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

MARCH 2001 NICA NEWS

THIS AND THAT

Diabetes Education Program

The National Diabetes Education Program (NDEP), a joint federal program run by the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), has joined forces with the Health Care Financing Administration (HCFA) to help older adults understand that routine self-monitoring of blood sugar levels can help delay or prevent the complications of diabetes. The NDEP is working with HCFA to reach Americans 65 years and older as well as younger people with disabilities who have diabetes with information on the treatment and benefits available for people with Medicare. An estimated 4.5 million Medicare beneficiaries have diabetes.

"Educating the public, especially older Americans, about diabetes and its complications as well as providing increased access to diabetes treatment are the keys to reducing the risks of this serious public health problem," said Health & Human Services Secretary, Tommy G. Thompson. "It is so important that we get the word out that people with Medicare can use their benefits to better monitor and manage their diabetes."

Routine self-monitoring of blood sugar levels is crucial to adults with diabetes and their health care providers as they devise a treatment plan for managing their disease. Diabetes is one of the leading causes of death and disability in the United States. Complications from diabetes include kidney disease, heart disease, nerve damage, blindness, and lower limb amputation.

Several years ago Congress expanded the Medicare diabetes benefits to help both insulin and noninsulin-treated people with diabetes pay for the equipment and supplies they need to test their blood sugar levels. To use the benefit, a patient needs to ask the treating physician to prescribe blood sugar testing supplies, including blood sugar test strips, lancets, blood sugar testing monitors, and spring-powered devices for lancets. These supplies are available at little cost to people with Medicare. In addition, the treating physician should certify that the patient or his or her caregiver has been properly trained to use the equipment.

The latest effort to raise awareness about the importance of routine self-monitoring of blood sugar comes amid renewed concerns about the dramatic increase in cases of diabetes nationwide, especially among ethnic and minority populations. The CDC has called diabetes the epidemic of our time. Currently, approximately 16 million Americans have diabetes, one-third of whom have been undiagnosed.

Diabetes Fact Sheet

Diabetes is the seventh leading cause of death in the United States. Do you know the facts?

Diabetes is a disease caused by a deficiency of insulin, a hormone secreted by the pancreas. Insulin is needed to convert sugar, starches, and other food into energy.
Type 1 diabetes, often called juvenile onset diabetes, may account for 5-10% of all diagnosed cases.
Type 2 diabetes may account for 90-95% of all diagnosed cases.
Risk factors for type 2 diabetes include obesity, a family history of diabetes, older age, and damaged glucose tolerance.
Symptoms include excessive thirst, extreme hunger, excessive urination, unexplained weight loss, sudden vision change, tingling or numbness in hands or feet, feeling tired most of the time, very dry skin, sores that heal slowly, and more infections than usual.
Diabetes complications include blindness, kidney failure, heart disease, stroke, and lower limb amputation.
Approximately 2,186 new cases of diabetes are diagnosed every day in the United States.
Diabetes and its complications occur in Americans of all ages and racial and ethnic groups. Older Americans are more commonly affected.
There is no cure for diabetes.

Diabetes Can be Controlled

Diabetes treatment includes eating to control blood sugar, getting regular physical activity, taking diabetes medicines and/or insulin, and monitoring blood sugar levels.
By keeping blood sugar levels in the normal range, people with diabetes lower their risk of long-term complications of diabetes, such as eye disease, kidney disease, and nerve damage.
In the short run, controlling blood sugar levels helps people with diabetes feel better, stay healthy, and enjoy a better quality of life.

The New Medicare Benefits Can Help People With Diabetes

Medicare can now help pay for diabetes self-monitoring equipment and supplies such as blood glucose monitors, test strips, and lancets.
The benefit starts once people with Medicare medical insurance (Part B) who have diabetes meet their annual deductible. After that point, people with Medicare pay only 20% of the cost of their diabetes self-monitoring equipment and supplies, and Medicare pays the other 80%. If you are in a Medicare health plan, check with the plan to find out if there is a co-payment. Either way, remember that Medicare helps pay for part of the cost of your diabetes equipment and supplies.
The new policy applies to people with Medicare regardless of whether they use insulin or not.

For free information about Medicare's coverage of diabetes supplies, contact: HCFA,
Center for Beneficiary Services
7500 Security Blvd.
Baltimore, MD 21244
1-800-633-4227
www.medicare.gov

