SHIP ORIENTATION
July 28, 2015 1Agenda
2 Introductions ACL and OHIC Overview SHIP History and Overview Program Objectives
SHIP Steering Committee
SHIP Technical Assistance Center Reporting and Performance Measures Managing Your Grant
Administration for Community Living & the Office of Healthcare Information and Counseling
ACL Mission
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Maximize the independence, well-being, and
health of older adults, people with disabilities
across the lifespan, and their families and
caregivers.
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About ACL
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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.
Office of Healthcare Information and Counseling
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The Office of Healthcare Information and Counseling manages programs and activities designed to empower Medicare beneficiaries, their families, and caregivers to make informed healthcare decisions.
• State Health Insurance Assistance Programs (SHIP)
• Senior Medicare Patrol (SMP)
• Medicare Improvements for Patients and Providers (MIPPA)
OHIC Structure
Project Officers:
Current State Assignments
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Matthew Brown: IA, ND, NE, OH, OR, SD, TN, WA JulieAnn Chavez: AL, DE, NC, PA, SC, WV
Anna Cwirko-Godycki: AK, AZ, CA, GU, HI, ID, NV Katie Glendening: GA, KY, MD, MS, PR, VI
Barry Klitsberg: CT, MA, ME, NH, NJ, NY, RI, VT Derek Lee: AR, LA, MT, NM, OK, TX, UT, WY Phillip McKoy: FL, IL, KS, MI, MN
Doris Summey: DC, IN, MO, VA
History & Purpose: Since its inception in 1990, several key events have impacted the program.
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Year Event Description
1990 SHIP grant enacted through Section 4360 of the Omnibus Budget Reconciliation Act of 1990 (42 U.S.C. 1395b-4) 1996 Evaluation published and program funding continued
2003 Medicare Prescription Drug Improvement and Modernization Act passed by Congress 2006 Medicare Part D coverage offered
2008 $15 million of funding provided from the Medicare, Medicaid, and SCHIP Extension Act of 2007
2009 $7.5 million of funding provided by the Medicare Improvements for Patients and Providers Act (MIPPA 1) Section 119 2010 Additional MIPPA funding provided by the Patient Protection and Affordable Care Act (P.L. 111-148) Section 3306 and the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152) 2011 First members of baby boomer population turn 65 and become Medicare eligible
2013 Additional MIPPA funding provided by Taxpayer Relief Act Section 610. Grant is administered by CMS & ACL
2014
• New SHIP grant funding methodology rolled out by CMS • Program moved from CMS to ACL
• Cooperative agreement awarded for new resource center to Northeast Iowa Area Agency on Aging and partners • ACL offers grant year (GY) 2014 supplemental and innovation funding and adjusts the formula for GY2015 • Protecting Access to Medicare Act (PAM) or the Medicare "doc fix“ / Sustainable Growth Rate (SGR), provides
funding for MIPPA in both FY14 and FY15
2015 •• New SHIP Technical Assistance (TA) Center goes live Additional MIPPA funding provided by the Medicare Access and CHIP Reauthorization Act (MACRA) or “doc fix”
1: Several key dates obtained from The George Washington University and National Health Policy Forum article “The Basics – The State Health Insurance Assistance Program (SHIP)”
Moving from CMS to ACL
Aligning the Program
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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)
ACL Initial Objectives
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Working for a smooth transition
Standing up an experienced team
Organizing ACL’s structure to allow for economies of scale Ensuring SHIPs keep established CMS connections and
opening additional connections
Working with the SHIP Steering Committee
Keeping or Improving the Status Quo
Reinstating the national SHIP grantee meeting
Put in place the contract and grant for the data system and
the TA Center
Beginning a SHIP Programmatic Evaluation
SHIP Statutory Purpose –
Establishing SHIP
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The Secretary of Health and Human Services shall make grants to States for the purpose of providing information, counseling, and assistance relating to…:
i. Information that may assist individuals in obtaining benefits
and filing claims (for Medicare and Medicaid);
ii. Policy comparison information for Medicare supplemental
policies…;
iii. Information regarding long-term care insurance; and
iv. Information regarding other types of health insurance benefits
that the Secretary determines to be appropriate;
And to establish a system of referral to appropriate Federal or State departments or agencies for assistance with problems related to health insurance coverage
P.L. 101-508, November 5, 1990 (Sec. 4360)
The Current SHIP Mission
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Strengthen the capability of grantees to support
a community-based, grassroots network of local
SHIP offices that provide personalized
counseling, education, and outreach to assist
Medicare beneficiaries with their Medicare and
The Current SHIP Program Objectives
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The SHIPs will:
1. Provide personalized counseling assistance with
benefits/health plan options selection available to all beneficiaries;
2. Engage in community outreach to beneficiaries in
public forums;
3. Provide beneficiaries access to enrollment assistance
from a trained, fully equipped, and proficient counselor workforce; and
4. Participate in ACL education and communication
activities.
