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CONSUMER PROTECTION TECHNICAL RESOURCE THE NATIONAL CENTER T HE S ENTINEL NOVEMBER 16, 2005 INSIDE THIS ISSUE: IMPORTANT NEW PROGRAM FOR PRESCRIPTION DRUG ASSISTANCE: CONFLICT WITH MEDICARE RX BENEFIT? SURVEY SAYS 2 AOA UPDATE 3 PHYSICIAN 4 In an effort to make it easier for patients IDENTITY THEFT to learn about, and get access to, WRITING OP-EDS 6 programs providing free or nearly free TENET HOPITAL 8 medicines, the trade group Pharmaceutical Research and The Partnership for Prescription Assistance UNDERSERVED COMMUNITIES 8 Manufacturers of America (PhRMA), in offers a single point of access to more conjunction with over fifty health care than 475 public and private patient assistance programs. “SHOOT THE TROOP” 10 provider, patient and community groups, MENTOR PROGRAM 11 created the Partnership for Prescription IDEAS-IN-ACTION 12 Assistance (PPA). Among the income, uninsured, etc.) organizations collaborating on this • For the first time, there will be a TOOLS YOU CAN USE 13 program are the American Academy of toll-free phone number that patients, MEDICARE RX TIPS 14 Family Physicians, the American caregivers and providers can call to HOW MAY I HELP 16 Autoimmune Related Diseases find out information from trained Association, the Lupus Foundation of operators and begin the application America, the NAACP, the National process for these programs. Patients Alliance for Hispanic Health and the may also apply at an updated easy-to- National Medical Association. use website. News You Can Use • Health care providers will have a Your National Consumer This partnership is a valuable tool to way to help needy patients that does Protection Technical Resource help you to help low-income or not require hours of staff time Center conducted a Medicare uninsured patients through a “one-stop- researching what programs are Prescription Drug Program shop” via the internet or toll-free phone available, searching for forms, and Teleconference on November number. In order to meet the needs of filling out the forms for the patient. 4th. This training focused on as many low-income or uninsured patients, specialists are available for both The PPA links patients to consumer protection and English and Spanish speakers and pharmaceutical company assistance program integrity. The online translation services are available in program as well as those run by public, archive of this presentation is seventeen other languages. private and government entities. now available on the web. To Through this program, patients answer learn more about this and Through this program: a series of short questions and, within upcoming trainings visit The • For the first time, there will be a one- five minutes, learn which programs Center’s website at stop portal for information on over 475 they may be eligible for and can begin public and private assistance programs the application process. www.smpresource.org. for patients with varying needs (low- (continued on page 2) THE SENTINEL Page 2 P R E S C R I P T I O N A S S I S TA N C E (continued from page 1) In a news release issued in October, the trade drug providers and recipients. The OIG said that group Pharmaceutical Research and Manufacturers because the Part D program would cover most of America said that an additional 5,000 people prescription drugs, Part D beneficiaries currently had been signing up each day as a result of the enrolled in a manufacturer-sponsored PAP no industry's new toll-free call center and a publicity longer would qualify for assistance, in part because campaign that includes a tour bus that has made it of Part D cost-sharing obligations that the through twenty five different states. beneficiaries must meet. In addition, many low- income beneficiaries will qualify for federal According to Ken Jones, a spokesman for subsidies, the OIG added. PhRMA, quoted in a New York Times article, the new Medicare prescription drug program could The advisory bulletin noted that beneficiaries were cause a decline in the programs' overall relieved of any financial risk from accepting enrollment, possibly as much as 40 percent. But he assistance from ill-structured PAPs by meeting said that the industry sign-up effort would requirements that such assistance be included in continue. "It's possible that there will be drop-off, true-out-of-pocket calculations. but at the same time, we're going to be very aggressive in reaching out to the millions of other According to the OIG, there is no need for drug Americans who are below the age of 65," Mr. companies to disenroll all Medicare-eligible PAP Johnson said. participants, only those who choose to enroll in a Part D plan as of Jan. 1, 2006 or later. "Occasional, Drug companies distributed free drugs with a retail inadvertent cost-sharing subsidies" were not value of $4.1 billion last year to an estimated three problematic in cases where the drug company did million to four million Americans, through their not and should not know that an individual was charity programs that in some cases focused on enrolled in a Part D plan. patients with financial needs who don't qualify for the Medicare prescription drug program. In addition, the advisory bulletin explicitly stated that pharmacies were not prevented from waiving A BNA article outlined the findings from a Special cost-sharing amounts owned by