Nebraska Department of Insurance

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THE NEBRASKA HEALTH INSURANCE INFORMATION, COUNSELING, AND ASSISTANCE (NICA) PROGRAM

DECEMBER 2000 NICA NEWS

ISSUES

New Cost-Sharing Amounts Recently Announced

Increases minimal for the year 2001

The Medicare Part B premium will go up beginning in January 2001 to $50.00. This premium covers physician services, hospital outpatient care, durable medical equipment and other services outside hospitals. For most seniors, this amount is deducted from their monthly Social Security check.

The Part B deductible will remain at $100 per calendar year. Beneficiaries are responsible for the first $100 of Medicare approved expenses each year. After the deductible has been met, Medicare generally pays 80 percent of all other approved charges for covered Part B services for the rest of the year. Beneficiaries are responsible for the other 20 percent, which is called coinsurance.

The Medicare Part A deductible for inpatient hospital care for the first through the sixtieth day of care is $792 in 2001. The cost to beneficiaries for hospital stays on days 61 through 90 will be $198 per day in the year 2001. For stays longer than 90 days, the cost will be $396 per day in the year 2001. The skilled nursing facility coinsurance, which must be paid after the first 20 days of such care, is rising by $2, to $99 per day in the year 2001. These Part A deductible and coinsurance amounts apply to each benefit period.

Finally, the vast majority of Medicare beneficiaries do not pay a premium for Part A coverage. However, beneficiaries who have less than the required number of quarters of Medicare-covered employment will have to pay a premium for Part A. This premium has dropped in the year 2001 by $1 to $300 per month for those seniors with less than 30 quarters of Medicare-covered employment, and for disabled individuals under 65 who lost disability benefits because of work and earnings. Seniors with 30 to 40 quarters of Medicare-covered employment are entitled to a reduced premium.

Sterling Private Fee-For-Service

The following chart gives information on changes with the Sterling Private Fee-for-Service Plan.

BENIFT	2000 PLAN BENIFITS	2001 PLAN BENIFITS
Premium	You pay $55 each month premium.	You pay $65 each month premium.
Outpatient Mental Health Care	You pay $10 for each individual or group visit.	You pay 50% of the cost for each individual or group visit.
Outpatient Surgery	You pay $10 for each visit or procedure performed in an ambulatory surgical center.	You pay $0 for each Medicare-covered outpatient surgery or visit to an ambulatory surgical center.
Durable Medical Equipment (includes wheelchairs, oxygen, etc.)	You pay $0 for each piece of Durable Medical Equipment. You must notify Sterling prior to obtaining any DME over $750 or you may be liable for a 40% coinsurance of the billed charges.	You pay 50% of the cost for Medicare-covered benefits for Durable Medical Equipment. If you do not notify the plan of an equipment or device purchase over $750, you will have to pay 70% of the billed charges.
Home Health Care	You pay $0 for all covered home health visits.	You pay 50% of the cost for Medicare-covered home health visits.

34 Million Copies of 2001 Handbook to be Mailed

Should be received by mid-October in Region VII Medicare's largest annual mailing to beneficiaries took place in October when more than 34 million copies of the Medicare & You handbook are mailed to beneficiaries all across the United States. The mailing is one part of Medicare's comprehensive effort to help beneficiaries understand their health care options.

The Medicare & You 2001 handbook provides the most up-to-date, comprehensive Medicare information available from the Health Care Financing Administration (HCFA). The handbook is one of the primary tools used by HCFA to inform seniors and people with disabilities about their Medicare benefits, rights and responsibilities. This year, more than 300,000 handbooks are also being mailed to physicians who treat seniors and people with disabilities who are covered under Medicare.

The 2001 Handbook includes:

Updated "Questions and Answers" to help beneficiaries make good decisions about their health care.
Information about Medicare+Choice plans available, including satisfaction data.
Resource phone numbers for beneficiaries and advocates to use.

