Administration for Community Living & the Office of Healthcare Information and Counseling

Agenda ACL overview OHIC Overview SHIP SMP MIPPA OHIC in Regions III and IV Staff Listing 2

ACL Mission Maximize the independence, well-being, and health of older adults, people with disabilities across the lifespan, and their families and caregivers. 3

About ACL ACL was established on April 8, 2012 Brought together: – Administration on Aging – Office on Disability, and – Administration on Developmental Disabilities ACL is structured to provide general policy coordination while retaining unique programmatic operations specific to the needs of each population we serve. 4

5 ACL Structure

Office of Healthcare Information and Counseling (SHIP / SMP / MIPPA)

7 So, where are we?

OHIC Programs The Senior Medicare Patrol (SMP) The State Health Insurance Assistance Program (SHIP) 8 The Medicare Improvements for Patients and Providers Act (MIPPA) funding Center for Benefits Outreach and Education (NCBOE) Additional OHIC Work

Who gets the funding? SHIPs – Either the State Unit on Aging or the State Department of Insurance (state decision) SMP – Any state agency, non- profit, educational institution, tribe or other not for profit entity – Competitive 3-yr grant 9 MIPPA – Separate pots of funding for: SHIPs AAAs ADRCs NCBOE – A single competitive 5- year grant – Currently National Council on Aging

The State Health Insurance Assistance Program

SHIP Program Snapshot The SHIP program: – Is intended for Medicare beneficiaries who prefer or need information, counseling, and enrollment assistance beyond what they are able to receive on their own – Provides grants to 54 grantees (all states, Puerto Rico, Guam, DC, and US Virgin Islands) – Oversees a network of more than 3,300 local SHIP program and over 15,000 counselors (57% volunteers) – 2/3 are located under State Units on Aging; 1/3 located under the State Department of Insurance. 11

SHIP Results

SHIPs Transition to ACL

SHIP sails to ACL The SHIP program moved to ACL from CMS in the Consolidated Appropriations Act of 2014 Ever Changing Medicare Demographics – 18% of Medicare Beneficiaries (over 9.4 million) are under the age of 65 ACL’s other Medicare beneficiary focused programs: – Senior Medicare Patrol – Medicare Improvements for Patients and Providers Act (MIPPA) – Aging & Disability Resource Centers (No Wrong Door) 15

CMS/ACL Partnership CMS designated Marilyn Maultsby as the liaison between CMS and ACL. ACL partners with CMS related to – SHIP Unique IDs – Complaints Tracking Module (CTM) – MARx 16

CMS Regional Office Liaisons Roles and Responsibilities Provide education and outreach/event support to SHIPs Request outreach/event support from SHIP Directors Provide local and regional Medicare/Medicaid and related training to SHIPs (in addition to annual National Training Program Train-the-Trainer events) Support SHIPs with casework issues, including Complaints Tracking Module (CTM) POC Convene regularly scheduled meetings with SHIP Directors 17

The SHIP National Technical Assistance Center 18

SHIP Evaluation - As-Is Themes: #Theme The SHIP network has a solid foundation from which to move forward. Currently, the long-term mission, vision, operating principles and objectives for the SHIP have not been clearly articulated. ACL depends on CMS and other federal agencies for information and infrastructure critical to the SHIP network. SHIPs view ACL as the bridge/coordinator with these key stakeholders. SHIP grantee operating models fall on a spectrum of centralized to decentralized approaches for reaching beneficiaries. There is some evidence that for specific initiatives or outcomes, selecting a centralized or decentralized strategy may be more beneficial. SHIPs require ACL operational assistance in four key areas. a)Provide Technical Assistance b)Clarify Integration Points (Roles & Responsibilities) c)Stabilize Funding d)Provide Training & Certification Support There are opportunities to enhance performance infrastructure by updating existing process measures, developing outcome measures, adjusting data collection and reporting, and using measures to drive improvement

SHIP Mission and Vision: The mission is the SHIP’s statement of purpose and the vision shows where we want the program to be in the next 3 years. Mission Our mission is to empower, educate, and assist Medicare-eligible individuals, their families, and caregivers through objective outreach, counseling, and training, to make informed health insurance decisions that optimize access to care and benefits. Vision We are the known and trusted community resource for Medicare information. 20

SHIP Moving Forward Maintain focus on Medicare beneficiaries Continue, expand, and tweak “education” efforts to meet growing and differing needs of the Boomer population Increase knowledge and expertise on Medicaid as it relates to those with Medicare Increase knowledge on Long-Term Care Insurance Enhance program and volunteer management structure and processes 21

The Senior Medicare Patrol Program

SMP Program Snapshot The SMP program: – Is an education and prevention program aimed at educating Medicare beneficiaries on preventing, identifying, and reporting health care fraud – Provides grants to 53 grantees (all states, Puerto Rico, Guam, and DC) – Oversees a network of more than 5,000 volunteers – Provides a direct link from Medicare Beneficiaries to Fraud Investigators 23

The SMP mission is to empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, errors, and abuse through outreach, counseling, and education. Prevent Detect Report The SMP Mission 24

SMP Results From , SMPs have ⁻Education: Almost 5 million beneficiaries have been educated during nearly 140,000 group education sessions led by SMPs. ⁻Counseling: More than 1.6 million one-on-one counseling sessions were held with or on behalf of a beneficiary. ⁻Media Outreach: Over 2.3 million media airings have been conducted on SMP and Medicare fraud awareness. ⁻Medicare Savings: Total expected savings to Medicare and Medicaid attributable to the projects were $122 million. 25

SMP Results (cont’d) Per the most recent OIG Report 1, in 2014: – 5,249 volunteers contributed nearly 157,000 hours of work – SMPs had nearly 750,000 direct interactions with beneficiaries – More than 100,000 media airings occurred 26 1:

SMP Resource Center 27

The Medicare Improvement for Patients and Providers Act (MIPPA) Funding

MIPPA Snapshot Provides funding ($25.5 million per year) to: – SHIP Grantees – Aging and Disability Resource Centers – Area Agencies on Aging – Tribes Funding used to help low income beneficiaries get access to their benefits Separate funding ($12 million per year) provided to the National Center for Benefits Outreach and Enrollment, currently at the National Council on Aging (NCOA) 29

The National Center for Benefits Access – the MIPPA Resource Center 30

OHIC in HHS Regions 3 & 4

SMP and SHIP Locations in Regions 3 & 4 SHIP – 12 State Units on Aging – 2 State Insurance Departments SMP – 6 State Units on Aging – 1 State Insurance Department – 5 Private Non-Profit – 1 AAA – 1 City Agency 32 6 programs are co-located in the same agency

Performance in Regions 3 & 4 SHIP (CY 2015) – 1,033,391 Client Contacts – 32,187 Public and Media Events 33 SMP (CY 2014) – 1,775 Volunteers – 43,219 Hours – 250,693 Beneficiary Interactions SHIP (FY 16) – $14,343,289 Funding in Regions 3 & 4 SMP (FY 16) – $4,078,062 MIPPA (FY 15) – $7,497,742

ACL Contact List 34