Medicare Advisory Bulletin issued by the HHS Office of beneficiaries as long as the waivers were based on Inspector General November 7th. Drug makers good-faith, individualized assessments of patients' that operate and control patient assistance financial needs and as long as such waivers were not programs could risk breaching fraud and abuse routine or advertised. However, such waivers could laws--especially the anti-kickback statute--if they not be funded using cash or in-kind donations by offer assistance in 2006 and beyond to Part D third parties, including PAPs. enrollees by subsidizing their Part D cost-sharing obligations. While the statutes are aimed at According to the Times article: reducing opportunities for fraud rather than • Bristol-Myers and Merck will be notifying curbing charity to individuals, they do call into patients that they will need to choose between the question any kind of financial relationship between PAP and Medicare Part D enrollment; • Johnson & Johnson is notifying doctors that “Survey Says” their patients must first be turned down for extra help under provisions of the new Medicare plan In 2003, more than 29 million people in the before they can apply to Johnson & Johnson's United States made less than 200% of the federal program; and poverty level and have no health insurance. (continued on page 3) THE SENTINEL Page 3 PRESCRIPTION ASSISTANCE (continued from page 2) • Eli Lilly is notifying 235,000 older people that its charitable program for the elderly will end next May. The OIG bulletin explicitly states that pharmaceutical manufacturers can make cash contributions to bona fide charities not affiliated with a manufacturer that operate without regard to donor interests, organizations typically run by patient advocacy and support organizations. To view the full OIG Special Advisory, visit www.oig.hhs.gov/fraud/docs/ alertsandbulletins/2005/PAPAdvisoryBlletinFinal- Final.pdf Assistant Secretary Carbonell visiting Hurricane Katrina shelter in Houston accompanied by Curtis Cooper, manager of the Houston-Galveston Area Agency on Aging and For more information about PPA’s mission to Charlene James director of the Harris County AAA increase awareness of patients assistance programs and boost enrollment visit PPA at their website: www.pparx.org or call toll-free at 1-888-477-2669. AoA is pleased to work in partnership with national organizations to coordinate the identification and distribution of funds and other resources from non-affected states and areas and AoA Update: Disaster Relief national organizations for use in affected and support areas. The National Association of Area Assistant Secretary for Aging, Josefina Carbonell, Agencies on Aging (n4a), in cooperation with traveled to Katrina-affected areas in Mississippi AoA, and the National Association of State Units and Louisiana to meet with state and local aging on Aging, has established a central database for leaders. In addition she toured shelters in Area Agencies on Aging (AAAs) and State Units Houston, TX. “We are deeply saddened by the on Aging to offer a variety of goods and services devastation left in the aftermath of Hurricanes to help older adults and agencies in the affected Katrina and Rita,” said Assistant Secretary areas. Numerous agencies have responded Carbonell. generously. Several AAAs have sent professionals from their own agency to work in the areas AoA is responding to these disasters by assisting needing assistance. the Aging Network in the affected areas. In addition to providing disaster relief funds for immediate reestablishment of infrastructure and SAVE THE DATE resources to support full recovery, AoA has The 2005 National TRIAD Training Symposium deployed Rapid Response Teams to assist state begins December 5 through the 8 in Tunica, MS. and local aging officials in the affected areas to Through this symposium, attendees will learn how assess and respond to the needs of elderly to start, maintain and improve their local TRIAD. residents and evacuees. The teams include experts in emergency management involving elderly For more information visit: www.nationaltriad.org/ people with special needs. biloxi/index.htm. THE SENTINEL Page 4 PHYSICIANS, BEWARE OF IDENTITY THEFT Physicians are increasingly the target of identity theft. They are particularly vulnerable given the amount of sensitive identifying material they must provide to participate in health insurance plans and for credentialing purposes. Misappropriation of Medicare provider information is a variant of what is commonly called "identity theft" among law enforcement personnel. The Justice Department officially defines identity theft as a "crime in which someone wrongfully obtains and uses another person's personal data in some way that involves fraud or deception. Trailblazer Health Enterprises (THE), the Part B carrier for the Mid-Atlantic, states issued a "Fraud Red-Alert" to its physician and supplier enrollees. The Fraud Red-Alert was to inform its enrollees that members of an organized group of individuals representing themselves as either Medicare Fraud Failure to report identity theft Investigator or as Centers for Medicare & Medicaid Services (CMS) employees could lead to significant from the enrollment, claims, or audit units were attempting to commit identity consequences—providers, theft by obtaining identifying information