Program Snapshot
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There are 54 grantees nationally (one in every
state, DC, Puerto Rico, Guam, and the US Virgin Islands)
Grantees oversee a network of more than 3,300
local program offices and over 15,000 counselors (57% volunteers)
2/3 are located in State Units on Aging; 1/3 are
SHIP Moving Forward
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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
Ginny Paulson
SHIP Technical Assistance Center
The Basics
Our Formal Name:
The State Health Insurance Assistance Program National Technical Assistance Center
Our Nickname: The SHIP TA Center
FUNDER: U.S. Administration for Community Living (ACL) GRANTEE: Northeast Iowa Area Agency on Aging (NEI3A) PARTNERS: Medicare Rights Center; Technical Frontiers
Incorporated (TFI); Health Benefits ABCs (HBABCs); consultants Mike Klug and Steve McCurley
Our Mission
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The SHIP TA Center will serve as a central source of
information for and about the SHIP program. The
center will provide training, technical assistance, and
promotional activities in support of the national SHIP
program and its 54 individual SHIP projects.
SHIP TA Center services will be available for optional
– not mandatory – SHIP use; however, the center aims
to serve every SHIP by providing timely, accessible, relevant, and accurate information.
Helping SHIPs with these functions:
Educating and Assisting Beneficiaries Training Staff, Volunteers, and Counselors Managing Volunteer Programs 24
What we don’t do
25Manage SHIP NPR
or
Provide SHIP NPR
Technical Assistance
Services available to SHIPs
Webinar training for SHIPs Monthly Medicare Minutes
Volunteer Program Management manual
Answers to technical Medicare and related health insurance questions via ([email protected])
Online Counselor Training Online Counselor Certification
Promote SHIPs to general public at www.shiptacenter.org Password-protected online information for SHIPs only at
www.shiptacenter.org
www.SHIPTAcenter.org
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SHIP Login
Director/Administrator Home
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SHIP Staff and Counselors
Counselor Training
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Contact Us
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National toll-free: 877-839-2675 General inbox: [email protected] Ginny Paulson (Director):
[email protected] 319-358-9402
Jeanne Mentel (Program Coordinator): [email protected]
Why does it matter?
Reporting
Data Matters
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Numbers are very important to our ability to “tell”
the story of our program:
Data is what we use to communicate to Congress (our
funders)
Can be used to show the program’s value If it isn’t reported, it didn’t happen
If it isn’t right, it doesn’t count (and will likely hurt us
Reporting the Data: NPR
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The National Performance Report (NPR) is the SHIP
reporting system
All data must be submitted to NPR to be counted Grantees submit data either directly to the system using
the on-line portal or;
They provide batch uploads to NPR from state
operated proprietary systems.
NPR is currently operated and managed by
Technical Frontiers Inc. (TFI) under the direction of ACL
What is reported in NPR?
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Client Contacts (CC): individual one-on-one contacts with
Medicare beneficiaries, their families, and/or their caregivers.
Public and Media Events (PAM): outreach and media
events conducted to educate the public on SHIP and/or Medicare content information.
Includes all media outreach, group education events, health
fairs, etc.
Resource Report (RR): provides an overview of who is
doing the work for the SHIP and how many hours they have provided to the program (i.e. staff, volunteers, in-kind). Done once annually.
https://shipnpr.acl.gov
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NPR Resources
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TFI can help with issue resolution and problems with
the site:
NPR Manuals:
Outline how to use the system Found at the NPR website
What do we count?
Performance Measures
39What do we count?
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CMS created 8 Performance Measures for SHIP These measures are used to create the annual
performance report for SHIPs
The Performance Measures and the Overall
Performance Score that is calculated from them are used in the annual funding formula.
The Performance Measures
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1. Total Client Contacts
2. Persons reached or enrolled at specific public events
(i.e. outreach)
3. Substantial, personal, direct client contacts
4. Contacts with Medicare beneficiaries under age 65
5. Low-income Medicare beneficiary contacts
6. Contacts with one or more qualifying enrollment topic
discussed
7. Contacts with one or more qualifying Part D
enrollment topic discussed
8. Total number of counselor hours
Note: All PMs are calculated by using number reached per 1,000 Medicare beneficiaries in the state in that category.
What counts?
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How is it calculated?
Performance Measures
Calculating the OPS
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Funding Formula
SHIP Formula Basic Overview
Base * First $10 M in funding
(per regulation)
Includes both a fixed component and a variable component taking into account Total Medicare benies (75%), Rural benies (15%), and % of benies in a
State (10%)
Discretionary Formula
Accounts for Total Medicare benies (70%), Low Income benies (10%), Frontier / Rural benies (5%), and Performance (15%)
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Base Formula
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Base Formula – first $10 million Fixed ($3,950,000):
$75,000 to each state, DC, & PR
$25,000 to GU and USVI
Variable ($6,050,000):
75% - State beneficiaries to US beneficiaries
15% - Beneficiaries residing in rural areas of the State to
the State beneficiary population compared to the national average
10% - Beneficiaries in the State to the total State
population compared to the national average
Discretionary Formula
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4 Factors:
1. Total Medicare Beneficiaries (70%): State’s
proportion of national beneficiary total
2. Low Income Medicare Beneficiaries (10%): State’s
proportion of beneficiaries under 150% FPL compared to the national average
3. Frontier/Rural Density (5%): State’s proportion of
total Medicare beneficiaries living in frontier and low population density rural areas compared to the national average
4. Overall Performance Score (15%): State’s OPS
Funding Formula Hold Harmless/Cap
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In 2015 ACL implemented a hold harmless/cap for
all SHIP base grants.
