MIPPA: More Medicare Changes for Minnesota


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  • This chart shows the various options during the Medicare Advantage (MA) Open Enrollment Period, depending on the type of coverage the person is starting with. For example, a person who has a Medicare Advantage Plan with prescription drug coverage (MA-PD) can use the OEP to get a different MA-PD, to switch to Original Medicare and a PDP, or to enroll in a Medicare Advantage Private-Fee-for-Service Plan without drug coverage and in a separate PDP. This person could not use the OEP to enroll in a MA-only plan or to switch to Original Medicare without enrolling as well in a stand-alone PDP. Remember, the Medicare Advantage Open Enrollment Period can be used to switch to a different plan or type of plan, but it cannot be used to change whether or not a person is enrolled in Medicare prescription drug coverage.
  • MIPPA: More Medicare Changes for Minnesota

    1. 1. MIPPA: More Medicare Changes for Minnesota Kelli Jo Greiner MN Board on Aging
    2. 2. Medicare Improvement for Patients and Providers Act of 2008 (MIPPA) • Congress overrode President’s veto on July 15, 2008 • MIPPA contains provisions that affect Medicare Part A, Medicare Part B, Medicare Advantage and Medicare Part D • Major Medicare legislation
    3. 3. MIPPA Part A Key Provisions • Extend Medicare Rural Hospital Flexibility Program (FLEX) through 9/30/10 • Provide new authority for states to improve access to mental health services for veterans in crisis and other residents of rural areas. • Establish a demo for development and testing of new community health integration models in certain rural counties • Increases payments to Community Health Centers
    4. 4. MIPPA Part B Key Provisions: Physician • Cancelled 10.6 cut in physician reimbursement (18 month reprieve but issue will return; potential 21% cut in 2010) • Increase bonuses paid to providers who measure and report on quality of care (PQRI) • Physicians use e-prescribing will receive a 2% Medicare payment bonus in 2010 and 2011; phased down after 2011. • Physicians who do not use e-prescribing by 2012 will be penalized by decrease in payments (1% in 2012; 1.5 % in 2013 and 2% in 2014 and beyond) • Development of a physician feedback program by CMS
    5. 5. MIPPA Part B Key Provisions: Value Based Purchasing and E-prescribing • Develop a plan to transition to a value-based purchasing program for Medicare professional services. • Physicians using e-prescribing will receive a 2% Medicare payment bonus in 2010 and 2011; phased down after 2011. • Physicians who do not use e-prescribing by 2012 will be penalized by decrease in payments (1% in 2012; 1.5 % in 2013 and 2% in 2014 and beyond)
    6. 6. MIPPA Part B Key Provisions: Welcome to Medicare Physical • Waives Medicare Part B deductible • Extends time frame for physical from 6 months to 1 year following Part B enrollment • Adds new services to the Welcome to Medicare physical including additional preventive services (to be determined) and end of life planning.
    7. 7. MIPPA Part B Key Provisions: Preventive Benefits • Provides Medicare coverage for “additional preventive services” that identify medical conditions or risk factors recommended by the U.S Preventive Services Task Force.
    8. 8. MIPPA and Part B Key Provisions: Mental Health Parity • Beginning in 2010, over a 5 year period, Medicare coinsurance for mental health services will be reduced to the same level as other Medicare outpatient services (from 50% to 20%)
    9. 9. MIPPA and Part B Key Provisions • Provides an 18 month extension (through 2009) of the exceptions process for annual limit on Medicare PT, OT and ST services. – Current limit is $1,810 • Delays implementation of the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) to 1/1/10
    10. 10. MIPPA and Part B Key Provisions • Reinstates add-on payment for ground ambulance services from 7/1/08-12/31/09 – 3% rural and 2% urban • Repeals the competitive bidding demonstration for clinical lab services • Provides funding for kidney disease education and awareness programs
    11. 11. MIPPA and Chronic Disease Provisions • MedPAC is required to study and report on improving chronic care programs. • Development of a program to fight chronic kidney disease • Increase payments for renal dialysis services • Bundle payments for dialysis drugs, testing supplies and other items used in the treatment of ESRD • Expand the number of eligible telehealth sites in rural areas • MedPAC to conduct a study on the merits of establishing a Medicare Chronic Care Practice Research Network to test new models of care coordination • Adds new funding to the Medical Home Demonstration Project
    12. 12. MIPPA and Medicare Advantage (Part C): • Prohibits marketing of plans in physician offices • Each MA plan will have to indicate the type of plan in plan name ( ex: Advantage Silver will have to be renamed to Advantage PFFS Plan) • Directs MedPAC to study and make recommendations concerning alternate payment formulas for MA plans • By March 2010, MedPAC to study how MA plans and Original Medicare can be compared based on performance and patient experience.