from Medicare-enrolled providers. beware. Callers were contacting physicians and their offices explaining that the CMS computer system had malfunctioned, requiring the callers to update lost information—including the physicians' provider records. Specific information requested included: • Copy of the physician's drivers license • Verification of practice location • Copy of the physician's Social Security number • Copy of physician's medical license • Unique Physician Identification Number • Copy of patient charts for a specific period of time • Verification of education Upon receiving this information, members of the group falsified enrollment data using the physicians' names and requested changes to the physicians' practice locations, telephone numbers, and pay-to-addresses so that reimbursement checks were forwarded to the new location. A fraud ring paid employees of a California hospital to steal physicians’ medical licenses and other information in order to steal $1.39 million from the state’s Medicaid program. Then there's computer-aided identity theft… It happens either when an insider with legitimate access to an organization's network or a computer hacker compromises a secured network in order to steal personal information stored within. This practice is referred to as database compromise. One case recently happened when the admission records of nearly 5,000 heart patients were downloaded by a man who hacked into the computer network of the University of Washington Medical Center in Seattle. Another similar instance happened when crooks broke into a computer at the Center for Sleep Disorders laboratory at the Indiana University School of Medicine in Indianapolis and accessed the personal information of 7,000 patients. Thieves have also discovered that, often with little risk, they can break into a physician’s office and steal computers. Generally, they're not interested in the clinical information that the computers may contain, although that remains a concern. What they're hoping to steal is something they can use for a variety of (continued on page 5) THE SENTINEL Page 5 IDENTITY THEFT (continued from page 4) criminal schemes – e.g. provider numbers, Medicare numbers and credit card numbers. And they're having a lot of luck. The following suggestions may help protect physicians and prevent theft of patient information. • Install security passwords on all computers in the practice. Enforce their use and periodic change by employees. • In general, authorize as few people as possible to have keys to the office. Employees, who have access to the office, should have a key to the main door only. • Do not authorize an employee to have a key to the office with access to patient or business-related information until that person has passed a probationary period. • Stipulate the return of keys from all employees, regardless of whether they quit or are fired. Employees who are fired should be required to turn in their keys, collect their personal belongings, and leave the office immediately upon termination. • Automatically change passwords whenever an employee quits or is fired. • Backup disks, tapes, or reports should be kept under lock and key, preferably off site. • No laptop computer should be used for clinical purposes unless it has complete password installation. Preferably, laptops should be removed from the office at day's end. If that is not possible, they should be locked in a safe or in some other secure site. Laptops with clinical information on them should not be left in cars, not even in trunks. • Use only bonded cleaning staff. If you cannot control the cleaning process (i.e., you rent office space in a building that provides cleaning services), inquire about the security check that the company uses to screen potential hires. Depending on the setup of your office, you may need to ask the cleaning crew's employer to sign a Business Associate agreement to ensure HIPAA compliance. • Ensure that access to clinical areas is locked during lunchtimes, hours when patients are not in the office, or if an employee is working late. If possible, main office doors should also be locked during these times. • Report any suspicious activity, possible breach of security, or threats of violence from terminated employees (or disgruntled patients) to the police. • Report any theft (prescription pads, drug samples, patient information, office materials, etc.) to the police. Health care providers who believe that they have been the victims of identity theft should act quickly to report the misuse of their identifying information. Failure to do so can lead to significant consequences for providers, including recoupment actions, suspensions of payment, institution of prepayment audits, etc. Victimized providers should immediately notify their carriers of the suspect conduct, and may consider notifying the National Consumer Protection Technical Resource Center 1-877-808-2468 who will alert the 64 Senior Medicare Patrol projects across the nation to the schemes. THE SENTINEL Page 6 TIPS FOR WRITING AN OPINION PIECE This is the last in a series of articles designed to describe essential “tools” your organization might utilize to gain media attention. Previous topics included a series of general tips on working with the media, discussion of the critical aspects of development and distribution of press releases and fact