STATE HEALTH INSURANCE COUNSELING

STATE HEALTH INSURANCE COUNSELING AND ASSISTANCE PROGRAM The State Health Insurance Counseling and Assistance Program (SHIP) is designed to help Medicare beneficiaries by providing information and assistance on Medicare health insurance, the Medicare Prescription Drug Program, updates to the Medicaid program, updates to Medicare Supplement Insurance, Long-term Care financing options, Medicare Advantage Plans, SenioRxMS and Access to Benefits Coalition. A. The purpose of SHIP is to: 1. Provide: a. beneficiaries with information and counseling regarding their Medicare benefits, Prescription Drug coverage and potential benefits of Medicare Advantage Plans; 1) Access: (a) the Internet utilizing various web sites as reference tools when counseling and assisting Medicare beneficiaries; (b) web-based training tools developed for SHIP such as: training, reporting, and MDHS Calendar; b. information and counseling regarding long-term care financing options; and 1) one-on-one counseling to beneficiaries concerning gaps, overlaps and duplication in health insurance coverage. 2. Assist: a. beneficiaries in understanding their Medicare benefits; b. beneficiaries in organizing and understanding their medical bills; 1) beneficiaries in understanding Medicare Supplemental Insurance policies and how these plans coordinate benefits with Medicare; c. beneficiaries in finding patient assistance programs with free or low cost drug programs or other eligibility with other programs through State web based application BenifitsCheckup; and d. beneficiaries with their enrollment in Medicare Prescription Drug Plans, Medicare Advantage Plans and the Low Income Subsidy program (Extra Help). 3. Increase: a. beneficiaries’ awareness of insurance companies licensed to sell Medicare Supplemental Insurance (Medigap) consisting of the standard plans; b. beneficiaries’ knowledge and awareness of Medicare Advantage Plans and the effect enrolling in such plans would have upon their health coverage; and c. beneficiaries’ knowledge of Medicaid program eligibility requirements; 4. Make appropriate referrals by linking and connecting beneficiaries with needed services; 5. Participate in the Centers for Medicare and Medicaid Services (CMS) training and conference workshops including teleconferences hosted by CMS in partnership with the Administration on Aging; 6. Collaborate with MS Access to Benefits Coalition (ABC) to provide coordinated assistance to Medicare beneficiaries; 7. Collect information of Medicare inquires from client contacts and submit information on the Client Contact forms in the National Performance Report (NPR) via https://shipnpr.shiptalk.org. 8. Collect information from SHIP Outreach events and submit information on the Public and Media Activity forms in the National Performance Report (NPR) via https://shipnpr.shiptalk.org. 9. Collect data of SHIP counselor and volunteers’ time for resource report and submit to State SHIP Director. a. Must keep track of number of counselors and volunteers within Region. b. Must keep track of hours spent by SHIP counselors and volunteers within Region. B. Eligibility Anyone inquiring or on behalf of persons disabled or a Medicare beneficiary is eligible for the SHIP Service. C. Unit of Service One unit of service equals one contact with a Medicare beneficiary or contact with a representative on behalf of a Medicare beneficiary. A creditable unit of service is a one-on-one contact reported in NPR via https://shipnpr.shiptalk.org or a contact at an outreach, training, or enrollment event. D. Minimum Program Requirements Each service provider offering the SHIP Service funded by CMS or other funds through an Area Plan must adhere to the following program requirements established by CMS and the Division of Aging and Adult Services. 1. Service Activities a. The SHIP program shall: 1) receive all incoming inquires from the general public regarding Medicare; 2) assess and evaluate inquiries received from a Medicare beneficiary or on behalf of a beneficiary; provide accurate information about community services and resources; maintain and be knowledgeable of current reference and resource files for beneficiaries; 3) assist beneficiaries to obtain needed services; 4) make appropriate referrals; 5) complete appropriate sections of the Client Contact Form; 6) follow up on all referrals with the beneficiary, person on behalf of the beneficiary or the resource agency to determine if the needed services were received; 7) maintain confidentiality. The beneficiary has the right to assured confidentiality regarding his/her record especially when providing assistance with enrollment in a Medicare Prescription Drug program, or the Low Income Subsidy program, a Client Agreement Form should be completed and signed by the SHIP Coordinator or SHIP Counselor and beneficiary; 8) if needed, obtain a signed Release of Information from the beneficiary that may be needed when making valid referrals with current personal information to resource agencies if appropriate; 9) access www.medicare.gov or www.cms.gov websites: as a resource for latest information on Medicare; 10) Establish, maintain and/or coordinate operation of Rural Access counseling sites. 