MMW Advocacy UpdateEmily Gelber-MaturoAssociate Director, Strategic Health InitiativesHealth & Disability Advocates

HDA: 25 years of Change that Matters

Federal Update• Action Item:

• Beneficiary Enrollment Notification and Eligibility Simplification Act (BENES)• Implementation Notification:

• Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE)

HDA: 25 years of Change that Matters

What is it?Beneficiary Enrollment Notification and Eligibility Simplification Act (BENES)

Alerts individuals nearing Medicare eligibility about Part B enrollment• six months ahead of the initial enrollment period • one month before initial enrollment period

Modernizes Enrollment• Aligns the general enrollment period with Medicare open enrollment for part C and

D plans. (Oct. 15- Dec. 7th)• Eliminates coverage gaps in the 5th, 6th, and 7th month of an individuals initial

enrollment period and in the annual general enrollment period, as well as updating the structure of enrollment periods.

• Formalizes and Standardizes Process Equitable Relief

HDA: 25 years of Change that Matters

Why does it matter?BENES ActIf you don’t receive benefits through social security, then there is no trigger to alert people that it is time to enroll when people turn 65.

If you don’t enroll during your enrollment period, then people are subject to late enrollment penalties. Upwards of 750,000 beneficiaries pay up to 29% higher part B premiums because they did not sign up for part B at the right time.

Enrollment periods have not be overhauled since the 60s when Medicare was created.

There is no formal process for people who were provided wrong information about enrollment into part B. You can request equitable relief now, but the Social Security Administration doesn’t have to respond.

HDA: 25 years of Change that Matters

How to Take ActionBENES ActThe BENES Act was recently introduced into the House of Representatives and the Senate. Contact Illinois’ senators and representatives to sign on as co-sponsors of bills S. 3236 and HR 5772.

Use the BENES Act of 2016 Advocacy Kit:• Sample letter• Contact information for IL senators and representatives• BENES Act Fact Sheet

HDA: 25 years of Change that Matters

What is it?The NOTICE ActRequires hospitals to give written and verbal notice to Medicare beneficiaries who have been on observation status for more than 24 hours. This notice has been referred to as the MOON (Medicare Outpatient Observation Notice).

What’s Observation Status?• Doctors place patients on observation status if their condition is not serious enough for inpatient

admission status, but still requires monitoring in case health worsens. • Observation status is a term hospitals use to bill, and under this status services are billed under

Medicare part B and D, instead of part A when a person is in the hospital. • Prior to the NOTICE Act, the only way to know your status was to ask.

HDA: 25 years of Change that Matters

Why does it matter? NOTICE Act

Observation Status Results in serious financial consequences:

• higher than expected hospital bills • Medicare won’t cover skilled nursing care needed

after discharge from the hospital.• Individuals have to navigate how to get the

hospital to bill their part D plan. Sometimes plans won’t cover drugs administered in the hospital, even though there is no choice but to use medications administered in the hospital.

HDA: 25 years of Change that Matters

Case Scenario: Negative Impact of Observation Status

HDA: 25 years of Change that Matters

How to Take ActionNOTICE Act has passed! Watch for implementation.

• This use of the MOON Notice was supposed to be implemented in August, but has been delayed. The effective date of the law is Oct 1st, and there is a 90 day period for hospitals to fully implement the MOON Notice.

• Keep an eye out for the official implementation date. https://www.cms.gov/Medicare/Medicare-General-information/Bni/index.html

• NOTE: CMS will consider a MOON that is provided to a patient prior to the patient receiving outpatient services for 24 hours.

• Because of the advocacy of MMW and other groups, the MOON Notice includes a section that asks why a person was placed on observation status.

HDA: 25 years of Change that Matters

HDA: 25 years of Change that Matters

State Update• Action Item:

• 1115 Behavioral Health Transformation Waiver

• Implementation Notification:• PA 099-0621• MLTSS Rollout

What is it?1115 Behavioral Health Transformation WaiverWhat’s an 1115 waiver?

• An 1115 waiver gives the state the authority to use federal Medicaid funds in ways that are not otherwise allowed under federal rules at the discretion of the Secretary of HHS after a negotiation process between CMS and the state.

• They are generally approved for 5 years, and allow the state to try new ways of implementing Medicaid coverage.

• New Benefits Tested Under the Waiver• Supportive Housing Services• Supported Employment Services• Services to ensure successful transitions for justice-involved individuals• Redesign of substance use disorder service continuum (Medication Assisted Treatment, recovery coaching,

withdrawal management)• Additional benefits for children and youth (respite services, intensive in home treatment)

• New Initiatives• Behavioral and physical health integration activities• Infant/early childhood mental health consultation• First episode psychosis programs (FEP)

HDA: 25 years of Change that Matters

Why does it matter?1115 Behavioral Health Transformation Waiver• People with serious mental illness and substance use disorders need

prompt access to a continuum of services that support their wellbeing in the community.

• While the waiver cannot address everything that is necessary within the behavioral health system, it is important that the State approach behavioral health in context of social determinants of health, and physical health needs.

• This waiver should improve delivery of services through Medicaid, improve the workforce, and provide additional supports for people with significant mental illness and substance use disorders, who cross both the disability and aging populations.

HDA: 25 years of Change that Matters

How to Take Action1115 Behavioral Health Transformation WaiverReview and share your opinions by submitting comments by Oct 2nd . See instructions on the website below.Await further stakeholder engagement following approval of the waiver.https://www.illinois.gov/hfs/info/1115Waiver/Pages/default.aspx

HDA: 25 years of Change that Matters

PA 099-0621Social Work Reimbursement LawWhat does it do?Requires state to promulgate rules to implement Medicaid reimbursement for clinical social workers in Illinois so they can independently bill.

Effective Date: January 1, 2017. After that the state has 90 days to promulgate rules.

Thanks to advocacy from MMW and other groups this was passed into law in July!

HDA: 25 years of Change that Matters

What is it?Managed Long Term Services & SupportsManaged long term services & supports is a managed care program for people that choose to opt out of MMAI. It provides a managed care plan that administers long term services and supports (like the community care program) only. People who participate in this program still have Medicaid and Medicare.

HDA: 25 years of Change that Matters

Why does it matter?MLTSS Enrollment letters mailed in June, July & August with 60 day choice letters.Individuals who received July letters and don’t enroll by Sept. 30 will be auto-assigned Oct. 1. Individuals who received August mailing and don’t make a choice by Oct. 31st will be auto-assigned by Nov. 1st. Enrollment by plan is available on this website: https://www.illinois.gov/hfs/MedicalProviders/cc/Pages/MLTSSEnrollment.aspx

HDA: 25 years of Change that Matters

How to Take ActionMLTSS

Are you seeing issues with the implementation of MLTSS? Let’s discuss. If you work with healthcare providers, you can help us make sure that they know that people enrolled in MLTSS still have Medicare and Medicaid. Some specialists have told members that they do not have coverage when the should be checking for Medicare coverage.Here’s a notice: https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn160831a.aspx

HDA: 25 years of Change that Matters

Make MMW Advocacy Stronger• Email egelber@hdadvocates.org if there are issues with how policies

are being applied, if there are issues that you think we should be advocating on as a coalition.

• Recently, MMW sent out a survey to our email list. Please respond to help guide our policy agenda!

• Respond to action alerts to let us know what you did to advocate. This will help us to preserve funding and show the power of the Make Medicare Work coalition.

HDA: 25 years of Change that Matters