sheets, and a guide to participating in media interviews. The focus on this final article is the op-ed or letter to the editor—a tool not too frequently utilized by many organizations. One of the best ways to gain credible visibility is to submit an opinion piece to a major newspaper and have it published. A good op-ed contains a fiery opinion, which is supported by facts. An op-ed is not an essay, something that slowly unrolls like a carpet, building momentum to some point or conclusion. It's just the opposite. In an op-ed, you essentially state your conclusion first. You make your strongest point up front, then spend the rest of the op-ed making your case, or back-filling with the facts. Done right, it's persuasive writing at its best. You will help your organization win converts, gain high-quality publicity and reach the elite audience of opinion-makers who regularly read the op-ed pages. Here's a checklist to keep your op-ed on track: • Focus tightly on one issue or idea --- in your first paragraph. Be brief. (Continued on page 7) HINTS FOR PLACING AN OP-ED • Before you send it, call and pitch the piece to the editor of the op-ed page to see if there is any interest. • Call early in the week and early in the day. • Ask about the paper's submission policy. Some major publications want the piece to be "exclusive" (submitted only to them). • Send your op-ed to several papers at a time, if this is allowed by their policy. • Write a cover letter briefly explaining your subject, why it is relevant and will capture reader interest, as well as your own background. Remind the editor of your phone call. • If you don't hear anything back from the paper by a week after submitting the op-ed, call to see if it was received. Cover letters should accompany any Op-Ed submissions. A good cover letter should include the writer’s: • Name • Mailing address • Day and evening phone numbers • Social Security number for payment when applicable • Short biographical sketch highlighting the writer’s credentials on the topic • Explanation of any ties the writer has to issues or organizations mentioned in the piece • Return fax number or e-mail address • Request for a tearsheet, a hard copy of the newspaper page containing the Op-Ed • Name and phone number of a contact person in case writer cannot be reached THE SENTINEL Page 7 OPINION PIECE (continued from page 6) • Express your opinion, then base it on factual, researched or first- hand information. • Be timely, controversial, but not outrageous. Be the voice of reason. • Be personal and conversational; it can help you make your point. • Be humorous, provided that your topic lends itself to humor. • Have a clear editorial viewpoint - come down hard on one side of Done correctly, an op-ed is persuasive the issue. Don't equivocate. writing at its best! • Provide insight and understanding: educate your reader without being preachy. • Near the end, clearly re-state your position and issue a call to action. Don't philosophize. • Have verve and "fire in the gut" indignation to accompany your logical analysis. • Don't ramble or let your op-ed unfold slowly, like an essay. • Use clear, powerful, direct language. • Emphasize active verbs, forget adjectives and adverbs, which only weaken writing. • Avoid clichés and jargon. • Appeal to the average reader. Clarity is paramount. • Write 750 double-spaced words or less (fewer is always better). Include a brief bio, along with your phone number, email address, and mailing address at the bottom. Many major newspapers today accept timely op-eds by email. Check the paper's website first to be sure what its policy is. Remember, if you are speaking as a representative of your organization’s Senior Medicare Patrol project or mention the program, an AoA disclaimer is generally required. However, if you are submitting your op-ed in your capacity as an employee of your particular organization, a disclaimer may not be required. While it's tempting to fire off your op-ed to The New York Times, remember that there are many other major newspapers to consider. The New York Times receives more op-eds daily than any other paper in the US, so competition is fierce. It's better to be published in another excellent paper than not to be published in The New York Times. For examples of well written Op Eds, visit: http://www.pubpol.duke.edu/newsmedia/op-ed/ examples.html We’d love to hear your media outreach success stories. To share feedback or your stories, contact Jolie Crowder at firstname.lastname@example.org. THE SENTINEL Page 8 UNINSURED OR UNDERINSURED PATIENTS OF TENET HOSPITAL SYSTEMS’S HOSPITALS MAY APPLY FOR A REFUND OF PAYMENTS In March 2005 the Tenet Hospital Systems settled a class action lawsuit and entered into a Compliance Agreement with the Office of the Inspector General regarding the hospital system’s practice of charging uninsured and underinsured patients more than patients with private insurance, Medicare or Medicaid. Under this agreement, the Hospital System agreed to refund patients’ out-of-pocket payments that they may have been charged if they apply for the refund before January 11, 2006. Tenet Hospital System owns many hospitals across the country. If you have counseled anyone who received services from a Tenet System Hospital between June 15, 1999 and December 31, 2004 and either: 1) did not have insurance coverage at all; or 2) had