SHAP Meeting Notes

SHAP Meeting Notes January 15, 2013

 Current Trends from Annual Enrollment Period o There is no such thing as a simple enrollment. Each client interaction is very complex and time consuming. o Lesson learned in pharmacy selection. Choosing an out of network pharmacy can result in a substantial increase in drug costs. o Sites found many people in the wrong Part D plan and changes resulted in large cost savings. One SHAP site calculated over $75K in savings through plan changes. o There was cross selling happening between Blue Cross Blue Shield Medigap plans and their Part D plans. o AARP Medicare Complete Medicare Advantage Plan signed clients up in large numbers o One sight offered a computer lab through their Savvy Seniors program for younger seniors to participate in finding their own D plans. There was a 50% success rate. o The Medicare.gov site offered some incorrect information for people with Extra Help o Outreach opportunities . H2O bill enclosures . PSAs on local cable T.V. stations. . Local newspapers-patch.com (online newspaper) . Bank Statement enclosures from local banks o The dedicated lines that were used for the ICRx coordinating plans are still helpful when communicating with these plans. The staff manning these lines tends to be more knowledgeable. o Wellcare 888-550-5252 o SilverScript 866-235-5660 o First Health Part D 866-665-0662 o United Healthcare (AARP) 877-710-5083 o Some Part D plans are moving from fixed dollar amount co-pays to % of cost co-insurance methods of calculating member out-of-pocket costs.

 Trends from ICRx Elimination Project o The National Council on Aging thanks you for your participation in this program. Please click here for a copy of the thank you letter from Hector Ortiz at NCOA.

Thank you letter.doc

o Many of the phone numbers on the lists given to SHAP sites were disconnected or incorrect. o Very few of the contacts on these lists resulted in Medicare Part D enrollments o Clients who changed their Part D plans in July and August using a Special Enrollment Period due to the loss of ICRx benefits didn’t necessarily remember to re-evaluate their plans for 2013. These people often were faced with unexpectedly high drug costs in January due to the deductible imposed in the new year. o Sites had very low response rate to contacts. One site sent 700 letters and followed up with phone calls. They were able to contact 107 people, 18 were eligible for assistance and none wanted to enroll in any programs. o One explanation for limited success to the project was that the client contacts were made during the Open Enrollment Period where clients were faced with excessive information about Medicare Part D. They were overwhelmed and chose do nothing rather than add more confusion to their plan choice. o New generic medications did not appear in the Planfinder leaving the annual cost misleading. The plan needed to be contacted for accurate information making the enrollment process more complex. o Information offered on T.V. boasted “free” medication so client’s were doubtful of expertise of SHAP counselors o Sites formed partnerships with community organizations to host enrollment events o Respondents said they were getting help from family members o This project brought some new clients to the attention of the SHAP sites o Counselors used CCP client agreement to meet Spenddown amounts to qualify for facilitated enrollment into LIS. o One site was able to secure enrollment for one of their clients, who had never enrolled into a Part D, without a late enrollment penalty by appealing to that plan with a compelling letter advocating for the client’s need.

 Update on the Benefits Access Program The Circuit Breaker Program has been replaced by the Benefit Access Application which can be found at www.state.il.us/aging . This application will provide access to a discount on the license plate sticker as well as the seniors and people with disabilities ride free program. Once the application is approved, which should be within 24 hours if no verification is needed, any driver’s license facility can look up the control number and provide the enrollee with the license plate sticker discount. The control number can also be obtained by calling 800-252-2904. In order to obtain the ride free pass, the enrollee must take the Eligibility Notice Form to their local RTA site. They should also be able to verify eligibility.

The BAA is a tw- year application. Once approved, the Application Inquiry will indicate the “Effective Term” for the claimant. The claimant can file 90 days prior to that termination date. It is recommended that people file this year so they receive the two-year eligibility.

Remember to use your 3-digit SHAP code on this application. Please click on the following link to locate your site’s SHAP code.

SHAP code list.xls

 DHS Medical benefits Redeterminations- DHS has contracted with a private company by the name of Maximus to electronically verify the documentation for redetermination of all existing Medical only cases. What this means is that Maximus, who has access to data on bank accounts, tax information, Social Security income and more will assist the DHS caseworkers by gathering and verifying all necessary documentation for existing Medical Medicaid cases.