The 2001 Handbook continues to contain performance and customer satisfaction information about original Medicare and Medicare+Choice plans, including the percentage of women who received screening mammograms, and the overall rating of care that patients received in their managed care plan.

Medicare beneficiaries can also learn more about Medicare on the Internet at www.medicare.gov, or by calling 1-800-MEDICARE (1-800-633-4227). Medicare is pleased to announce its Internet Website for beneficiaries and providers. This site has information specific to our area. www.nebraskamedicare.com

Website includes: Beneficiary Pages, Enrollment Information, Covered Services, Physician/Supplier Directory, How to Contact Us, Frequently Asked Questions & Answers, Publications, Upcoming Events, Part A Provider & Part B Physician/Supplier Pages, Local Medical Review Policies, Provider Events, Electronic Data Interchange (EDI), Related Resources, Glossary/Definitions of Common Medicare terms.

New Ambulance Fee Schedule

As required by the Balanced Budget Act of 1997, HCFA recently participated in negotiations with affected industry groups to develop the new ambulance fee schedule. The proposed rule reflects the consensus of the negotiated rulemaking committee.

"We want to make sure that beneficiaries continue to get needed ambulance services and that Medicare pays ambulance suppliers more fairly and accurately," HCFA Administrator Nancy-Ann DeParle said. "These changes will protect beneficiaries and taxpayers from paying too much while preserving access to needed services."

Under the proposed rule:

Seven categories of ground ambulance services, ranging from basic life support to specialty care transport, and two categories of air ambulance services will be established;
Payment of each category is based on the relative cost of the service, adjusted to reflect wage differences in different parts of the country. Mileage will also affect payment levels;
Ambulance providers will not be allowed to charge beneficiaries more than 20% of Medicare's approved amount for the service. Currently, providers can charge beneficiaries higher rates;
The fee schedule allows for increased payments when ambulance services are provided in rural areas.

To better serve beneficiaries in rural areas, HCFA will consider alternative approaches to ensure adequate payment for isolated, essential, low-volume, rural ambulance suppliers as data becomes available.

The new fee schedule will be phased in over four years starting January 1, 2001. This is also the date that ambulance providers are required to accept assignment under Medicare.

The negotiated rulemaking committee included the American Ambulance Association, the American Hospital Association, the Association of Air Medical Services, the International Association of Firefighters, the International Association of Fire Chiefs, the National Volunteer Fire Council, the National Association of Counties, the National Association of State Emergency Medical Services (EMS) Directors, and the National Association of EMS Physicians.

- taken in part from a Sept. 11, 2000 HCFA Press Release

THE AMBULANCE FEE SCHEDULE HAS BEEN POSTPONED TO BEGIN APRIL 2001

HCFA ANNOUNCES NEW MEDICARE HOSPITAL OUTPATIENT PAYMENT SYSTEM

The Health Care Financing Administration announced a new Medicare payment system for hospital outpatient services to encourage more efficient delivery of care and to ensure more appropriate payment for services by Medicare and its beneficiaries. Over time, the regulation will save beneficiaries millions of dollars in coinsurance payments for outpatient services.

HCFA, which oversees the Medicare program, will implement the new payment system, which became effective August 1, 2000.

"This regulation helps Medicare reduce copayments for hospital outpatient services that are being used more frequently by elderly and disabled Americans," said HCFA Administrator Nancy-Ann DeParle. "The new system gives hospitals changed incentives to become more efficient and will result in more consistent payments across hospitals.

"The new prospective payment system increases total payments to hospitals, although individual hospitals may see an increase or a decrease in their payments," DeParle said. "During the transition period, we are protecting hospitals by paying a part of any reduced payments they might incur for outpatient services. For rural hospitals, we will fully cover any payment reductions. And hospitals will receive additional payments for new medical devices and drugs for up to three years." The new payment system is based on groups of services called ambulatory payment classifications (APC), which divides all outpatient services included in the new payment schedule into 451 groups. The services within each group are clinically similar and require comparable resources.