health insurance but was asked to make copayments or deductibles at the time of treatment, you should inquire about current bills that they might have from the hospital. They may be entitled to a refund of payments that they may have already made, and/or a recalculation of a bill that they owe. Any collection action that might be ongoing against these individuals by the hospital must be stopped while the bill is recalculated. To find out which hospitals are owned by Tenet Hospital System, you should go to http:// www.tenetclassaction.com. 8 TIPS FOR CONDUCTING OUTREACH TO UNDERSERVED COMMUNITIES The Senior Medicare Patrol program continues to grow nationwide. As the program grows so must our abilities to provide educational outreach to include those who too often slip through the proverbial social cracks of society. Much of the health care literature defines "underserved populations" as groups whose demographic, geographic, or economic characteristics impede or prevent their access to health care services. Underserved populations include (but are not limited to): elderly people; culturally diverse populations such as African- Americans and Native American Indians; non-English speaking persons; persons living in rural, isolated areas; homebound persons; persons with disabilities such as deafness and/or blindness; and persons who are medically fragile. Below are eight tips each SMP should consider when reaching out to the underserved populations in your region. Tip #1: Adjust Your Expectations • Underserved populations may not respond to outreach the way your mainstream audience does. • Response is shaped by history, culture and lifestyle. Tip #2: Form Partnerships (continued on page 9) THE SENTINEL Page 9 UNDERSERVED COMMUNITIES (continued from page 8) • Why? Partners contribute different things, including: resources, access to target populations, manpower, and know how. • Who? Community and faith-based organizations, state and local nonprofits, primary healthcare providers, and government entities. Tip #3: Educate • Minority and hard-to-reach populations are often undereducated about the importance of preventative health care, and services out there that are often available to them. Consider broadening the scope of your traditional SMP Consider these eight tips when reaching out to education to include information about health services underserved communities. available to underserved populations in your area (i.e. free health screenings, flu vaccinations, health clinics, etc…). Tip #4: “In-language” and “In-culture“ • Educational materials should be written in the language of the culture you are trying to reach. • Address cultures in their native language. If this is not possible, take the initiative to learn a few language basics (e.g. “Hello”, “Welcome”, and “Thank you”). Your ability to do so will demonstrate to the other culture that you are making a serious effort to bridge the cultural barrier. Tip #5: Recruit Volunteer Ambassadors for your SMP project • The public face of your initiative should reflect the population you wish to reach. Tip #6: Deliver Education and Outreach Within Their Community • Underserved populations may be homebound, illiterate, or may be intimidated by “traditional” settings. Use a variety of mediums to get your message out (e.g. newsprint, radio, and television). • Some members of target population may feel uncomfortable outside of their neighborhoods. Find places that are familiar and easy for your target audience to get to and take the education to them. Tip #7: Put Your Results in Context • Where did you start from? What did you achieve? • What worked? What didn’t? What should you do differently next time? Tip #8: Share with Others • Let others know what worked for your project. We can all learn from one another’s experiences. Reaching out to underserved populations requires the development of cultural competency. As the network of SMPs continues to expand nationally the need for resources related to outreach to and/or training of underserved population will be widely needed. If your project has developed resources that would be helpful to other SMPs, especially materials translated into other languages, please forward them to The Center at email@example.com. If you are looking for materials to meet your needs in serving these communities, please visit our resource library on the web at www.smpresource.org. THE SENTINEL Page 10 ACCOUNTING FOR OUT-OF-POCKET DRUG COSTS—MORE ON “SHOOT THE TROOP” For those of you that attended the recent SMP outlined in statute, TrOOP expenses include Regional Conferences, you will remember the deductibles, copayments, coverage gap payments or reference to “shoot the TrOOP,” —this expression any other expenses that result from drugs that are for inaccurate accounting of beneficiaries’ out-of- included in the plan formulary and provided by in- pocket expenses. This topic came up again at the network providers. Payments may be structured to annual American Health Lawyers Association require higher out-of-pocket payments for drugs in Fraud conference and, it appears, that plans, as well different “tiers” of the plan formulary. as beneficiaries may have an incentive to “shoot the TrOOP.” Beneficiaries, family members, charity organizations or the state prescription assistance programs By doing a “sloppy job” of tracking out of pocket (SPAP) may