & InterventionsNational Coalition on Mental Health & Aging2005

2. Three Key EventsSince1995 White House Conference on Aging • Surgeon General’s Report on Mental Health (1999) • Olmstead Decision (U.S. Supreme Court, 1999) • President’s New Freedom Commission on Mental Health (2003)

3. Surgeon General’s Report on Mental Health (1999) SUMMARY “ Disability due to mental illness in individuals over 65 years old will become a major public health problem in the near future because of demographic changes. In particular, dementia, depression, and schizophrenia, among other conditions, will all present special problems in this age group.”

4. Olmstead DecisionU.S. Supreme Court SUMMARY The institutionalization of persons with disabilities, including those with mental illnesses, who, given appropriate supports, could live in the community is a form of discrimination that violates the American’s with Disabilities Act.

5. President’s New Freedom Commission on Mental Health BARRIERS TO CARE • A fragmented service delivery system; • Out of date Medicare policies; • Stigma due to mental illness and advanced age; • A mismatch between services that are covered and those preferred by older persons; and • A lack of adequate preventative interventions and programs that aid early identification of geriatric mental illness.

6. OTHER FACTORS • Baby Boomers are aging! • Majority remain unserved or underserved • Inadequate workforce • Substance abuse • Co-morbidity of MI & SA • High suicide rate • Family and caregiver issues • Possible negative impact of Medicare Part D

7. NCMHA RECOMMENDATIONS • Assure access to an affordable and comprehensive range of quality mental health and substance abuse services that are age appropriate, culturally competent, and consumer driven. • Amend statutes that address public and private health and long-term care insurance to guarantee parity, eliminate exclusions based on pre-existing conditions, ensure full access to a comprehensive range of quality services, and assure access to medications. • Coordinate benefits for those dually eligible for Medicare & Medicaid. • Promote Medicaid Home and Community Based Waivers as alternatives to institutionalization.

8. NCMHA RECOMMENDATIONS(continued) • Promote research and the implementation of emerging and evidence-based practices. • Support integration of older adult MH & SA services into primary health care, long-term care, and community-based services. • Promote screening for co-occurring disorders and development of integrated treatment strategies. • Increase collaboration to promote more effective use of resources and reduce fragmentation of services.

9. POSITIVE OUTCOMES • Treatment Works! • Successful treatment of MI & SA results in overall health benefits • Prevention, early intervention, and treatment can significantly reduce overall healthcare costs

10. Medicare Part DWhat is it?Medicare Modernization Act (MMA) of 2003 MMA created a retail drug benefit for Medicare beneficiaries that will allow millions of previously uninsured and underinsured people to have coverage for medicines that they never had before.

11. Medicare Components

12. Part D benefit will be delivered by the private sector on an at-risk basis through Medicare Advantage Plans (MA-PDs) Some beneficiaries get their Medicare through managed care entities that offer integrated medical and drug coverage within one plan People enrolled in MA plans will get drug coverage through the MA-PDs There are local MA plans (by county) There will be Regional MA plans (PPO type) Prescription Drug Plans (PDPs) A PDP is a stand-alone drug plan that will administer the drug benefit for seniors who want to stay in the traditional Medicare FFS option Part D Benefit Administration

13. Eligibility and Enrollment • The Medicare Part D benefit is open to any individual who is eligible for Medicare Part A or enrolled in Medicare Part B • People 65 years and older • People under age 65 with certain disabilities • The beneficiary must enroll in a Medicare prescription drug plan (known as a Medicare Part D plans) to get Medicare prescription drug coverage • The beneficiary will be offered a selection of plans in his/her Region • Any beneficiary without ‘credible’ prescription drug coverage will need to enroll in order to avoid a penalty

14. Auto-enrollment • Dual Eligibles (individuals with Medicare and Medicaid) • Medicaid prescription drug coverage for full-benefit dual eligibles ends December 31, 2005 and switches to Medicare January 1, 2006. • Full-benefit dual eligibles who do not enroll in a Medicare Part D plan by December 31, 2005will be auto-enrolled by CMS in a Part D plan in their area • Dual Eligibles can switch plans if another plan better meets their needs • (15% of Duals are not Full Benefit Duals).

15. Low Income Assistance • People with Medicare who are not “Dual Eligibles,” who are below 150% of the Federal Poverty Level, and meet certain asset tests may qualify for “extra help” (financial) These individuals may be “auto-enrolled” by CMS after the voluntary enrollment period ends (5/15/06) • Institutionalized “Dual Eligibles” do not have any out-of-pocket expenses • Full-benefit “Dual Eligibles” do not pay more than $5 per prescription

16. $5100 $ 3600 in out of pocket spending How much will Medicare Part D cost?Part D Standard Benefit • The Standard Benefit is the foundation upon which all other benefit designs are developed • All benefit designs must be actuarially equivalent to the Standard Benefit • All beneficiaries qualify for at least the Standard Benefit Catastrophic Coverage Beneficiary Responsibility 100% Coinsurance 75% Insurer Coverage Greater of 5% or $2-$5 Co-Insurance 50% Insurer Coverage Beneficiary Deductible 25% Beneficiary Coinsurance $0 $250 $2250 Total Annual Spending on Prescriptions

17. Important Dates • Individuals with Medicare can begin to compare Part D plan formularies • www.MEDICARE.GOV • 1-800-MEDICARE • Medicare & You handbook will be mailed to all beneficiaries • Beneficiaries will receive information from the plans in their area October 15 2005

18. Important Dates • Enrollment begins in the Medicare Prescription Drug Plans. • For the first year, enrollment will last from November 15, 2005 – May 15, 2006 • In following years, it will be from November 15 – December 31 November 15 2005

19. January 1 2006 Important Dates Medicare prescription drug coverage begins for those who are enrolled in a Part D plan Open Enrollment Ends Penalty phase begins for those without credible prescription drug coverage who have not enrolled in a Part D plan May 15 2006