    13. 13. MIPPA and Medicare Advantage (Part C): • Beginning January 2011, require MA-PFFS plans to have adequate health care provider networks in counties where 2 or more non- PFFS plans exist • Employer PFFS plans will be required in 2011 to do this regardless of other plans • Requires MA-PFFS and MSA plans to have Quality Improvement Programs in place
    14. 14. MIPPA and Medicare Advantage (Part C): • Prohibit MA-PFFS plans from deeming without negotiating an actual contract for payment and care with the provider. • Beginning January 2010, prohibits Medicare Advantage and Part D plans from – Door to door sales – Cold calling – Free meals – Cross selling of non health-related products – Limitations on commissions and gifts
    15. 15. MIPPA and Medicare Advantage (Part C): • Extends existing MA-SNP through 2010 but prohibits designating new MA-SNPs. • In 2010, all SNPs must have evidence based model of care – Initial assessment – Annual reassessment – Plan that identifies goals and objectives, including measurable outcomes, specific services and benefits to be provided • MA-SNPs must also provide for the collection, analysis and reporting of data to measure health outcomes and other measures of quality. • For duals,in 2010, prohibits MA-SNPs from requiring additional bene cost sharing above what they would pay if they remained in Original Medicare and Medicaid
    16. 16. MIPPA Medicare Key Provisions: Low income beneficiaries • Extends the QI Medicare Savings Program through 12/31/10 (ARRA) • Increases the Medicare Savings Program asset limitation to Part D LIS resource amount which changes annually – In MN, MSP asset limit is $10,000 single/$20,000 couple • Eliminates estate recovery for Medicare Savings Programs • Translates the Medicare Savings Program model application form into 10 non-English languages • Requires SSA to provide Medicare Savings Program applications to individuals applying for Medicare, includes providing assistance in completing applications.
    17. 17. MIPPA Medicare Part D Key Provisions: Low income Subsidy • Removes Part D late enrollment penalties for people found eligible for the LIS • Exempts life insurance and in-kind support and maintenance (ISM) from income and resources when determining LIS eligibility (questions will be removed from LIS application) • Provides a beneficiary’s right to federal court review for denials of LIS
    18. 18. MIPPA Medicare Part D Key Provisions • Beginning January 2012, Medicare Part D coverage for barbiturates and benzodiazepines will be permitted • Codifies the requirement for Part D plans to cover most drugs in certain important classes of drugs – Anti-cancer – Immunosuppresants – HIV/AIDS drugs – Anti-convulsants – Anti-psychotics – Anti-depressants • Requires CMS to define any exceptions to this policy
    19. 19. MIPPA Medicare Part D Key Provisions • Requires drug plans to pay “clean claims” submitted electronically within 14 days; non electronic claims must be paid within 30 days. Claims paid after that time will be subject to interest • Requires drug plans to update drug pricing standards for pharmacy reimbursement at least weekly. An initial update on January 1 of each year is required to accurately reflect the market price of acquiring the drug. • Effective in 2009, clarifies that a “medically accepted indication” for Part D covered drug is defined as any use that is supported by one or more citations in drug compendia or such use is medically accepted based upon supportive clinical evidence in peer reviewed medical literature.
    20. 20. Other Key MIPPA Provisions • Two new types of Medicare Supplements (Medigap) will be offered • Cardiac and Pulmonary rehabilitation services will be covered • Within 2 years, requires the OIG to report on the extent to which Medicare providers follow rules regarding discrimination against beneficiaries with LEP • Providers conducting MRI, CT and nuclear medicine/PET must be accredited by 1/1/12
    21. 21. 2010 Medicare Update • Up-to-date information!