pay these out-of-pocket expenses. costs, or giving credit for out-of-pocket costs that Employment health insurance or Medigap should not be included, plans can give beneficiaries insurance may not pay TrOOP for beneficiaries. credit for out-of-pocket drugs expenses and move beneficiaries into Medicare’s catastrophic coverage What Out of Pocket Expenses Do Not Count threshold. Having met this threshold, Medicare as TrOOP? pays 95% of catastrophic prescription drug costs on Beneficiaries are likely to expect that any drug cost behalf of beneficiaries and plans get additional “risk should be counted as part of the TrOOP. But they adjusted” payments for high drug cost individuals. do not. For example, these costs do not count toward the TrOOP: Of course, the reverse is also true—plans may do a sloppy job of accounting for TrOOP expenses and • Over the counter drugs fail to give beneficiaries full credit for TrOOP expenses—so that beneficiaries do not move from • Drugs that are not on the plan the “coverage gap” (i.e. “donut hole”) to Medicare formulary catastrophic coverage, for example. In any case, it • Drugs purchased from non-plan is clear that advocates must be fully aware of which providers beneficiaries’ expenses count toward the TrOOP • Drugs purchased without the drug plan and help beneficiaries examine the written notices card from their plan about the TrOOP. • Drugs purchased from Canada So what counts as a TrOOP expense? • Non-covered drugs, including dietary or The TrOOP is the beneficiaries’ share of drug herbal supplements expenses—those that beneficiaries must pay out-of- • The value of a coupon or rebate pocket before Medicare pays anything on their certificate to pay for formulary drugs at behalf. Under the drug plans outlined in federal a plan pharmacy law, the TrOOP includes: • Drug costs paid from a health care reimbursement account (HRA) that has 1. the $250 deductible, been funded solely by an employer. 2. 25% copayment, or $500, of the next $2,000 of prescription expenses, and How Will Beneficiaries Know Whether Their $2,850 during the coverage gap, totaling $3,600 in Out-Of-Pocket Expenses Have Been Counted? 2006. For plans that do not follow the plan design (continued on page 11) THE SENTINEL Page 11 “SHOOT THE TROOP (continued from page 10) THE CENTER’S SMP MENTOR PROGRAM Medicare requires that plans send a written notice There are 48 SMP projects across the nation currently to beneficiaries in each month that they have drug participating in the Mentor Program. Volunteer expenses. This notice shall list the item(s) or service “Mentor Teams” have been established to provide (s) for which payment was made and the amount of support and develop program strategies, skills, and the payment for each item or service. This notice successful practices through monthly conference calls must include information about the enrollee’s right with the 13 new grantees and many new program to request an itemized statement, appeal/grievance directors. Currently, call dates and times are being rights, and exceptions process. Finally, this notice arranged. The volunteer mentor teams began must include the cumulative, year-to-date total assisting the projects in October. amount of benefits provided, including information regarding deductibles, initial coverage limits before reaching the catastrophic cost threshold, total out- To become more assessable to the various time zones of-pocket expenditure (TrOOP), and any applicable that exist among the SMP Projects, the Center formulary changes expanded its weekday hours of operation to 7:00 am - 5:30 pm Central Standard Time. Most beneficiaries are unlikely to pay much If you are a new grantee or director and are interested attention to this notice and are also unlikely to save in being mentored, or if you are a director who would receipts from the drug store showing the amount of like to serve as a mentor, check out the information out-of-pocket cost that they have incurred. In below: addition, most beneficiaries will complain about out-of-pocket expenditures only if they understand Mentor Program their plan well enough to understand that it may be Reason to participate as a mentee: in their own self-interest to keep track of their out- of-pocket costs. Concerned that they may be paying • New Grant • Special Population Focus more in out-of-pocket costs than they should be, • New Director • Wanting Regular and beneficiaries will complain to their local pharmacy Focused Assistance personnel first, and may be reluctant to appeal this • Networking issue to their plan. The Centers for Medicare and Medicaid Services Reasons to participate as a mentor: intends to audit TrOOP accounting by plans. Senior Medicare Patrol programs should monitor • Networking—Networking—Networking accounting of TrOOP expenditures and will want • Expertise in a Special Population to pay close attention to beneficiaries’ concerns in • Sharing Best Practices Among the SMP this area. The SMPs may want to develop tools to Community help beneficiaries keep track of these costs and to • Seasoned Director or Project help beneficiaries understand that it is in their interest, as well as that of the Medicare program, to make sure that the plans accurately account for For more information about The Center’s SMP TrOOP expenses. Mentor Program, contact Shirley Merner toll-free —————————— 1Drug at 