11) Coordinate with or establish and maintain, recruit and train volunteers/part-time persons to use prepared tools at rural counseling sites; 12) coordinate with organization established as rural counseling sites with internet capability, examples: libraries, faith-based organization, other non-profit organizations and WIN Job Centers; 13) coordinate hours of operation for Rural Access Counseling, i.e. 2 – 3 days per week, 4 hours per day, monthly for rural access; 14) use State web-based calendar to post outreach activities identifying the AAA is utilizing the site; 15) send report of scheduled events by the 25th of each prior month to the State SHIP Office. b. The SHIP Coordinator shall: 1) complete the National Medicare Training Program Modules and pass the SHIP Certification Exam annually; 2) have email and internet capability to receive the latest information essential for counseling services; 3) involve the media and other mechanisms to inform the general public of the availability of SHIP services; 4) recruit and train volunteers to be utilized in the delivery of SHIP services; (a) ensure volunteers know their job description and (b) ensure volunteers sign the Volunteer Confidentiality Agreement 5) maintain a comprehensive resource file, directory, listing or classification system which identifies available resources, locations, fees charged, services provided, client eligibility requirements and populations serviced, etc.; 6) participate in Federal and State conferences, CMS/AoA workshops, meetings, MDHS/DAAS mandatory quarterly training sessions, serve on committees, and other activities to develop a comprehensive coordinated networking system and relationship with resource and service agencies in the community, increasing the availability and accessibility of services and resources for senior citizens in the AAA’s service delivery area; 7) attend the annual National Medicare Training Program in Atlanta, Georgia ensuring each SHIP Coordinator has latest training CMS training and modules; 8) report to the AAA information obtained on the needs of beneficiaries, the adequacy of community resources in meeting the needs of beneficiaries, and the effectiveness of public and private effort in meeting the priority needs of individuals in the community and the frequency of requests for the services; 9) submit client contacts and public and media activity into the NPR via https://shipnpr.shiptalk.org by the deadline designated by the State SHIP Office. Data will be retrieved by the State SHIP Office every month; and 10) maintain files that consist of the following items at a minimum to support attendance at training sessions: a training agenda, sign-in sheets, and materials from the lecture. 2. Access to Service 1) The beneficiary may enter the SHIP service system at any point from any source, (telephone, written referral, walk-in, media advertisement, family friend, relative, neighbor, church, senior center, adult day care center, hospital, civil or social organization, federal, state or local or government agencies, etc.) 3. Service Delivery Characteristics a. Each client record shall contain the following information where appropriate: 1) Client Contact Form with appropriate entries, and 2) Client Agreement or authorization release, if sensitive personal information is gathered. b. SHIP services must be available during normal working hours, Monday through Friday. c. The SHIP provider must have satisfactory arrangements to ensure that files are kept in a locked file cabinet and inaccessible to the general public. d. SHIP must have satisfactory procedures established to provide or obtain services for the non-English speaking, physically handicapped, developmentally or mentally disabled elderly person 60 years of age and older, where appropriate. 4. Staffing a. There must a qualified State SHIP Director responsible for the day-to-day operation of the program. b. There must be an adequate number of Area Agency SHIP Coordinators and certified SHIP Volunteer Counselors to meet the beneficiaries in each county for the purpose of the program. c. SHIP staff must be able to communicate with individuals who have speech, visual or hearing impairment. d. Staff responsible for SHIP must be knowledgeable of the available services and resources in the community. e. Volunteers may be utilized as Counselors but must meet the requirements outlined in the Division of Aging and Adult Services’ Memorandum of Understanding Regarding Volunteer Counseling Responsibilities and Obligations, specifically: 1) undertake initial self-paced training with the Medicare Modules and shadowing of certified SHIP Counselors and pass the SHIP Certification for counseling; 2) continue mandatory quarterly training as required under this program; become a registered user in the SHIPtalk website via https://shipnpr.shiptalk.org; 3) complete client contact sheets and submit them into the NPR via https://shipnpr.shiptalk.org or submit client contact sheets each month to the local SHIP Coordinator; 4) restrict use of confidential and personal data to performance of duties described in the program guidelines; 5) refrain from promoting private or personal interest in conjunction with the performance of duties covered in SHIP guidelines; and 6) volunteers associated with or related to any person or organization affiliated with the selling of insurance is prohibited – no exceptions. f. In-service training is required for SHIP staff and is the responsibility of the Area Agency on Aging or its designee. g. Staff (paid or volunteer) must receive specialized training that consists of: 1) understanding and implementing the Agency’s operational policies and procedures; 2) completing Client Contact Form, Client Agreement and submission of Client Contact and Public and Media Activity Forms into the NPR via https://shipnpr.shiptalk.org; 3) using customer service counseling skills to improve: telephone techniques and procedures; the interviewing process; and active listening skills; and 4) understanding the aging process. h. Plan and coordinate with volunteer or paid staff at Rural Access counseling sites.