Department of Aging Publishes State Plan on Aging

Written By: Attorney Jeffrey A. Marshall, CELA*

Every four years the Pennsylvania Department of Aging is required to develop a “State Plan on Aging” to submit to the Federal Administration on Aging. The plan is mandated by both federal and state law. It is also required in order for Pennsylvania to receive federal funds under the Older Americans Act.  The State Plan on Aging helps to structure the Department’s priorities and to set an aging agenda for the commonwealth.

During the first half of 2008 the Department used various means to gather stakeholder input, including town meetings held throughout the state.  It then published a draft State Plan on Aging for 2008-2012.  The draft State Plan lists four major goals:

Goal 1- Empower older Pennsylvanians and their families, including those from diverse communities, to make informed decisions on their health care and long-term living options.

Goal 2- Enable older Pennsylvanians, including those from diverse communities, to remain in the setting of their choice to improve their quality of life and to actively participate in the services they receive

Goal 3- Empower older Pennsylvanians, including those from diverse communities, to stay active and healthy.

Goal 4- Ensure older Pennsylvanians, including those from diverse communities, are free from abuse, neglect, exploitation and abandonment.

A copy of the draft plan is available online at

http://www.aging.state.pa.us/aging/lib/aging/080604_Draft_Plan_Final.pdf

Attorney Marshall can be contacted at webmail@paelderlaw.com or at 1-800-401-4552

Rules Proposed to Protect Medicare Advantage Plan Consumers

Written By: Attorney Jeffrey A. Marshall, CELA*

The federal government has proposed rules to protect seniors from abuses in the marketing of Medicare Advantage and Drug Plans. 

Seniors can choose to receive their Medicare coverage through original Medicare (the traditional fee-for-service program) or from a Medicare private plan (the Medicare Advantage program). With the enactment of the Medicare Modernization Act of 2003 (PL 108–173—Dec. 8, 2003), the federal government created strong incentives to encourage seniors to abandon original Medicare for one of the private plans. 

Of the 44 million Medicare beneficiaries, at least 25 million are now in some type of private plan — either a Medicare Advantage plan, which provides a wide range of health services, and which must offer prescription drug coverage, or a free-standing prescription drug plan, which covers just medicines.

Medicare Advantage Plans are provided by an alphabet soup of insurers including, Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee-for-Service Plans, Medicare Special Needs Plans and Medicare Medical Savings Account Plans (MSA).  The sometimes hard sell marketing tactics used by commission-based agents of the Plans has come under much recent criticism by consumer advocates and federal and state officials.

In June 2007, the government announced that seven of the leading companies in this market, including UnitedHealth, Humana and Coventry, had agreed to suspend marketing of certain Medicare Advantage plans.  Later Medicare allowed these companies to resume marketing after they took steps to more closely monitor their sales agents.

On May 8, 2008, the Centers for Medicare & Medicaid Services (CMS) issued a proposed new rule to deal with some of the perceived abuses in marketing Medicare Advantage health plans and Medicare prescription drug plans. In a statement, CMS said the proposed rule is intended to provide "enhanced protections" for senior citizens enrolled in these plans and to "strengthen marketing standards and extend additional protections to all beneficiaries including those receiving the low-income subsidy (LIS) and beneficiaries enrolled in special needs plans."

The proposed rule incorporates a number of requirements that CMS previously imposed through operational guidance.  It also introduces several new requirements for Medicare Advantage and prescription drug plans.  Included are prohibitions on door-to-door marketing and cold-calling that go well beyond what the insurance industry recently endorsed as necessary.

The new marketing standards would:

    ● Prohibit cold-calling and expand the current prohibition on door-to-door solicitation to cover other unsolicited circumstances.  Agents will be able to respond to telephone inquiries, but not make “cold calls” to potential Medicare beneficiaries.  Any appointment with a beneficiary to market health care-related products would have to be limited to the scope that the beneficiary agreed to in advance.  The proposed rule would also prohibit agents from offering annuities, life insurance and other “non-health care related products” while selling Medicare Advantage or Part D plans.

    ● Prohibit sales activities at educational events such as health information fairs and community meetings or in areas such as waiting rooms where patients primarily intend to receive health care-related services, as well as limit the value and type of promotional items offered to potential enrollees.  The rules would set a $15 limit on the value of gifts and promotional items offered to potential customers. In addition, insurers will no longer be able to follow the common practice of purchasing meals, whatever their value, for attendees of sales presentations. 

    ● Require that Medicare Advantage organizations that use independent agents to market Medicare Advantage and Part D plans use State-licensed agents for such marketing, and require that Medicare Advantage organizations report to States, in a manner consistent with State appointment laws, that they are using those agents.

    ● Require commission structures for sales agents that are level across all years and across all Medicare Advantage plan product types.  Under the proposal, the commission paid for the initial sale and first year of coverage could not exceed the commission paid for renewal of coverage in a subsequent year. Commission structures for prescription drug plans would also have to be level across the sponsors’ plans.  These requirements are designed to discourage “churning” of beneficiaries from plan to plan each year in a manner that earns agents and brokers the highest commissions and would ensure that beneficiaries are receiving the information and counseling necessary to select the best plan based on their needs.