1-877-808-2468 or via email at costs paid from funds of an employee-funded health care reimbursement account do not count toward firstname.lastname@example.org. TrOOP. THE SENTINEL Page 12 “I DEAS-I N-A CTION” H IGHLIGHT This fall at the AoA Regional SMP Conferences, we heard about many promising practices in action which we would like to highlight and share with the entire SMP community through a series of articles in future editions of the newsletter. At the Chicago Regional Conference we learned about a new product made possible by the Minnesota Board on Aging/Senior LinkAge Line. Jackie Bruno, Health Insurance Counseling Advisor at the Minnesota Board on Aging, distributed their deck of playing cards, all 52 with a different message/tip for seniors and people with disabilities, fresh off the presses. The following article discusses how this project came to be through partnerships and hard work, and how it enables the Minnesota project to better reach their community. An Idea Was Born The idea, Jackie said, was born before she came to the project from the mind of Krista Boston the Manager of the Minnesota Board Turn a plain deck of playing cards into a on Aging’s Consumer Choices Team. Her first step in making the fun tool to teach seniors idea a reality was to contact the vendors. They decided to work with Decks-R-Us out of Florida (407-298-3579 or email@example.com) who could produce the cards at seventy-one cents per deck. Finding the Right Partners… The next step, partnership, was not a hard one for Jackie because the Minnesota Senior LinkAge Line is a centralized project that houses both the SMP projects (Healthcare Anti-Fraud Demonstration Grant) and the SHIP project, as well as three other AoA Grantees: AoA’s Alzheimer’s Disease Demonstration Grant to the States Program, AoA’s National Family Caregiver Support Program Grant and Age and Disabilities Resource Center (ADRC) which is funded by CMS as well as AoA. In addition, the Family Caregiver Support Program has a depression campaign known as Black Clouds, Sunny Days, which they incorporated into the project as well. These groups were all able to work together to produce cards with primarily fraud related messages, but also messages about memory loss, caregiver assistance, and depression. Jackie said the best part about these partnerships was cost-sharing and knowing they were efficiently using government money. The Challenges… The hardest part of this project was coming up with text for each card and proofreading. To facilitate the partnership, Jackie collaborated with the Alzheimer’s Demonstration Project, Family Caregiver Support Program and ADRC by writing text for their approval. Jackie reported that proof reading the cards was the most difficult part. To get through the challenges of proofing, Jackie relied on the collaboration of her team to ensure all the proper content, phone numbers and logos were on each individual card. Looking back on the project the one thing Jackie said she would change, would be to allow more time for the editing process, especially when working with long-distance vendors. (continued on page 13) THE SENTINEL Page 13 “IDEAS-IN-ACTION” (continued from page 12) The Results and Benefits! This project has been an outstanding success. It allows the Minnesota projects to reach out primarily among senior centers, nursing homes, and allows caregivers to share the cards with their family members. Jackie said their hope is that seniors will begin to read the tips on the cards when their games get a little slow and allow their messages about crucial issues to filtrate throughout the Medicare consumer communities. The Minnesota Board on Aging recently distributed their cards at a Senior Expo at Mystic Lake Casino sponsored by Mid-America Events and Expo for 45,000 seniors. The Casino setting was an ideal place to hand out the cards, and they were a huge hit. The Minnesota Board on Aging also partners with the Minnesota Area Agencies on Aging to distribute the cards, because they are the partner who facilitates the SMP volunteer efforts. In general Jackie has found these cards to be a great giveaway at presentations about Medicare Part D Prescription Drug Coverage (a huge potential for fraud). As Jackie said, a giveaway is a great thing for frustrated seniors. The Future of the Partnership… The Minnesota Senior Medicare Patrol project is looking to continue its efforts to create an educational cookbook that has messages for seniors interspersed with the recipes especially targeted to one of the most vulnerable populations: elderly women. For more information about this quarter’s featured “Ideas-in-Action”, please contact Jackie Bruno with the Minnesota Board on Aging/Senior LinkAge Line at firstname.lastname@example.org. Tools You Can Use A Prescription for Helping Needy Seniors BenefitsCheckUpRxTM, is a powerful, easy-to-use online tool that’s available at www.BenefitsCheckUpRx.org. It can help seniors learn about and enroll in programs that dramatically reduce the cost of prescription drugs, including the new Medicare prescription drug coverage. It can also help them find and enroll in other important government and private company programs. Provided by The National Council on the Aging and developed with the support of the U.S. Administration on Aging and the Department of Health and Human Services, the service has already helped