A key provision of the 1997 budget law is a change in beneficiary coinsurance payments. The current coinsurance is based on 20 percent of charges billed by the hospitals and community mental health centers. In fact, for many outpatient services, beneficiaries pay 50 percent or more of the total payment to the hospital for outpatient treatment. In addition, a limit has been placed on the beneficiary's liability for each outpatient service received. The patient will be liable for no more than the inpatient deductible for that year ($776 in 2000) for each hospital outpatient service received.

HCFA will make certain that hospitals and their billing companies have the information and training they need to carry out system changes for the new outpatient prospective payment system. The agency also will monitor the progress of hospitals as they make the necessary changes and will continue to work closely with the hospital associations.

New toll-free numbers for Medicare Part A Intermediaries
Mutual of Omaha's new number is:
(877) 647-6528

Blue Cross Blue Shield's new number is:
(877) 602-7775

Sandra Gaube, Executive Director Of VIE, Will Move On Dec. 31

Sandra said she has thoroughly enjoyed working with agencies throughout the State in her 16.5 years at VIE. She has worked with approximately 300 volunteers over the years.

Under her direction, VIE has received support and trust from the Omaha community. VIE received the Aksarben Ike Friedman Leadership Award. Nine of Sandra's VIE Volunteers have won United Way Volunteer of the Year Awards.

Sandra said her tenure with VIE was exciting and she wishes to thank everyone for their support.

She will serve as a Volunteer in the Ralston Special Olympics and help her husband in their new business venture.

NICA Fall Update Quiz

Volunteers that were not able to attend the Fall NICA Update training were sent handouts as well as a quiz.

These volunteers were asked to review the material, complete the eight-question quiz and return the quiz to the NICA Program Office. One of the requirements of maintaining volunteer status is to stay up to date with recent Medicare changes. That is why it is important if you did not attend the update, that you take the time to review the material and return the quiz.

Thank you for taking the time to complete the quiz.

Medicare Pilot Will Help Seniors Stop Smoking

The Health Care Financing Administration (HCFA) announced recently that the agency will test ways to help older Americans stop smoking, one of the leading causes of death of Medicare beneficiaries. "Smoking is the single most preventable cause of death and illness in the U.S., especially among older Americans," said Nancy-Ann DeParle, HCFA Administrator. "But it's never too late to stop." Medicare, the federal health insurance program that covers Americans 65 and older, spent $14.2 billion in 1993 treating smoking-related illnesses, nearly 10% of the Medicare budget. Independent researchers have estimated that between 1995 and 2015, Medicare will spend $800 billion treating smoking-related illnesses. "We know that if we can find ways to help Medicare beneficiaries stop smoking, it will enrich their lives and help them live longer," said Jeffrey Kang, M.D., HCFA's clinical officer. "The health benefits are substantial, even for people who have smoked for a long time."

"By law, smoking cessation therapy as such is not a Medicare benefit," DeParle said. "If the demonstration proves successful in identifying the most effective ways to help seniors stop smoking, this could prompt Congress to consider a Medicare benefit to cover smoking cessation."

The demonstration cessation project will test specific strategies for helping older people quit smoking in states selected because of the prevalence of smokers age 65 in their populations. These states include Alabama, Florida, Missouri and Ohio, with additional states to be determined later.

Peer Review Organizations (PROs), Medicare's quality assurance contractors, will run the program in each selected state. The PROs will publicize the project through newspaper and broadcast advertisements, doctors' offices and community outreach programs. Eligible beneficiaries can use a toll-free telephone line to register to participate in the demonstration.

Counseling, either by health care providers or trained telephone counselors, and FDA-approved drugs, either nicotine replacement therapy or prescription drugs, will be used in a variety of combinations. These include counseling by health care providers only; provider counseling in conjunction with medication; and telephone counseling with drugs.

The demonstration will last approximately three years. Individual participants will be offered smoking cessation assistance for 12 months and health care professionals will follow their progress to evaluate success rates. Participants will be recruited on a rolling basis over the life of the program.

