2017 National Training Program

1. 2017 National Training Program Module 4 Current Topics

2. Lessons • Legislation Updates • Medicare Updates • Marketplace Updates • Accessibility Support Current Topics

3. Lesson 1—Legislation Updates • 21st Century Cures Act • Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Current Topics

4. 21st Century Cures Act • Improving Medicare local coverage determinations (LCD) • Medicare Administrative Contractors to post details of LCDs 45 days before effective date • Medicare Pharmaceutical and Technology Ombudsman • To respond to manufacturer complaints, grievances, and requests about coverage, coding, or payment • Medicare site-of-service price transparency • Hospital outpatient departments and ambulatory care centers must post the estimated payment amount for a service and the beneficiary liability Current Topics

5. 21st Century Cures Act (continued) • Delay in authority to terminate contracts for Medicare Advantage (MA) Plans failing to achieve minimum quality ratings through Plan Year 2018 • Updating the “Welcome to Medicare” package • Preserving Medicare beneficiary choice under MA beginning in 2019 • First 3 months each year, those who are MA eligible can change coverage • Allowing people with End-Stage Renal Disease to choose an MA Plan beginning in 2021 • Organ procurement will be covered by Original Medicare Current Topics

6. Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) MACRA made 3 important changes to how Medicare pays those who give care to people with Medicare. • Called the Quality Payment Program (QPP) • Ends the Sustainable Growth Rate (SGR) formula for determining Medicare payments for health care providers’ services by tying quality to payment • Makes a new framework for rewarding health care providers for giving better care, not just more care • Combines our existing quality reporting programs into one new system Current Topics

7. Lesson 2—Medicare Updates • Program Enrollment • Medicare Access and CHIP Reauthorization Act Medicare Provisions (MACRA) • Durable Medical Equipment Prosthetic, Orthotic, and Supplies (DMEPOS) Competitive Bidding Round 2019 • Medicare Outpatient Observation Notice (MOON) • Medicare Advantage (Part C) • Medicare Prescription Drug Coverage (Part D) • New Medicare Card Current Topics

8. Medicare Program Enrollment 2017 Average Medicare Monthly Projected Enrollment in Millions Current Topics

9. Medicare Access and CHIP Reauthorization Act Medicare Provisions (MACRA)—Updates • Savings to Medicare and Medicaid Programs • Income-Related Premium Adjustment for Part B and Part D • Continuing Automatic Extension of Providers Opt-Out Election • Medicare Supplement Insurance (Medigap) Policy Changes MACRA Current Topics

10. MACRA Savings to Medicare and Medicaid Programs • Significant provisions of the Medicare Access and CHIP Reauthorization Act (MACRA) include • Higher income thresholds starting in 2018 for determining Part B and Part D premium subsidies • Beginning in 2020, more people will pay higher Part B and Part D premiums due to a change in the indexing of income thresholds MACRA Current Topics

11. Income-Related Premium Adjustment for Part B and Part D Beginning in 2020, the income thresholds would be adjusted each year by increasing the previous year’s income threshold amounts by the consumer price index for urban consumers. MACRA Current Topics

12. Medicare Supplement Insurance (Medigap) Policy Changes—Update • Limitation on certain Medigap policies for people newly eligible for Medicare • On or after January 1, 2020 • Medigap policies sold to people newly eligible for Medicare will no longer provide coverage for the Part B deductible • Newly eligible means an individual who, before January 1, 2020, is neither 65, nor has Part A • Plans C and F will become Plans D and G respectively for policies sold to those newly eligible • High deductible Plan F may be grandfathered • Policies bought before January 1, 2020, won’t be affected MACRA Current Topics

13. Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Round 2019 • Consolidate all rounds and areas included in DMEPOS Competitive Bidding Program into a single round of competition • Contracts will be effective January 1, 2019, through December 31, 2021  • Will include 141 competitive bidding areas (CBAs) and have a total of 11 product categories • Adds insulin pumps and supplies as a product category to be bid in the national CBA Current Topics

14. Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act • Medicare Outpatient Observation Notice (MOON) Update • Hospitals must issue the MOON to people with Medicare in Original Medicare and Medicare Advantage Plans • Hospitals beganusing the MOONbyMarch 8, 2017 • Available in • Both English and Spanish • PDF and Word formats Current Topics

15. Medicare Advantage Plans and Medicare Prescription Drug Program Updates • 2018 requirements • Medicare Advantage Plans (Part C) • Medicare Prescription Drug Plans (Part D) Current Topics

16. Medicare Advantage (Part C) Provider and Supplier Enrollment   • Health care providers must be enrolled in Medicare to contract with a Medicare Advantage organization • Creates consistency with CMS’s current health care provider and supplier enrollment • Helps to protect Medicare beneficiaries and the Medicare Trust Funds • Ensures that only qualified providers and suppliers treat Medicare beneficiaries  Current Topics

