Nebraska Department of Insurance

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

SEPTEMBER 2001 NICA NEWS

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ISSUES

CMS TARGETS THE NUMBER TWO CANCER KILLER

A national campaign to screen Medicare beneficiaries for colorectal cancer -- one of the nation's most preventable cancers and yet, sadly, the number two cancer killer -- was launched by the CMS, the federal agency that administers Medicare, and the Centers for Disease Control and Prevention (CDC). President Bush proclaimed March, 2001, as National Colorectal Cancer Awareness Month.

HCFA and the CDC, along with the National Cancer Institute, are targeting people 50 and older in the early detection and prevention effort called Screen for Life. Risk for the disease increases with age. Colorectal cancer strikes men and women with almost equal frequency and often progresses without symptoms. Colorectal cancer is usually curable when discovered early and early diagnosis is possible with regular screenings.

"We want our beneficiaries to know that Medicare covers four types of colorectal cancer screening tests," said Tommy G. Thompson, HHS Secretary. "The good news is that we know we could save thousands of lives a year through screening."

Medicare currently covers:

• a yearly take-home fecal-occult blood test with no co-pays or deductible;
• a flexible sigmoidoscopy every four years. Benefici- aries pay 20% of the Medicare approved amount after the annual Part B deductible;
• a colonoscopy for high-risk individuals every two years. Beneficiaries pay about 20% of the Medicare approved amount after the annual Part B deductible;
• a barium enema as an alternative to either the sigmoidoscopy or the colonoscopy.

Beginning in July, 2001, Medicare began covering a screening colonoscopy every 10 years for people not at high risk for colorectal cancer. Risk is greater for those with a history of inflammatory bowel disease or polyps, or a family history of colon or rectal cancer.

The disease, second in cancer deaths only to lung cancer, will kill about 56,000 people this year. About 135,000 men and women will likely be diagnosed with colorectal cancer this year. About 56 percent of Americans 50 and older have not taken the screening tests that can detect the cancer when treatment can be most effective, and in many cases, the cancer can be cured.

"We want older Americans to know that cancer of the colon is preventable, treatable, and curable when it is detected early. That's why Screen for Life is so important," Thompson said.

"Medicare encourages every one of our beneficiaries to ask his or her doctor or health care professional for a colorectal screening test."

To find a doctor or health care professional who can give a Medicare-paid screening test, call 1-800-MEDICARE, (TTY/TDD 1-877-486-2048) or visit their Web site at www.medicare.gov for a list of all participating Medicare physicians.

For more information on cancers of the colon or rectum call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (TTY1-800-332-8615) or visit the federal government's Screen for Life Web site at www.cdc.gov/cancer/ScreenforLife

HCFA is currently conducting a study in both North and South Carolina to improve utilization of colorectal screening services in the Medicare population.

Nearly 40 million people have Medicare.

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TRICARE for Life (TFL) For Military Retirees

TRICARE for Life starts October 1, 2001. It provides expanded medical coverage for: Medicare-eligible retirees, including retired guard members and reservists; Medicare-eligible family members and widow/widowers; and certain former spouses if they were eligible for TRICARE before age 65. You must have Medicare Part B to be eligible for TFL.

If eligible, they will get all Medicare-covered benefits under the original Medicare plan, plus all TFL-covered benefits. If they use a Medicare provider, Medicare will be the first payer for all Medicare-covered services, and TFL will be the second payer. TFL will pay all Medicare copayments and deductibles and cover most of the costs of certain care not covered by Medicare.

For more information on TRICARE for Life call 1-888-DOD-LIFE (1-888-363-5433) or check out the TRICARE website for frequently asked questions at www.tricare.osd.mil/ndaa/faq.cfm. Call 1-800-538-9552 for other military retiree benefit questions.

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MEDICARE TO COVER SURGICAL PROCEDURE FOR INCONTINENCE

HHS Secretary Tommy G. Thompson today announced that the Centers for Medicare & Medicaid Services (CMS) will expand Medicare coverage to include a surgical treatment known as sacral nerve stimulation for urinary incontinence and other voiding difficulties.

"This coverage decision emphasizes our commitment to making the best in proven new technologies available to Medicare beneficiaries," Secretary Thompson said. "This is especially important because incontinence affects so many Medicare beneficiaries, and this procedure can significantly improve many people's quality of life."

Urinary incontinence affects approximately 13 million adults in the United States, with nearly half of nursing home residents having some degree of incontinence. It is twice as prevalent in women as it is in men, and costs more than $15 billion per year, including both direct treatment of the disease and nursing home costs.

Under this treatment, an electrical pulse generator about the size of a pacemaker is implanted in the abdominal wall of a patient, with a wire leading to the sacral nerves, which help control bladder contractions. Electrical impulses are transmitted from the generator to the sacral nerves through the implanted wire. These impulses control the troublesome contractions of the bladder muscle, giving the patient the ability to regulate the frequent and uncontrollable contractions that cause incontinence.

In order to be eligible for this procedure, a Medicare beneficiary with urge incontinence or the urgency-frequency syndrome must also have failed more conservative treatments, such as behavioral modifications, drug therapy or other surgical interventions.

The decision by CMS, formerly the Health Care Financing Administration, to expand coverage was made using Medicare's evidence-based coverage process. The scientific and clinical evidence reviewed by CMS regarding the clinical value of sacral nerve stimulation is sufficient to support coverage of this technology for Medicare beneficiaries nationwide.

"CMS's new coverage process is helping Medicare make the right decisions, based on scientific evidence, on when the program should cover new items, services and procedures," said Jeffrey Kang, M.D., director of CMS's Office of Clinical Standards and Quality.