No state will gain or lose more than 5% from one
year to the next.
This restriction will remain in place for the time
being as long as funding remains stable.
Grant Management Overview
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Understanding the Notice of Award Key Personnel
Reporting
Prior Approval Requests GrantSolutions.gov
Understanding the NOA
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Provides detailed information on the grant award
including:
Date Issued (section 1) Project Period (section 6) Budget Period (section 7)
Grantee (Section 9a) and Key Personnel (9b & 9c) ACL Project Officer (Section 9d)
Approved Budget Breakout by Budget Category
(Section 11)
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Key Personnel
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Authorizing Official/Representative (AOR):
This is the person that has the authority to commit the
agency to the award/funding and the conditions attached to it.
Typically State Unit on Aging Directors.
Designated by the grantee – this is not an ACL decision. Principle Investigator/Project Director (PI/PD):
This should be the person responsible for managing the
grant.
Note: Only these two individuals will be sent official notices on the grant award. Be sure that whomever your agency designates is going to be responsive to these
Reporting - NPR
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NPR Monthly Reporting: All client contact and public
and media event information must be submitted to ACL monthly through NPR. Due date is the end of the following month (i.e. April data is due May 31st).
NPR Resource Report: Due May 31st of every year.
Reporting – Mid-Term Report
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SHIP Mid-Term Narrative Progress Report:
Provides a description of the progress made toward
meeting the objectives outlined in the SHIP renewal application.
Covers period from April 1st to August 31st. Due September 30th.
Reporting - Financial
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Federal Financial Report (FFR Standard Form 425): Must report quarterly cash transactions via the Payment
Management System. Due 30 days after the end of each quarter.
Final FFR – due 90 days after the end of a budget or
project period:
Period April 1 to March 31
Due July 1st.
Submitted by uploading the SF 425 into GrantSolutions.
Prior Approval Requests
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Change in Key Personnel (Including Effort Levels) Pre-Award Costs
Use of Carryover Funds
Extension of Project and Budget Period Significant Rebudgeting/Specific Costs Change in Scope
Change in Recipient Organization
Prior Approval Requests
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Barry and Katie will be conducting a detailed
training on these requests on Wednesday of the conference.
GrantSolutions
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ACL uses GrantSolutions to manage all discretionary
grants (including SHIP and SMP but not MIPPA).
Grantees must submit all official grant reports and
requests through GrantSolutions.
Grantees must maintain an active GrantSolutions
account and password.
Useful tools, contacts, and resources
Other Important Things
Unique IDs
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Provide SHIPs a designated SHIP number to access
to 1-800-Medicare staff to obtain information that may be necessary to assist beneficiaries.
To obtain a Unique ID a counselor must: Complete a confidentiality statement
Have training to be3 entrusted with private information
relating to the beneficiaries they counsel, and
Unique ID Management
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SHIP Directors are responsible for the management
of the Unique IDs.
SHIP Directors must:
Request new Unique IDs using NPR
Attest twice a year (as requested by CMS) that their list
of Unique IDs is up-to-date and that staff have been properly trained on privacy rules
Complaint Tracking Module (CTM)
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CMS’ official repository for managing and resolving
Medicare Advantage and Part D complaints.
A web-based, secure, and intuitive module with
restricted access to only authorized users.
SHIPs can request access for limited view and entry
functions:
Access is only for State employees Must do an annual re-certification Annual online security awareness course Log-in at least once per year
MARx
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MARx (Medicare Advantage Prescription Drug
system) is CMS’ Enrollment System
Contains the most up-to-date enrollment information
for beneficiaries
More current than 1-800-Medicare or
Medicare.gov
Some SHIPs have been given access to this system Approval Process includes:
Online application
Use of CTM before getting MARx access is required
CTM and MARx Contacts
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These systems are managed by CMS, not ACL. CMS has designated Regional SHIP Liaisons for the
CTM and MARx systems.
Note: These are not the same contacts we have for all
other SHIP things
There are manuals and standard operating
procedures for both systems
Please contact Matthew Brown if you need additional
CMS Contacts
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Regional SHIP Liaisons:
Region 1 – Joseph Stone and Jennifer Syria Region 2 – Norma Harris and Maria Martinez Region 3 – Monique Scott
Region 4 – Teresa Zayas
Region 5 – Gregg McAllister, Dell Gist, and Brenda Delgado Region 6 – Gaye Humphrey and Sylvia Garcia
Region 7 – Lorelei Schieferdecker, Amy Flynn, and Nancy Rios Region 8 – Mike Fierberg
Region 9 – Peter Bauer Region 10 – Julie Bannester