2011 Current Topics Module 4

1. 2011 Current Topics Module 4

2. For state level data • http://www.cms.gov/home/rsds.asp 9.2M Medicare and Medicaid Eligible DRAFT Medicare Current Topics

3. 2. Agency Priorities Improving Care for Individuals Better Coordination of Care Fighting Fraud and Abuse DRAFT Medicare Current Topics

4. I. Improving Care for Individuals Value-based Purchasing Focus on Hospital Acquired Conditions Reducing Unnecessary Hospital Readmissions Bonus Payments Preexisting Condition Insurance Plans DRAFT Medicare Current Topics

5. ACA Pre-Existing Condition Insurance Plans (PCIPs) • Covers people without insurance due to a pre-existing condition until 2014 • Administered by state or Department of Health and Human Services • Premium not higher due to your condition • Standardized by age • Doesn’t base eligibility on income DRAFT Medicare Current Topics

6. ACA PCIP Standard Covered Benefits Primary and specialty care Hospital care Prescription drugs Home health care and hospice care Skilled nursing care Preventive health and maternity care DRAFT Medicare Current Topics

7. ACA Who is eligible for PCIP coverage? • U.S. citizens or legal residents • With a pre-existing medical condition • Not have creditable health coverage • For the previous 6 months before you apply • Your state Consumer Assistance Program (CAP) • Helps you enroll • File complaints and appeals • Information at https://www.pcip.gov/ DRAFT Medicare Current Topics

8. ACA Accountable Care Organizations (ACOs) • Providers organize ACOs • Facilitate provider coordination and cooperation • Improve quality of care • Reduce unnecessary costs • Voluntarily meet quality thresholds • Share in cost savings achieved for Medicare • Comment period closed • In listening mode DRAFT Medicare Current Topics

9. III. Fighting Fraud and Abuse Save taxpayer dollars New steps DRAFT Medicare Current Topics

10. Fighting Fraud and Abuse • Tax dollars saved • Over $4 billion recovered and returned in 2010 • Over $5 billion so far in 2011 • Nine Anti-fraud Strike Force teams • In fraud hot spots around the country • Hundreds of convictions • Criminals had billed Medicare $100s of millions • Senior Medicare Patrol www.smpresource.org • Reached 1.5 million with critical information DRAFT Medicare Current Topics

11. ACA Fraud and Abuse Prevention • New steps to keep criminals on the defensive • Tougher screenings for health care providers • Site visits • Keep fraudulent providers out of programs • Medicare • Medicaid • CHIP • Types identified as higher risk subject to more thorough screening DRAFT Medicare Current Topics

12. ACA Fraud and Abuse Prevention • Identify trends that indicate fraud • Increase penalties for fraud • Authority to suspend payments • When credible allegation is being investigated • $350 million for fraud fighting resources DRAFT Medicare Current Topics

13. 3. Medicare Updates Medicare • Original Medicare • Medicare Advantage (Part C) • Medicare Prescription Drug Coverage (Part D) DRAFT Medicare Current Topics

14. Part A Costs for Inpatient Hospital Stays DRAFT Medicare Current Topics

15. Part A Costs for Skilled Nursing Facility Care DRAFT Medicare Current Topics

16. 2011 Part B Amounts Part B Annual Deductible - $162 DRAFT Medicare Current Topics

17. Income-Related Part B Premium *Higher if you have a late enrollment penalty • Part B premium income thresholds • Frozen at 2010 levels through 2019 DRAFT Medicare Current Topics

18. ACA Annual Wellness Visit • Once every 12 months covers • Comprehensive health risk assessment • Personalized prevention plan • Health advice • Referrals for education and counseling • No cost if doctor accepts assignment • Can be performed by nurse practitioners and physician’s assistants • Effective January 1, 2011 DRAFT Medicare Current Topics

19. When to get Your Wellness Visit • Had Part B for at least 12 months • Welcome to Medicare physical not required • Had “Welcome to Medicare” exam • Must wait 12 months before annual Wellness visit • Effective January 1, 2011 DRAFT Medicare Current Topics

20. Preventive campaign summer of 2011 • Learn about covered preventive services • PSA’s, online ads, community events • Access preventive publications • www.medicare.gov/share-the-health/ DRAFT Medicare Current Topics