17. Medicare Advantage (MA) Service Category Cost-Sharing Requirements • CMS will not permit cost-sharing for the first 20 days of the Skilled Nursing Facility (SNF) benefit for CY 2018 • The per-day cost-sharing for days 21 through 100 must not be greater than the Original Medicare SNF amount • Cost-sharing for the overall SNF benefit must be no higher than the actuarially equivalent cost-sharing in Original Medicare • MA Plans may not charge higher cost-sharing than Medicare for chemotherapy administration, skilled nursing care, and renal dialysis Final CY 2018 Call Letter Current Topics

18. CY 2018 Voluntary and Mandatory Medicare Out-of-Pocket (MOOP) Limit Range Amounts by Plan Type Current Topics

19. Seamless Enrollment of Individuals Upon Initial Eligibility for Medicare • Temporarily suspended acceptance of any new seamless enrollment proposals • CMS has published data on seamless conversion enrollments • Identifies the organizations that have received CMS approval to offer seamless enrollment • Specifies the lines of business from which these organizations are permitted to enroll members Current Topics

20. Part D—Drug Utilization Updates • To improve safety and reduce waste • Allows Part D plans to designate specific drugs for which a member’s initial fill could be limited to a one-month supply • After the first one-month supply, the change to extended days’ supply would be continuous for the person with Medicare • Encourages sponsors to inform people with Medicare directly of additional formulary drugs that become available mid-year Current Topics

21. Tiering Exceptions: Policy ClarificationsPreferred and Non-Preferred Drugs • Plan should not restrict their consideration of a tiering exception request based on the tier label; and • Should not limit their consideration to a single lower tier if there are multiple lower tiers containing alternative drugs Current Topics

22. Specialty Tiers Drugs • Part D sponsor may design its exception process so that very high cost or unique drugs aren't eligible for a tiering exception • Only Part D drugs with sponsor-negotiated prices that exceed an established dollar-per-month threshold are eligible for specialty tier placement • CMS will maintain the $670 threshold for CY 2018 • CMS continues to investigate these and other trends to shape future analyses involving the specialty tier Current Topics

23. Additional Delay in Enforcement of the Medicare Part D Prescriber Enrollment Requirement • Until January 1, 2019 • Prescribers will have sufficient time to complete their enrollment activities • Provide Part D sponsors and pharmacy benefit managers and Medicare Advantage Organizations offering Medicare Advantage Plans with Prescription Drug (MA-PDs) coverage additional time to finalize the system enhancements needed to comply Current Topics

24. Part D Low Enrollment • CMS has the authority to non-renew Part D plans that do not have a sufficient number of enrollees • Plans that have fewer than 500 enrollees are urged to voluntarily withdraw • Stand-alone plans with less than 1,000 enrollees are encouraged to consolidate Current Topics

25. Improved Coverage in the Coverage Gap Current Topics

26. New Medicare Card Current Topics

27. Background • The Health Insurance Claim Number (HICN) is a Medicare beneficiary’s identification number, used for processing claims and for determining eligibility for services across multiple entities (for example, Social Security Administration (SSA), Railroad Retirement Board (RRB), States,Medicare providers, and health plans). • The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 mandates the removal of the Social Security Number (SSN)-based HICN from Medicare cards to address current risk of beneficiary medicalidentity theft. • The legislation requires that CMS mail out new Medicare cards with a new Medicare Number (also referred to as Medicare Beneficiary Identifier – (MBI)) by April2019. • The new Medicare numbers won’t change Medicare benefits. People with Medicare may start using their new Medicare cards as soon as they get them. Current Topics

28. Operational Goals Primary Operational Goal: To decrease Medicare Beneficiary vulnerability to identity theft by removing the SSN-based number from their Medicareidentification cards and replace with a new unique Medicare Number. • In achieving this goal, CMS seeksto • Minimize burdens forbeneficiaries • Minimize burdens forproviders • Minimize disruption to Medicareoperations • Provide a solution to our business partners that allows usage ofHICN and/or new Medicare Number for business critical dataexchanges • Manage the cost, scope, and schedule for theproject Current Topics

29. Operations: 3 Steps to New Medicare Numbers • Generate new, unique Medicare Numbers for all people with Medicare: Includes existing (currentlyactive, deceased, or archived) and people new-to-Medicare • Deceases/archived will get new number for claims cross walk, but no card will be mailed • Issue new, redesigned Medicare cards: New cards containing the new Medicare Number to existing and new people with Medicare • Modify systems and business processes: Required updatesto accommodate receipt, transmission, display, and processing of the new Medicare Number Current Topics

