Nebraska Department of Insurance
THE NEBRASKA HEALTH INSURANCE INFORMATION, COUNSELING, AND ASSISTANCE (NICA) PROGRAM
MARCH 2003 NICA NEWS
CHANGES
Change in Medicare billing for Critical Access Hospitals
There has been a change in the way Critical Access Hospitals (CAH) bill beneficiaries for Emergency Room services that result in an inpatient stay. Prior to January 1, 2003, if a beneficiary went to an ER at a CAH and then was admitted to the hospital as an inpatient, the charges were "bundled" into the inpatient charges and the patient owed the Part A inpatient deductible if they were starting a new benefit period. With the new rule change that was effective January 1, the charges have to be "unbundled" and the beneficiary will get a separate bill for the outpatient services through Part B.Nursing Homes Must Post Staffing Information for Families
Effective January 1, 2003, nursing homes across America are required to publicly post the number of nursing staff they have on duty to care for patients on each daily shift. This new requirement comes as part of the implementation of the Benefits Improvement and Protection Act of 2000 (BIPA) that requires nursing facilities to post the number of licensed and unlicensed staff directly responsible for resident care. Licensed and unlicensed nursing staff includes registered nurses, licensed practical nurses, and nurse aids. CMS is developing a regulation that will outline the required format and content of the daily postings.Beneficiary Outreach Activities Ceased
On December 24, 2002, CMS notified Medicare Carriers and Fiscal Intermediaries to cease all beneficiary outreach activities such as participation in local seminars, health fairs, partnership efforts, newsletters, visits to senior centers, and liaisons with senior advocate groups -- including the Nebraska Medicare Beneficiary Coalition that NICA coordinates. This change is due to increased budget constraints and the growth of Medicare claims in recent years. The contractors for Nebraska include Blue Cross/Blue Shield of Nebraska and Mutual of Omaha for Part A, and Blue Cross/Blue Shield of Kansas for Part B. The contractors will continue to answer telephone calls and written inquiries from beneficiaries, and to review and pay Medicare claims. In addition, CMS indicated that outreach activities would fall upon the State Health Insurance Programs, such as NICA in Nebraska. With this loss, and with the constant changes in Medicare coverage and plan options, the role of local NICA Volunteers to educate seniors on Medicare is now more important than ever.Nebraska QIO Contract Change
CIMRO of Nebraska is the new Quality Improvement Organization (QIO) for Nebraska. The previous QIO was Sunderbruch of Nebraska. The goals of the new QIO are to promote quality health care services, determine medical necessity of services rendered, and ensure that professionally recognized standards of care are met. CIMRO has a 30-year history of conducting quality improvement and utilization review activities, and is headquartered in Illinois. The Nebraska corporate office is located at 1230 O Street, Lincoln, NE 68508. CIMRO can be reached by phone at 402-476-1399, toll free 800-458-4262, or by fax at 402-476-1335. In addition, CIMRO has a beneficiary helpline, 800-247-3004, established to facilitate timely and appropriate communications (such as beneficiary rights, protections, and responsibilities and the purpose of the QIO program) to the beneficiary community. The helpline will also serve to receive information from beneficiaries who feel that Medicare rights have been denied, or who are concerned about the quality of care received.Deep Brain Stimulation
Medicare will soon begin covering deep brain stimulation for patients with severe disabling symptoms from essential tremor disorder or Parkinson's disease. Coverage for the procedure will be limited to patients who have received the best medical care but still have significant difficulty in performing daily activities. Deep brain stimulation uses implanted electrodes to deliver electrical stimulation to certain targeted areas of the brain. This will provide a new option for Parkinson's disease and essential tremor disorder patients who have reached maximum benefit from medical treatment and continue to have severe disabling symptoms from these disorders or unacceptable side effects from medications.2003 Rates: Sterling Private Fee-for-Service
Currently, the only Private Fee-for-Service plan offered to Medicare beneficiaries in Nebraska is through Sterling Life Insurance Company. PFFS is a Medicare + Choice option, and is available to all Medicare beneficiaries, other than those with ESRD. The monthly premium and copays have changed for 2003. The monthly plan premium in 2003 is $88. Copays include: $15 primary physician care visit, $30 specialist physician care visit, $500 maximum copay for each hospital admission up to 90 days, $0 copay days 1-10 & $25 copay days 11-100 of Medicare-covered Skilled Nursing Facility admission, $50 additional copay per day ($500 maximum) for non-notification of planning inpatient admission, 25% of cost for Medicare-covered Home Health visits. Additional charges apply for certain other services. Generally no drugs, physical exams, eye exams, hearing aids, or glasses are covered unless they are Medicare-approved charges. For more information, contact the NICA office for a brochure, or call Sterling at 1-888-858-8572 or visit www.sterlingplans.com.Don't Forget!! Social Security Age has Changed!!
This is the first year that the full retirement age change has taken effect, increasing beyond age 65. There will be beneficiaries this year who will not be eligible for full benefits until age 65 years and 2 months. This does not affect Medicare eligibility, as people are still eligible to begin signing up for Medicare three months prior to their 65th birthday month. It is very important that NICA volunteers work to get the word out that Medicare eligibility is still 65 years. As the full retirement age increases toward age 67, if beneficiaries are not aware and wait to sign up for Medicare upon becoming eligible for Social Security, they will miss the Medicare Initial Enrollment Period and will be required to go through General Enrollment. This could delay the effective date of Medicare benefits, and possibly result in penalties they will have to pay for the rest of their lives.NICA VOLUNTEERS CAN HELP GET THE WORD OUT!!