thousands of seniors find the prescription savings programs they need. And now, with a click of your mouse, you can help add to the list of seniors who no longer have to struggle to afford their medicines. NCOA thanks you in advance for your interest and your support. THE SENTINEL Page 14 M EDICARE RX T IPS The Centers for Medicare & Medicaid Services (CMS) is sponsoring a national televised program on CNBC, November 19 from 6:30 to 7:00 PM ET. Hosted by John Palmer, “Medicare Rx: A National Conversation” will explain the new drug benefit, how it works, and how to select a plan. CMS has made available on their partner center (http://www.cms.hhs.gov/partnerships/news/mma/ default.asp#publications) new materials for local media and community outreach on the new drug benefit, including live-read radio scripts, drop-in bulletins, print advertisements, Internet banner ads, and more. The materials may be used without approval for free placement: • Medicare Prescription Drug Coverage is Coming in 10, 30, and 60 second spots. • With New Prescription Drug Coverage, Medicare Covers More Than Ever! In 100, 150, and 400 words. • Medicare Covers Prescription Drugs! 50 Words On November 5, CMS mailed people with Medicare and full Medicaid coverage an auto-enrollment notice on yellow paper to inform them about the change in their drug coverage from Medicaid to Medicare. The notice explains the following: • that these people will be enrolled in a Medicare Prescription Drug Plan if they don’t join one by the end of the year, • what plan Medicare will enroll them in, • their costs in the plan, and • that starting January 1, 2006, Medicare will help pay for their prescription drugs instead of Medicaid. The notice includes a one-page letter, and two pages of questions and answers about Medicare prescription drug coverage. The notice is available at http://www.cms.hhs.gov/medicarereform/Enrollment-Q&A-10- 20-05-with-cover-sheet.pdf The latest issue of Medlearn Matters, a series of articles on the new Medicare prescription drug coverage, is now available. “New Educational Products Available on Medicare Prescription Drug Coverage – The Eighth in the Medlearn Matters Series” (SE0559) is available at: http://www.cms.hhs.gov/medlearn/ drugcoverage.asp The publication contains information on the latest drug coverage products - including a training course accredited for continuing education for doctors, nurses and health care professionals; a physician brochure with basic information on the new coverage; as well as a one page informational tear-off sheet that can be distributed in health care settings. THE SENTINEL Page 15 For more information about the National Consumer Protection Technical Resource Center, please visit us at Visit us on the web at www.smpresource.org www.smpreource.org. All newsletter submissions and inquires should be directed to Candice Griffin at email@example.com. Newsletter development is supported in part by grant No. THE NATIONAL CONSUMER PROTECTION TECHNICAL 90AM2806, from the Administration on Aging, Department of RESOURCE CENTER Health and Human Services. Grantees undertaking technical Phone: 877.808.2468 resource centers under government sponsorship are E-mail: firstname.lastname@example.org encouraged to express freely their findings and conclusions. Therefore, points of view or opinions do not necessarily represent official Administration on Aging policy. H OW MAY I H ELP Y OU? Responding to technical assistance inquiries is one of the primary services provided by The Center. We receive dozens of inquiries monthly via our toll free technical assistance line and email-- from the simple: How can I access material in The Center’s resource library?; to the complex: Can you explain the Part D benefit? — we’ve received hundreds of inquiries via our toll-free technical assistance line and emails since we opened our doors. Below you will find highlights from one of our inquires. Question: “I am a new grantee and I’ve heard mention of the Products and Practices of Distinction, can you tell me more?” Response: The Center offers the Products and Practices of Distinction (PPoD) program to any interested Senior Medicare Patrol (SMP) Project to facilitate the sharing of innovative, effective, and cost efficient efforts of SMPs to address Medicare/ Medicaid errors, fraud, and abuse. These products and practices are easily duplicated or adapted to local SMP programs, and offer proven and effective means to further our nationwide effort to curtail fraud, waste, and abuse within the health care system. The third round of nominations for Products and Practices of Distinction are due February 1, 2006. Submitting is easy; just follow these steps… Online: Log on to www.smpresource.org Click on SMP Resources Click Add Item Select “Yes” for Products and Practices of Distinction submission -or- Snail Mail: Complete Application (Projects will receive by December 15, 2005) Be sure to submit a cd-rom of the nominated product or practice -or- Email: Email Scott Cooley at email@example.com with the following information: Name 350 Word Summary Project Name Attachments of Relevant Documents for Submission Mailing Address If you have further questions regarding the Products and Practices of Distinction, please feel free to contact Scott Cooley at firstname.lastname@example.org.
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