HCFA will evaluate and publish the preliminary results in 2003.

The smoking cessation demonstration announced in July was prompted by research sponsored jointly by HCFA and U.S. Public Health Service, which produced scientific evidence that counseling and Food and Drug Administration-approved smoking cessation drugs are effective in encouraging older smokers to quit. The Public Health Service recently published a new guideline, "Treating Tobacco Use and Dependence: A Clinical Practice Guideline."

Smoking accounts for more than 430,000 deaths every year in the U.S. More than 70% of these deaths occur in people age 65 and older, who suffer the most from smoking's harmful effects. Smoking often leads to disability and poor quality of life. It either causes or contributes to a number of chronic illnesses, including cancer, heart and lung diseases, diabetes and osteoporosis.

Recent smoking cessation efforts have targeted younger populations, yet research shows that older smokers are more likely to be successful in quitting than younger adults and reap many benefits from quitting. These benefits include reducing the risk of heart attack, cancer and stroke, improving circulation and breathing, and better overall physical functioning.

"Health risk begins to decline within a few months of quitting," DeParle said. "Within five years, many ex-smokers have about the same risk for heart disease and stroke as persons who never smoked."

Smoking cessation is a special concern for Medicare because more smokers will be entering the program in coming years. The prevalence of smoking in the Medicare population is currently declining slowly, but the actual number of smokers will increase with the aging of baby boomers."

The smoking cessation demonstration is the latest part of HCFA's Healthy Aging Project, a new initiative aimed at identifying the best ways to keep seniors healthy. In developing the demonstration, HCFA consulted with a number of other agencies and organizations including the National Institutes of Health, the Agency for Healthcare Research and Quality, and the Centers for Disease Control and Prevention.

"Medicare is about more than just paying bills after people get sick," DeParle said. "We want to help people stay healthy and enjoy a richer and smoke-free quality of life."

Conseco Discontinues Medicare Supplements

Conseco Senior Health Insurance Company has provided us with notice that they are discontinuing marketing Medicare Supplement insurance in Nebraska.

Reporting Changes

You will no longer need to record the county in which you are volunteering. The NICA Program Office has stopped tracking Records of Counseling by the county number. As of Oct. 1, 2000, the NICA Program Office will track Records of Counseling and NICA Outreach Forms by the Volunteer's name. If you have any questions, please call Tiffany at (402) 471-4506.

Perspective Can Temper Misfortune

In dwelling on our problems, we sometimes miss the chance to improve ourselves and help others. A group of conventioneers learned this lesson one night.

About 20 attendees formed friendships during the course of this convention and one night were sitting in the living room of an inn. The usual light-hearted conversation turned serious when one young man confessed that he had been diagnosed with cancer. A couple reported that their child needed a kidney transplant. Another woman explained how she recently had lost her husband to a car accident.

The tales of tragedy continued. Then, one man suggested that each person anonymously write down the three biggest personal problems they were facing.

Everyone put their woes into a wicker basket. The man passed the basket around, asking each person to pick a paper from the basket. Then he said, "Friends, open the paper and just read to yourself the problem that you chose. Would you like to trade your problems that you wrote down with those that you chose from the basket?"

When everyone responded no, he asked, "Do your problems seem so difficult now when you see what others must endure? Tonight you've learned that despite the hardships you face, and despite the worries that grind away at you and cause you to lose sleep at night, you've come to appreciate and understand the simple fact that the problems you face are nothing compared to what others must deal with. In light of everyone else's problems, your own problems seem manageable. If nothing else, that's something to be grateful for. The burdens that have been placed upon us are there for a reason," he explained. "Because without our problems, we would not search for answers. And if we led our lives without searching for answers, we would never become better, or stronger or more understanding. Sometimes it takes a serious problem to wake us up to what's really important in life. As an example, you'll find that many of the answers you're looking for can be found by helping others facing similar problems, and that act of service is what's really important."