Docstoc

The Sentinel 1105

Document Sample
The Sentinel 1105 Powered By Docstoc
					              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 jcrowder@smpresource.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
    info@smpresource.org. 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              smerner@smpresource.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 customerrddeckrus@aol.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 jacqueline.s.bruno@state.mn.us.



                                            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 cgriffin@smpresource.org.

                                                                 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: info@smpresource.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 scooley@smpresource.org 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 scooley@smpresource.org.

				
DOCUMENT INFO
Shared By:
Categories:
Stats:
views:28
posted:5/27/2010
language:English
pages:16