Medicare Best Practices Senior Waste Patrol Projects

1
Medicare Best PracticesSenior Waste Patrol
Projects

• Presented By
• Debbie Armstrong, PT, JD
• Director of Elder Rights
• New Mexico State Agency on Aging
• AIRS Conference June 2003

2
Introduction

• Senior Waste Patrol Projects
• SHIP Programs
• New Mexico State Agency on Aging
• Health Insurance and Benefits Assistance Corps
  (HIBAC)
• Seniors Saving Medicare (SSM)
• History of Integration HIBAC and SSM
• Future Directions Expanded IA
• Elevated to Cabinet-Level Department

3
Senior Waste Patrol Projects

• Dept of Justice/CMS initiative to reduce fraud,
  abuse, error and waste in Medicare/Medicaid
• Creates partnerships with state and federal
  agencies to identify, investigate, prosecute
  cases
• Grant funded through AOA
• Use of retired professionals as trained
  volunteers to educate Medicare beneficiaries to
  identify potential Medicare/Medicaid billing
  errors, fraud and abuse
• Empower beneficiaries as healthcare consumers

4
SHIP Programs

• CMS funded by formula based on state population
• Health insurance information and counseling
• Medicare, MedicareChoice
• Medigap
• Long-Term Care Insurance
• Social Security
• Medicaid QMB/SLMB
• Prescription Drugs

5
Health Insurance and Benefits Assistance Corps
(HIBAC)

• Statewide 150 trained volunteer counselors
• Information and counseling on standard SHIP
  topics plus
• Public benefits Medicaid, food stamps, utility
  assist
• Veterans benefits
• Housing
• LTC and other community-based programs
• Extensive outreach and education

6
Seniors Saving Medicare (SSM)

• Finishing 4th year highest funded program in
  country
• Statewide 150 trained volunteer counselors
  provide outreach and education
• To date, approx. 200,000 recovered to Medicare,
  Medicaid or Beneficiaries More cases pending
• We also pursue Medicare Rights and MC
  under-utilization per legal services contractor
• Ultimately, to detect fraud, one must understand
  programs and benefits, as well as claims

7
History of Program Integration

• HIBAC well established program for many years
• SSM developed as separate program
• SSM was often contacted for general Medicare info
• Constituents rarely presented with single problem
  or question SSM had to refer inquiries to HIBAC
• HIBAC and SSM duplicated training and outreach
  efforts
• HIBAC and SSM competed for same volunteers
• Finally, cross-trained volunteers staff and
  combined efforts SSM now identified as special
  project of HIBAC

8
Future Directions Expanded IA

• Care Coordination In development
• Statewide centralized database for Aging Network
  IA
• Atlanta Regional Commissions ESP software
• Build upon HIBAC/SSM programs

9
Aging and Long Term Care Department

• NM State Agency on Aging elevated to
  cabinet-level department
• Elder Rights Division planned expansion
• Incorporate LTCLink intake and screening for
  Medicaid LTC programs
• Case management