Questions & Answers

Am I eligible to get Medicare coverage of diabetes self-testing equipment and supplies?
You are eligible for this coverage if you meet all of these conditions:
- You have Medicare Part B;
- You are a person with Medicare who is being treated by a physician for diabetes (with or without insulin);
- You have a doctor's prescription for a blood sugar meter and related supplies; you or your caregiver has been trained to use the equipment and test results correctly;
- Your self-testing equipment is designed for home use.
How much do I pay for self-testing equipment and supplies under Medicare?
In the Original Medicare Plan, you have to pay only 20% of the Medicare-approved amount after meeting the $100 annual deductible for Medicare Part B. If you are in a Medicare health plan, check with the plan about whether you need to make a co-payment for diabetes self-testing equipment and supplies. Your Medicare-approved supplier will fill out the required insurance form for you. Medicare pays only the approved amount or the amount charged, whichever is lower. The amount and type of supplies covered depend on your doctor's prescription. Medicare policy may limit how many test strips and lancets are covered each month.
What diabetes supplies does Medicare help to pay for?
Medicare helps to pay for:
- Blood glucose meters (one every five years);
- Test strips;
- Lancets (used to stick fingers and get a drop of blood);
- Spring-powered lancet devices;
- Batteries;
- Blood glucose control solutions (if purchased separately from your blood sugar meter);
- Training in how to control your diabetes;
- Lancet device and replacement batteries if the items are packaged and purchased separately from the blood glucose meter;
- External infusion pumps (if medically necessary).
What diabetes supplies does Medicare not cover?
Medicare does not cover insulin or syringes.
At our recent update the question was asked whether Medicare covered shoes for diabetics.
For any item to be covered by Medicare, it must (1) be eligible for a defined Medicare benefit category, (2) be reasonable and necessary for the diagnosis or treatment of an illness or injury or to improve the functioning of a malformed body member, and (3) meet all other applicable Medicare statutory and regulatory requirements.
Shoes, inserts, and modifications are covered in limited circumstances. They are covered in selected patients with diabetes for the prevention or treatment of diabetic foot ulcers.
Shoes are also covered if they are an integral part of a covered leg brace and if they are medically necessary for the proper functioning of the brace. Heel replacements, sole replacements, and shoe transfers involving shoes on a covered brace are also covered.
A matching shoe which is not attached to a brace and items related to that shoe will be denied as noncovered.
Shoes which are billed separately (i.e., not as part of a brace) will be denied as noncovered.
Prosthetic shoes are covered if they are an integral part of a prosthesis for patients with a partial foot amputation.
Shoes are denied as noncovered when they are put on over a partial foot prosthesis or other lower extremity prosthesis which is attached to the residual limb by other mechanism.
With the exception of the situations described above, orthopedic footwear will be denied as noncovered.
Another question asked at a spring update was whether Medicare covered oxygen in skilled nursing facilities.
No, Medicare does not cover oxygen in skilled nursing facilities.

Comparison Guides Have Arrived

The 2001 Comparison Guide for Medicare Supplement Insurance in Nebraska has arrived. These handy guides compare companies selling medigap insurance in Nebraska. There are approximately the same number of insurance companies selling Medicare Supplement Plans A-J as previous years, but this year there are several additional companies selling the High Deductible Medicare Supplement Option.

The "Choosing a Medigap Policy" HCFA publication is a helpful brochure to use in conjunction with the guides.

For Unwanted Mail and Phone Calls

If you're tired of unwanted mail or phone calls, send a written request to the following:

Mail Preference Service
Direct Marketing Assoc. PO Box 9008
Farmingdale, NY 11735

Telephone Preference Service
Direct Marketing Assoc. PO Box 9014
Farmingdale, NY 11735

Medicare Appeal Rights

People with Medicare have certain guaranteed rights. These rights protect them when they get health care services, and protect them against unethical practices. One of these rights is the right to appeal decisions to deny or limit payment for medical care.

Rights Under Original Medicare

A person with Medicare has the right to appeal any decision about his/her Medicare services. This is true whether he/she is in the original Medicare plan or a Medicare managed care plan. Let's use Martha as an example. If Medicare does not pay for an item or service she has been given, or if she is not given an item she thinks she should get, Martha can appeal. If she files an appeal, she should ask her doctor or provider for any information related to the bill that might help her case.

If she believes she is being discharged too soon from a hospital, she has the right to an immediate review by the Peer Review Organization (PRO). PROs are groups of practicing doctors and other health care professionals paid by the federal government to monitor the care given to people with Medicare. They are responsible for reviewing beneficiary complaints about the quality of care provided by inpatient hospitals, hospital outpatient departments and hospital emergency rooms; skilled nursing facilities; home health agencies; Medicare Managed Care Plans and ambulatory surgical centers. A person with Medicare can stay in the hospital at no charge and cannot be discharged before the PRO makes its decision.

Protection While Hospitalized

People with Medicare are protected when they are in the hospital. This is true whether they are in the original Medicare plan or a Medicare managed care plan. If Martha is admitted to a Medicare participating hospital, she should be given a copy of An Important Message from Medicare. It explains her rights as a hospital patient. If she isn't given one, she should ask for it. All people with Medicare should receive this upon being admitted to a hospital. This message tells her that:

She has the right to get all of the hospital care that she needs, and any follow-up care after she leaves the hospital.
What to do if she thinks the hospital is making her leave too soon.

Appeal rights for all people with Medicare are on the back of the Medicare Summary Notice that is mailed to them. The notice will also tell people if and why a bill was not paid and what appeal steps to take.

Training on the new Reporting Forms

Many of you heard, at the NICA Spring Updates, that NICA would be using new reporting forms. The change is a requirement of the grant that the Health Care Financing Administration gives to the State of Nebraska, Department of Insurance to run the NICA Program.

During the training, I will go over the new forms and give information on how to complete the forms. This training will be casual and fun. Please come prepared to drink coffee, eat some type of dessert and learn all about the new reporting forms. People say that change is always hard, but this will be easy, I promise!

Please, Please, Please call Rebecca Hasty or myself at (402) 471-2201 to register for the training date of your choice. Thank you.

Tiffany Geis
Senior Program Coordinator

Date	City	Location/Address	Time
July 17	Ogallala	Holiday Inn Express 501 Stagecoach Trail	5:00 - 7:00 p.m.
July 18	Ogallala	Holiday Inn Express 501 Stagecoach Trail	8:00 - 10:00 a.m.
July 18	North Platte	North Platte Agency on Aging 120 W. 2nd	12:30 - 2:30 p.m.
July 18	North Platte	North Platte Agency on Aging 120 W. 2nd	3:00 - 5:00 p.m.
July 19	Kearney	Kearney Agency on Aging 4623 2nd Avenue, Suite 4	9:30 - 11:30 a.m.
August 13	Norfolk	The Norfolk Arts Center 305 No. 5th St.	9:30 - 11:30 a.m.
August 15	York	Chances R Restaurant, York.	9:30 - 11:30 a.m.