    22. 22. PLEASE NOTE • 2010 Medicare Part A and Part B cost sharing information has not been made public yet • 2010 Part D benchmark and premiums have not been made public yet
    23. 23. 2010 Medicare Part D Preview 10/1/09: Mailings and Marketing begin 11/15/09: Open Enrollment begins 12/31/09: Open Enrollment ends
    24. 24. Annual Coordinated Election Period (AEP) • People can join, drop, or switch – Prescription drug plans – Medicare Advantage plans – Medicare Advantage plans with prescription drug coverage
    25. 25. Minnesota Amounts for 2010 • National Average Part D Basic Premium: $? • MN Benchmark amount: $? • MA capitation rate in MN – Ranges from $? per month per bene
    26. 26. What Color is the Letter? • GREY: Loss of Extra Help (Sept. 2009) CMS • ORANGE: Change in co-payment level (October 2009) CMS • BLUE version 1: Reassignment due to plan leaving market CMS – (October 30, 2009) CMS will reassign to new plan • BLUE version 2: Current plan above benchmark in 2009; CMS – CMS will reassign to new benchmark plan for 2010 • TAN: LIS who chose plan on own and will no longer be benchmark plan; CMS – CMS will not reassign to a new benchmark plan for 2010 • PURPLE: Deemed Status for 2010 approved CMS • YELLOW: Auto-enrollment notice (ongoing) CMS • GREEN: Facilitated enrollment (ongoing) CMS
    27. 27. Part 2: Mailings From the Plans • October 1, 2009: Plans begin marketing to beneficiaries • By October 2, 2009: Plans leaving market in 2008 issue termination letters to current enrollees. • By October 31, 2009: Plans notify beneficiaries of formulary, benefit and premium changes for 2009
    28. 28. Medicare Part D Standard Benefit 2006 2007 2008 2009 2010 Deductible $250 $265 $275 $295 $310 Initial Coverage Limit $2,250 $2,400 $2,510 $2,700 $2,830 Out of pocket (OOP) threshold $3,600 $3,850 $4,050 $4,350 $4,550 Total Covered Drugs at OOP $5,100 $5,451.25 $5,726.25 $6,153.75 $6,440 Copays at Catastrophic Level $2/generic $5/brand $2.15/generic $5.35/brand $2.25/generic $5.60/brand $2.40/generic $6.00/brand $2.50/generic $6.30/brand
    29. 29. 5% 95% Catastrophic Benefit 100% 75%25% $295 Deductible Monthly Premium $2,830.01 - $6,440 $310.01 - $2,830 $.01 - $310 Over $6,440 (copays of $2.50/$6.30) Drug Costs Beneficiary Costs Part D Plan 2010 Part D Standard Benefit No Extra Help (LIS)
    30. 30. Catastrophic Benefit Co- Pays $2.50/ $6.30 15% 85% $60 Deductible Sliding Scale Premiums $62.01- $6,440 $.01 -$62 Over $6,440 Drug Costs Beneficiary Costs Part D Plan 2010 Part D Partial Extra Help (LIS) •Lower Premiums •Lower Deductible •Lower Coinsurance •No Doughnut Hole will vary
    31. 31. Benchmark • A prescription drug plan with a monthly premium at or below the low income premium subsidy amount. • MN Benchmark amount in 2009 = $33.19 • Dual eligible premiums for these plans are completely covered by Extra Help – Duals can enroll in non-benchmark plans but will have out of pocket costs for premium
    32. 32. Catastrophic Benefit 100% Plan No co-pays Co-Pays Co-Pays $1.10/$3.30 <100% FPL $2.50/$6.30 >100% FPL No premiums No deductibles $.01 - $6,440 Over $6,440 Beneficiary Costs Part D Plan 2010 Part D Full Extra Help (LIS) No Premiums if in Benchmark Plan No Deductible No Coinsurance No Doughnut Hole No monthly cap on co-pays Drug Costs
    33. 33. Full Dual Eligible Co-pays 2006 2007 2008 2009 2010 Copays for institutionalized FBDE (SNF and ICF/MR) does not apply to assisted living $0 $0 $0 $0 $0 Income < 100% FPG $1/generic $3/brand name $1/generic $3.10/brand name $1.05/generic $3.10/brand name $1.10/generic $3.20/brand name $1.10/generic $3.30/brand name Income > 100% FPG $2/generic $5/brand name $2.15/generic $5.35/brand name $2.25/generic $5.60/brand name $2.40/generic $6.00/brand name $2.50/generic $6.30/brand name
    34. 34. REGION 19
    35. 35. Medicare Advantage in MN • Coordinated Care Plans (Local HMOs and PPO) • Cost Based Plans with Part D • Regional Preferred Provider Organizations • Private Fee-for-Service • Special Needs Plans • Medicare Medical Savings Accounts
    36. 36. Medicare Advantage Option 1 in Minnesota (Medicare A, B and D benefits) • These plans provide: – Medicare A benefits – Medicare B benefits – Medicare Part D benefits • Option 1 includes: – Medicare Advantage HMO/Point of Service – Cost plans – Medicare Advantage Private-Fee-For- Service – Medicare Advantage Regional Preferred Provider Organization