If they need additional information from the client, they will send a request, in writing, along with a self-addressed stamped envelope. This information is due back to Maximus within 10 business days (the same amount of time as the re- de process has always required.) Maximus will contact the client as the 10 day deadline approaches, if they have not received all necessary documents, and on the 10th day, they will pass the information to DHS with their recommendation to approve or deny the case. The DHS caseworker then has 20 days to process the application.

For clients who are only on Social Security and/or pension this should be a relatively seamless process. It may place an additional burden on the network because DHS has fallen behind on redes and some clients have not had to prove program eligibility for 2-3 years. This inquiry may surprise some Medicaid recipients. The first batch began review on 1/22/13 and consists of 10,000 individuals who are presumed no longer eligible for benefits.

 CountyCare Program This is a medical benefit program available to o Cook County residents o Age 19-64 o Ineligible for Medicaid o Legal immigrant status for at least 5 years or a U.S. citizen o Meet income limits of 133% FPF (1) $14,856 (2) $20,123) o Have a SS number or have applied for one The application process begins with a phone call to 312-864-8200 or toll free at 1-855-444-1661 to determine eligibility. Please click on the following links for a program description and clinic site lists.

CountyCare Program.pdf

 2013 Donut Hole contribution Please click on the following link for a chart of the donut hole contribution percentages until its elimination in 2020.

Closing-the-Doughnu t-Hole-Chart.pdf

 Managed Care Phase 2-Erin Weir The Integrated Care Program (in effect since May 2011) is a mandatory managed care program for individuals with Medicaid ONLY (no Medicare) in suburban Cook, Lake, Kane, DuPage, Will, and Kankakee Counties. Individuals enrolled in the Integrated Care program (ICP) have been receiving all of their medical services from an ICP managed care plan since May 2011 (or since their enrollment into Medicaid, whichever is later). The two ICP plans are Aetna Better Health and IlliniCare.

On February 1, 2013, the Integrated Care Program will begin a new phase (called Phase 2). During this phase, everyone who is on an ICP plan will begin having their long term care services and supports (LTSS) paid for by Aetna Better Health or IlliniCare. This means that Aetna Better Health and IlliniCare will be paying long term care facilities and home and community based service providers (such as CCP service providers) for their clients, instead of the state. The attached FAQ document gives more information about how this process will work, but here are some of the important basics: This transition will affect about 1,400 Community Care Program clients who are enrolled in ICP plans. For those clients, the local Case Coordination Unit (CCU) will still be responsible for determining a client’s eligibility for CCP. The managed care plan will then take over care coordination. (The client will be assigned a care manager at the managed care plan.) The managed care plans must keep the same care plans in place (with the same providers) for at least 180 days, unless the client wants to make a change. The managed care plans can negotiate rates with providers, but may not pay less than the state rate. The managed care plans must utilize providers who are CCP certified by the Illinois Department on Aging to provide CCP services.

CCP clients who will be affected by this change were sent the following letter (attachment). Please click on the following links for additional information

FAQ for Integrated ICP SP 2 Client Care Service Package 2 12 21 Notice 12.pdf Final 13 03 12-12.pdf

 Legislative Breakfasts Legislative Breakfasts are scheduled now through early March. Please click on the following link for the schedule of upcoming events.

Legislative Breakfast Flyer.pdf

 SHAP FY 2014-RFP Beginning in FY2014, SHAP will be an added component of Aging and Disability Resource Network (ADRN). ADRN will also include what is currently referred to as Coordinated Point of Entry (CPOE). The sites who are awarded this program will need to provide holistic, person-centered assistance. Applicants will be asked to provide a proposal to serve either single or multiple townships. Some of the requirements for participation include: o At least one full time staff member assigned to ADRN activities o Provide assistance after regular business hours if this need is expressed by a client o All staff working on ADRN will need to take and pass an accreditation test designed and provided by AgeOptions o At least a BS, BA, or RN degree from an accredited university or equivalent o Participate in AgeOptions I&A Trainings o At least one staff person certified by the Alliance of Information and Referral Systems (AIRS) o Have the ability to provide quality referrals to callers with disabilities. Additional information about the RFP will be available by the end of February.

 FY 2013 SHAP Meeting Schedule

o January 17, 2013 10:00-11:30 In-Person Meeting o April 18, 2013 10:00-11:30 Conference Call o July 18, 2013 10:00-12:00 In-Person Meeting o October 17, 2013 10:00-11:30 Conference Call