30. Operations: HICN and New Number • Health Insurance Claim Number(HICN) • Primary Beneficiary Account Holder Social Security Number (SSN) plus Beneficiary Identification Code(BIC) • 9-byte SSN plus 1 or 2-byteBIC • Key positions 1-9 arenumeric • New Medicare Number • New Non-Intelligent UniqueIdentifier • 11bytes • Key positions 2, 5, 8, and 9 will alwaysbe alphabetic Note: Identifiers are fictitious and dashes fordisplay purposes only; they are not stored in thedatabase nor used in fileformats CMS anticipates that the MBI won’t be changed for an individual unless the MBI is compromised. Current Topics

31. Operations: Transition Period • The transition period will run from April 1, 2018 through December 31,2019 • CMS will complete its system and process updates to be ready toaccept and return the new Medicare Number on April 1,2018 • All stakeholders who submit or receive transactions containing the HICN must modify their processes and systems to be ready to submit orexchange the new Medicare Number by April 1, 2018. Stakeholders may submiteitherthe new Number or HICN during the transitionperiod • CMS will accept, use for processing, and return to stakeholders eitherthe new Medicare Number or HICN, whichever is submitted on the claim, during the transitionperiod Current Topics

32. Operations: Transition Period (continued) • Medicaid and supplemental insurers • We will give State Medicaid Agencies and supplemental insurers the new Medicare Numbers for Medicaid-eligible people who also have Medicare before we mail the new Medicare cards. During the transition period, we’ll process and transmit Medicare crossover claims with either the current HICN or new number • Railroad Retirement Board (RRB) beneficiaries • RRB will continue to send cards with the RRB logo, but you can’t tell from looking at the new Medicare Number if it’s for an RRB beneficiary Current Topics

33. Current Outreach Focus: Supporting Providers • Providers are making systems changes to support the new Medicare number • How we’re supporting this • General information and guidance • Developing a secure look-up tool for providers (to find new number at the point-of-service) • Message on the HIPAA Eligibility Transaction System (HETS) to tell if a beneficiary’s new Medicare card was mailed Current Topics

34. Outreach to People with Medicare This is where we really need YOU! Current Topics

35. Consumer Research on New Medicare Cards • Consumer testing in November 2016 and January–April 2017 examined general messaging and reactions, design options for the new Medicare cards, and informational text that will accompany the new cards when they are mailed • Mix of locations, demographics, language, coverage type • Findings help shape data-driven messaging and outreach; honed by experience and questions Current Topics

36. What We Know from People with Medicare • In general, reactions were positive • A good thing to do—protecting identities • Smart—will keep SSNs out of the hands of criminals • Helpful—need a new card because old card is worn and frayed • Long overdue—should have been done some time ago • Some concerns expressed among a minority of participants • Beneficiaries with Medicare Advantage plans concerned about confusing new Medicare card with MA card • A few who use their card to reference their SSN or use their Medicare card as an alternate form of identification Current Topics

37. Messaging That Works Current Topics

38. Messaging That Works (continued) Current Topics

39. Other Key Points to Reinforce • Understand that mailing everyone a new card will take some time. Your card might arrive at a different time than your friend’s or neighbor’s. • Make sure your mailing address is up-to-date. If your address needs to be corrected, contact Social Security at ssa.gov/myaccount or 1-800-772-1213. TTY: 1-800-325-0778. • Beware of anyone who contacts you about your new Medicare card. We will never ask you to give us personal or private information to get your new Medicare number and card. Current Topics

40. Sending New Medicare Cards • New cards start mailing in April 2018 and all cards are replaced by April 2019 deadline • Gender and signature line won’t appear on new Medicarecards • Once their card is mailed, someone with Medicare also can access their New Medicare Number on a Medicare Summary Notice or through MyMedicare.gov • The Railroad Retirement Board will issue new cards toRRB beneficiaries Current Topics

41. Your Guide for Outreach Now – September 2017: Setting Expectations • General Messaging • Coming in 2018: New Medicare cards! • Make sure your address on file with Medicare is correct or go to ssa.gov/myaccount to update • Simple and responsive high-level messaging on Medicare.gov and 1-800-MEDICARE, Guard Your Card ad campaign • Training to prepare partners ahead of broad-based outreach and education September 2017: Card Awareness • New Medicare card design is unveiled • Beneficiaries get information about the new card in the 2018 “Medicare & You” Handbook: When you get your new card, safely and securely destroy the old Medicare card, keep the new number confidential • Educational Materials and a more detailed training webinar will be available for Partners Current Topics