    37. 37. Medicare Advantage Option 2 in Minnesota (Medicare A and B benefits) • These plans provide – Medicare A – Medicare B – No part D • May enroll in a stand alone PDP only under Cost plan and PFFS • Option 2 includes: – Medicare Advantage HMO/Point of Service – Cost plans – Medicare Advantage Private-Fee-For Service
    38. 38. Medicare Advantage Option 3 in Minnesota (Medicare A, B, D and all Medicaid) • These plans provide all – Medicare A benefits – Medicare B benefits – Medicare Part D benefits – Most Medicaid benefits • Option 3 includes: – Medicare Advantage Special Needs Plans (MA-SNP: MSHO and MnDHO)
    39. 39. Medicare Advantage Option 4 in Minnesota • These plans provide all – Medicare A benefits – Medicare B benefits – Medicare Part D benefits – Some Medicaid benefits • Only available to beneficiaries age 18-64 • Option 4 includes – Medicare Advantage Special Needs Basic Care Plans (MA-SNBC)
    40. 40. Medicare Advantage Option 5 in Minnesota (Medicare A and B, deductible must be paid first) • These plans will pay for Medicare A and B services once a high annual deductible is met – Deductible amount varies from plan – Once deductible is reached , the MSA plan will cover most costs of Part A and B services – No Part D coverage • Option 5 includes – Medicare Advantage Medical Savings Accounts (MA-MSA)
    41. 41. MA Open Enrollment Period Limits If coverage is Can use OEP to get Cannot use OEP to get Medicare Advantage with prescription drug coverage (MA-PD) A different MA-PD or Original Medicare + PDP or MA-PFFS + PDP MA-only or Original Medicare only (cannot drop drug coverage) Medicare Advantage with no prescription drug coverage (MA-only) A different MA-only or Original Medicare only MA-PD or Original Medicare + PDP (cannot add drug coverage) MA-only PFFS + PDP MA-PD or different MA-only PFFS and same PDP or Original Medicare and same PDP MA-only or Original Medicare only (cannot drop drug coverage) Original Medicare and a prescription drug plan (PDP) MA-PD or MA-PFFS and the same PDP MA-only or A different PDP to use with Original Medicare (cannot drop drug coverage) Original Medicare only MA-only MAPD or Original Medicare + PDP (cannot add drug coverage) MSA N/A The MA OEP does not apply to enroll into or disenrollment from an MSA plan
    42. 42. Minnesota: The Numbers (July 2009) • Total MN Medicare population = 746,505 – 282,008 enrolled in Medicare Advantage plan – 38,786 enrolled in a Special Needs Medicare Advantage Plan (38,635 are dually eligible) – 43% of MN Medicare population enrolled in a Medicare Advantage option as of July, 2009
    43. 43. 2010 Proposed Changes • Specialty Tier Threshold • Transition Notices in LTC • Posting of Prior Authorization and Step Therapy • Medication Therapy Management Program Requirements • Reference Based Pricing • Reassignment of LIS • Retroactive Auto-enrollment of full benefit dual eligibles demo
    44. 44. 2010 Possibilities • Some MA-PFFS plans may leave the market • Some MA-SNP may no longer include Medicare benefits • Some Part D plans may leave the market • Some new plans may enter the market • Premiums may increase • Benchmark may increase • Formulary changes
    45. 45. What is the SHIP? • State Health Insurance Assistance Program • 400 certified volunteers • Medicare Experts located in your community • State based program that provides – One to one counseling and assistance to people with Medicare and their families – Free service provided through phone, in person, community events and media activities – Grants provided by CMS – MBA Senior LinkAge Line® has been the designated SHIP for MN since 1993 – Available in all 87 counties of Minnesota – 54 SHIPs in United States • Most are in State Units on Aging • Some are located within State Insurance Dept.
    46. 46. HELP IS HERE • Senior LinkAge Line® (Federally designated MN SHIP) – 1-800-333-2433 – Health Care Choices produced by MN Board on Aging • Disability Linkage Line® – 1-866-333-2466 • www.cms.hhs.gov • www.Medicare.gov • Live Chat now available at www.minnesotahelp.info
    47. 47. 47 Need more Information, Answers or Help? • Senior LinkAge Line® 1-800-333-2433 • Disability Linkage Line ® 1-866-333-2466 • Veterans Linkage Line 1-888-546-5838 (LinkVet) • www.cms.hhs.gov • www.Medicare.gov 1-800-MEDICARE • www.socialsecurity.gov 1-800-772-1213 • www.MinnesotaHelp.info
    48. 48. QUESTIONS? • CONTACT INFORMATION – Kelli Jo Greiner – 651-431-2581 – Kellijo.greiner@state.mn.us