21. ACA Medicare Advantage Enrollment Periods • MA Open Enrollment Period eliminated • Annual Coordinated Election Period (AEP) • Now October 15 – December 7 • Enrollment effective January 1 • Known as Open Enrollment • Can change plan or switch to Original Medicare DRAFT Medicare Current Topics

22. ACA New MA Annual Disenrollment Period • To disenroll and switch to Original Medicare • Make a request directly to MA organization • Call 1-800-MEDICARE • Enroll in a standalone prescription drug plan • Between January 1-February 14 • Effective first of the month after enrollment DRAFT Medicare Current Topics

23. New Special Enrollment Period • Can enroll in 5-Star MA, MAPD or PDP plan • Enroll at any point during the year • Once per year • New plan starts first of month after enrolled • Star ratings on Planfinder October 1 • Updated yearly • Effective December 8, 2011 DRAFT Medicare Current Topics

24. ACA Medicare Advantage Plans • Can’t charge more than Original Medicare • Chemotherapy • Dialysis • Skilled nursing facility care • Other certain services • Must limit your costs for Part A/B services • Effective January 1, 2011 DRAFT Medicare Current Topics

25. ACA Payments to Medicare Advantage Plans • Frozen in 2011 • Benchmarks vary • % Original Medicare pays on average at county level • Phased in over 3, 5, or 7 years • Depending on level of payment reductions • MA benchmarks reduced in 2012 • 85% of funds must be spent on health care • Effective 2014 DRAFT Medicare Current Topics

26. Medicare Prescription Drug Coverage Updates • Enrollment Period • Coverage Gap • Income-related Premium • Indian Health/AIDS Drug Assistance • Low-Income Benchmark Premium DRAFT Medicare Current Topics

27. ACA Open Enrollment Period • Formerly called the Annual Election Period • Changes in 2011 • October 15 – December 7 • Coverage begins January 1, 2011 • Joined/switched Medicare Advantage Plan • Joined/switched Medicare Prescription Drug Plan DRAFT Medicare Current Topics

28. New Special Enrollment Period • Can enroll in 5-Star MA, MAPD or PDP plan • Enroll at any point during the year • Once per year • New plan starts first of month after enrolled • Star ratings on Planfinder October 1 • Updated yearly • Effective December 8, 2011 DRAFT Medicare Current Topics

29. ACA Part D Coverage Gap • If you reach the coverage gap in 2011 • You get a 50% discount on brand-name Rx drugs • Counts toward TROOP • You get a 7% discount for generic drugs • Entire price counts toward catastrophic coverage • Dispensing fees not discounted • Additional savings in coverage gap each year • Gap to be closed in 2020 DRAFT Medicare Current Topics

30. ACA Medicare Prescription Drug Coverage Premium • Higher income pay higher Part D premium • Uses same thresholds used to compute income-related adjustments to the Part B premium • As reported on your IRS tax return from 2 years ago • Beneficiary financial information not on Planfinder • Must pay if you have Part D coverage • Social Security notifies beneficiary • Effective January 1, 2011 DRAFT Medicare Current Topics

31. ACA Note: Can be appealed to SSA (not plan or CMS) DRAFT Medicare Current Topics

32. 5. Electronic Health Records Updates • American Recovery and Reinvestment Act (ARRA) and the Health Information Technology for Economic and Clinical Health Act (HITECH) • Medicare’s “Blue Button” DRAFT Medicare Current Topics

33. ARRA EHR Incentive Program HITECH Health Information Technology for Economic and Clinical Health Act (HITECH) Provides incentive payments Use of electronic health records system Sometimes called “HITECH” DRAFT Medicare Current Topics

34. ARRA Program Benefits HITECH • Increased data confidentiality • Streamlined clinician workflow • Improved quality of care • For information and registration • www.cms.gov/EHRIncentivePrograms/ DRAFT Medicare Current Topics

35. NEW: Medicare’s “Blue Button” • On www.MyMedicare.gov • Helps you manage your health information online • Download your Medicare claims • Download self-entered information • Emergency contacts • Names of pharmacies and providers • Self-reported allergies • Medical conditions • Prescription drugs DRAFT Medicare Current Topics

36. DRAFT Medicare Current Topics