The rule also proposes new protections for beneficiaries enrolled in special needs plans (SNPs).  SNPs are a type of Medicare Advantage plan that provides coordinated care to individuals:

-In certain institutions such as nursing homes,

-Who are eligible for both the Medicare and Medicaid programs and/or

-Have certain severe or disabling chronic conditions. 

Provisions in the proposed rule would:

    ● Require that 90 percent of new enrollees in SNPs be special needs individuals, to ensure that SNPs focus on the population for which these Medicare Advantage plans are designed.

    ● More clearly establish and clarify delivery of care standards for SNPs.

    ● Protect beneficiaries from being billed for cost-sharing that is not their responsibility. 

For SNPs that target beneficiaries who are eligible for both Medicare and Medicaid, the rule would establish standards designed to ensure that those beneficiaries are able to access essential services that are available through Medicaid in addition to those benefits available through the SNP.

The rule also contains provisions to streamline eligibility determinations for extra help for low income Medicare beneficiaries.  

While the proposed rule is seen as an improvement, it does not go as far as some state officials had desired.  In particular, the proposed rule specifies that “states do not have the authority to regulate the marketing” of private Medicare plans. 

The proposed rule and related materials are available on the CMS website,  http://www.cms.hhs.gov/HealthPlansGenInfo   

For information on Special Needs Plans see “Do we know if Medicare Advantage Special Needs Plans are Special?” Kaiser Family Foundation, January 2008.

http://www.kff.org/medicare/upload/7729.pdf

Attorneys Marshall & Parker Honored as Pennsylvania

“Super Lawyers”

Marshall, Parker & Associates’ Attorneys Jeff Marshall & Matt Parker have been named to the list of Pennsylvania Super Lawyers for 2008.  This is the fifth consecutive year Mr. Marshall has attained this status. 

In addition to the Super Lawyer award, Mr. Marshall was also honored on the Top 100 Lawyer List which represents the 100 Pennsylvania lawyers who received the most votes.

The Top 100 Lawyer List and Super Lawyer List were published in the June 2008 edition of Philadelphia Magazine and Law and Politics Magazine. In November 2007, Law & Politics Magazine mailed more than 34,000 ballots to attorneys across Pennsylvania requesting each lawyer to vote for the most effective attorneys they had personally observed in action. Each nominated lawyer was given a score based on the number of votes. The top point-getters were then reviewed by a panel of experts to determine the final outcome for the Super Lawyer award. The final list of Pennsylvania Super Lawyers is made up of less than five percent of all Pennsylvania lawyers. The Top 100 list is made up of less than 3/10ths of one percent of all Pennsylvania lawyers.

"It is rewarding to know that other lawyers around the state think highly of our work," commented Attorney Marshall.  "But, this is more than an individual honor.  It really validates the overall quality of the services provided by all of our firm's lawyers, paralegals and other staff.  Any award Matt and I receive reflects their support, hard work, and dedication." 

Marshall, Parker & Associates is known throughout Pennsylvania for the legal help it provides seniors in the areas of estate planning, long term care planning, and estate administration.

Shelly Jo Heikes Joins the Marshall, Parker & Associates Team

Marshall, Parker & Associates is pleased to announce the addition of Shelly Jo Heikes as a Planning Specialist in the firm’s Long Term Care Services Department.

Shelly has worked in the local banking and insurance industry for over ten years.  Just prior to joining Marshall, Parker & Associates, Shelly was an Individual Retirement Account Specialist for C&N Bank in Williamsport. “We are so pleased to have someone with Shelly’s background and ability join our staff,” commented managing attorney Jeff Marshall.

Shelly is a native of the Williamsport area and currently resides in Salladasburg where she attends Salladasburg United Methodist church. She enjoys spending time with her family and friends, camping and traveling.

In her new position at Marshall, Parker & Associates, Shelly will assist seniors and their families with long term care planning issues, including Medicaid eligibility and home care options.

Shelly can be contacted at webmail@paelderlaw.com or 1-800-401-4552.

 “Give A Caregiver A Break” Essay Contest Announced

Home Instead Senior Care and CARING Today Magazine is sponsoring an essay contest for Caregivers providing care to a family member or friend.  You can earn one of 13 prizes for free care for your family member or friend.

Every CAREGIVER has a story to tell:

Tell us yours in 500 words or less for a chance to win!

Let us know about the day-to-day experience of caregiving: How you’ve embraced the role of caregiver for a senior loved one, what impact it’s had on you and how you’ve inspired others, demonstrating how a Home Instead CAREGiver could make a difference in your life. Your entry gives you a chance to win the GRAND PRIZE worth $5,000, one of two FIRST PRIZES worth $2,500 each, or one of twelve EXTRORDINARY CAREGIVER AWARDS worth $500 each!

Entry deadline is July 16, 2008. Winning essays will be published in the November/December issue of CARING Today magazine.  To enter or find more information, visit www.caringtoday.com  or www.homeinstead.com/essay .

For more information, please contact Jo Mueller.  Jo is the Community Service Representative for Home Instead Senior Care in Lewisburg.

1-866-522-6533

Learn How to Protect Your Assets from Long Term Care Costs at our FREE Community Workshop in Williamsport

Saturday, August 2, 2008

10:00 AM until 12:00 PM

Holiday Inn Downtown

100 Pine Street in Williamsport

Reserve your seat by calling 1-800-401-4552 or visit our registration page online.