42. Your Guide for Outreach (continued) October 2017 – December 2017: Open Enrollment • Continue “Card Awareness” outreach through messaging embedded in regular Open Enrollment events and earned media, steady drumbeat messaging via press, social media, speaking engagements, blogs, etc. • Card messaging should supplement, but not supersede “review and compare” actions for Open Enrollment January 2018 – March 2018: New Cards are Coming! • Ramp up pre-mailing outreach and identify opportunities for sharing messages and materials with providers and people with Medicare April 2018 – April 2019: Watch for your New Card • Cards are mailed! • Simple, direct instructions included with the new card mailing • Active, localized information sharing • Robust messaging on Medicare.gov, 1-800-MEDICARE, Medicare social media • Specialized communications for those with limited English proficiency and alternative format needs Current Topics

43. A Few Words About Fraud • No surprise—we anticipate there will be “bad actors” who try to take advantage of this change and have monitored limited reports already • Existing basic messages around fraud prevention and detection still apply • Medicare will never contact you uninvited for your Medicare number or other personal information. • Don’t share your Medicare number or other personal information with anyone who contacts you by phone, email, or by approaching you in person, unless you’ve given them permission in advance. • Usual processes still apply for raising concerns and reports of potential fraud • “Guard Your Card” ad campaign at end of summer will introduce that new Medicare cards are coming and tie to protecting a person’s information Current Topics

44. Stay Connected Find more technical information, detailed updates, training opportunities, and materials to share on the web: https://www.cms.gov/newcard Comments and questions are always welcome! Send to: SSNRemoval@cms.hhs.gov Current Topics

45. Lesson 3—Marketplace Updates • New Special Enrollment Period Verification (SEPV) • New Health Coverage Enrollment Option for Small Business • Proxy Direct Enrollment Pathway for 2018 Individual Market Open Enrollment Period Current Topics

46. Special Enrollment Period (SEP) Overview • SEPs provide a way for people who lose health insurance or experience other qualifying events during the year to enroll in or change coverage outside of the annual open enrollment period • In most cases, consumers have 60 days from the date of the qualifying event to enroll in coverage • SEP qualifying events fall into 6 categories. To learn more about when consumers may qualify for an SEP, visit Marketplace.cms.gov/outreach-and-education/special-enrollment-periods-available-to-consumers.pdf Current Topics

47. Special Enrollment Period Verification(SEPV) • Beginning in Summer 2017, new applicants (those who aren’t already enrolled in Marketplace coverage) who attest to certain types of SEP qualifying events will be subject to the SEPV process or pre-enrollment verification. Eligible consumers must submit documents that confirm their SEP eligibility before they can enroll and start using their Marketplace coverage. • Phase 1: On June 23, 2017, pre-enrollment verification starts for 2 SEP types: • Loss of coverage • Permanent move • Phase 2: In August 2017, pre-enrollment verification starts for 3 additional SEP types: • Marriage • Gaining or becoming a dependent through adoption, placement for adoption, placement in foster care, or a child support or other court order • Medicaid/CHIP denial • For more information, visit https://marketplace.cms.gov/technical-assistance-resources/sep-preenrollment-verification-overview.pdf Current Topics

48. New Health Coverage Enrollment Option for Small Business—Intention to Propose Rule Making • Instead of enrolling online at HealthCare.gov, employers would enroll directly with an insurance company offering SHOP plans, or with the assistance of an agent or broker registered with the Federally-facilitated SHOP • Employers would still obtain a determination of eligibility by going to HealthCare.gov • Employers that have enrolled in SHOP coverage for plan years that began in 2017 would be able to continue using HealthCare.gov in 2018 for enrollment and premium payment, until their current plan year ends and it’s time to renew • Employers can sign up for SHOP coverage taking effect in 2017 on HealthCare.gov until November 15, 2017 • States operating State-based SHOP Marketplaces would be able to provide for online enrollment, or could opt to direct small employers to insurance companies and SHOP-registered agents and brokers to directly enroll in SHOP plans Current Topics

49. Proxy Direct Enrollment Pathway for 2018 Individual Market Open Enrollment Period • New streamlined and simplified direct enrollment process for consumers signing up for individual market coverage through Exchanges that use HealthCare.gov • Consumers applying through direct enrollment partners will now be able to complete their application using one website • Provide for easier access to healthcare comparisons and shopping experiences for coverage offered through HealthCare.gov Current Topics

50. This Training is Provided by the CMS National Training Program (NTP) To view all available NTP training materials, or to subscribe to our email list, visit CMS.gov/outreach-and-education/training/CMSNationalTrainingProgram. Stay connected. Contact us at training@cms.hhs.gov, or follow us @CMSGov #CMSNTP Current Topics