More information can be found at www.hcfa.gov/coverage/8b3.htm.

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BenefitsCheckUp.org

On Tuesday, June 5, 2001, millions of American seniors found out if they are eligible for prescription drug discounts, Medicaid or other benefits using a single Web site.

BenefitsCheckUp.org is the first Web site to provide one-stop shopping for nearly 1,000 state and federal benefits programs, according to the National Council on the Aging (NCOA), which launched the site.

By filling out a confidential questionnaire online, seniors or members of their family can determine--within minutes--whether they are eligible for a slew of different state and federal programs, and where they can enroll.

For privacy reasons, the Web site does not ask for the individual's name, address, phone number, Social Security number, or other identifying information. It does require seniors to enter their age, income and ZIP code.

More than 5 million seniors are currently missing out on programs for which they are eligible, according to the NCOA.

As many as 3 million eligible seniors do not participate in Medicaid, for example, and 3 million are eligible for food stamps but are not getting them. Twenty-nine states have pharmacy assistance programs that are not being fully utilized, the NCOA said. And many middle- and upper-income seniors do not take advantage of Veteran's programs, property tax relief, nutrition programs and educational benefits for which they qualify.

"BenefitsCheckUp is a shining example of how a public and private partnership can make life easier for seniors and their families," said Dr. James Firman, president of the Washington-based NCOA.

The service is free to the public, with backing from AOL Time Warner Inc., New York Life, Lucent Technologies, the Merck Company Foundation, and the Archstone Foundation. The US National Institute on Aging helped fund development of the Web-based service.

Firman said the NCOA would be working with the AARP, Catholic Charities USA and other organizations to get the word out about the new service.

America Online's GovernmentGuide.com will host the Web site.

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We've Got Bingo

NICA has a new game to play called Medicare Bingo. It's similar to regular bingo and you'll recognize the free space.

NICA will use the Bingo game at NICA Initial Trainings.

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Fall Outreach Project

The NICA Program Office is currently involved in the mailing of over 7,500 litter bags filled with Medicare information to Assisted Living facilities and hot meals recipients around Nebraska. In 1999, NICA completed a similar project to serve the homebound by distributing the litter bag packets to 3,000 people. This year, we've expanded the program to serve residents in Assisted Living facilities.

The volunteers who deliver the hot meals in each community are including the litter bags on the trays delivered to the homebound. The Assisted Living facilities administrations are delivering the bags for us to their residents.

So far, our office has sent out approximately 3,000 litter bags. We believe this project will be completed by October.

Many Department of Insurance employees have helped NICA program staff stuff the bags. Thanks for helping the NICA program with this successful program, DOI employees.

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Cervical Cancer

The National Cancer Institute (NCI) estimates that about 12,800 cases of newly diagnosed invasive cervical cancer will occur in the United States each year and that about 4,600 of the affected women will die.

Research has shown that many women aged 65 and older have not had a Pap test or pelvic exam in the past 3 years because they vastly underestimate their risk for cervical cancer, or their providers do not recommend them. The fact is that women aged 65 and older account for 25 percent of all cervical cancer cases, and for 41 percent of all deaths from cervical cancer. Pap tests can detect abnormal cervical cell changes before they become cancerous. It is one of the stated goals of Healthy People 2010 to increase to 90 percent the number of women who receive screening Pap tests and to further reduce cervical cancer deaths.

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Pap Tests for Women Aged 65 and Older: Dispelling the Myths

While controlling blood pressure and preventing bone loss are common health concerns for women aged 65 and older, getting Pap tests is not. However, statistics show that regularly scheduled cervical cancer screening also should be a priority for older women: Women aged 65 and older have the highest incidence and mortality rates for cervical cancer. They also have the lowest screening rates.

The NCI conducted in-depth interviews with general and family practitioners at the 1997 American Academy of Family Physicians (AAFP) Conference. The purpose of these interviews was to identify what prevents family and general practitioners from performing Pap tests on women aged 65 and older, and to create and test effective messages and communication channels to encourage physicians' interest in Pap tests for women aged 65 and older.

Comments made during the interviews uncovered some "myths" that physicians believe to be true, or claim that their patients believe to be true. The following quotes are actual comments expressed during the interviews.

Myth:
"Cancer of the cervix is mostly a disease of young women."

Myth:
"For women 65 and older who are not sexually active and have never had an abnormal Pap test, I tell them that.they do not have to have a Pap test."

Facts:
Some women who are not now sexually active may still need Pap tests. Cervical cancer is caused by the human papillomavirus (HPV)-a sexually transmitted virus-which is why it is so important to screen women who are or have ever been sexually active. Keep in mind that older women who are not currently sexually active may have been infected years before. HPV can live in the body for years, even a lifetime, without any indication.

Myth:
"By the time women reach age 65, a lot of them have had hysterectomies, and therefore a Pap test would actually not be very important."

For many older women, lack of information and cost stop them from having Pap tests. Educating women about the purpose of the Pap test and why it is important to have regularly scheduled Pap tests is crucial.

Effective July 1, 2001, Medicare began paying for a pap test and pelvic exam every two years instead of every three for women not at high risk for uterine or vaginal cancers. (Medicare covers these tests annually for women at high risk.) For Medicare information, call 1-800-MEDICARE (1-800-633-4227) or visit Medicare's Web site at www.medicare.gov.

NCI's Cancer Information Service (CIS) offers free cervical cancer information packages for health care providers. For the latest, most accurate information about cervical cancer and Pap tests, both women and health care providers can call the CIS at 1-800-4-CANCER.

The Social Security Administration
has an on-line site for women:
www.ssa.gov/women