Medicare and the Health Insurance Marketplace and Medicare Coverage for Mental Health Services

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Coordinator: Welcome and thank you for standingby. For the duration of todays call all participantswill be on a listen-only mode. During the question and answer session ifyou would like to ask a question please press star 1 on your touchtone phone. Todays call is being recorded – shouldyou have any oppositions you may disconnect at this time. I would now like to hand the call over toMiss( Alicia Mcentire ). Miss( Mcentire) you may begin.( Alicia Mcentire ): Thank you. Thank you everyone for meeting today.My epithet is( Alicia Mcentire ). Im a Public Health Analyst with SAMHSAand in my capacity now I serve as a Special Assistant for Health Reform and Health Care Financingwithin SAMHSAs Center or Substance Abuse Treatment. SAMHSA would like to express our sincere thanksfor CMS for this important opportunity for collaboration. Increasing access to insurance coverage, especiallyfor populations with behavioral health needs, is a shared point of SAMHSA and CMS. Before we continue I do only want to add thefollowing disclaimer. This CMS National Training Program productis not a legal document. Official legal steering is contained in therelevant statutes, the rules and finds. So Id like to merely – before I turn it overto our talker today I are intended to just talk for a minute about element use andmental illness in the US. Behavioral health topics change millions ofadults every year. Detects from the National Survey on DrugUse and Health found in the past year that 1 in 12 adults had a substance use disorderand 1 in 5 adults had a mental health issue.Many of these adults is not have health insurancedespite their suitability for Medicaid or other assistance in the health insurance marketplace. The Affordable Care Act presents a varietyof options to help individuals with behavioral health conditions access health insuranceand many for the first time, nonetheless, recent reports have shown that many of the currentlyuninsured are still unaware of this years open enrollment period and the potential opportunitiesavailable in the marketplace. Because health insurance is vital to helpingindividuals maintain optimal health SAMHSA along with our federal partners, especiallyCMS, are focusing attempts on education and outreach to protect diverse people areaware of their assurance options.Now todays webinar built around previous workundertaken by SAMHSA, including developing toolkits, education campaigns, technical assistanceand engaging in social media tries. More information on this can be found at Now Id like to introduce( David Santana ).( David) is a Health Insurance Specialist atthe Centers for Medicare and Medicaid Services – CMS.( David) helps as subject matter expert andlead trainer for the National Training Program Division in the Office of Communications. In this persona he is responsible for effectivelydeveloping educational materials and communicating informed about CMS programs and resourcesto CMS stakeholders. In addition( David) provides technical assistanceconcerning CMS program policies to governmental entities at the federal and mood stage aswell as neighbourhood agencies and organizations.Id like to welcome( David ).( David Santana ): Thank you and welcome everyoneand thanks again for uttering us the opportunity to partnership and bring you some valuableinformation that may serve you to council those who relied upon you for assistance andto stimulate informed health care decisions. We are at slide multitude 3 and were goingto start this presentation focusing on individual mart and those individuals who areeither have Medicare or may soon be eligible to get Medicare. So were going to tell this individual whatthey need to know and, again, at the end of the day we just want them to have the informationso they can make an informed health care decision.We likewise are going to – Im going to tellyou a little bit about when they may get coverage in the marketplace and when they cant withregard to those with Medicare and also were going to touch a little bit on those who arefaced with the decision with regard to Medicare with the decision on whether or not they shouldenroll in the Medicare Prescription Drug Plan. Next move, which is entitled Medicare and theMarketplace. So were going to start with – were goingto start the presentation by brought forward by four main points.And the latter are four main themes that we canget across to souls in Medicare. The first one is that Medicare is not a partof the Healthy Childrens marketplace. So thats the first thing and there aremany numerous individuals who are asking questions in terms of their Medicare and the marketplace. This time we are expecting to have about 54 million souls in the Medicare program. By 2030 were going to have about 80 millionindividuals entered in the Medicare program by itself. So thats telling you that we will havemany mortals aging into the Medicare rapidly for the next few years. So it is vital that we have the basic informationthese men need so they can make an informed choice when the time comes. So the second message is if you have Medicareyoure reported. Generally if you have Medicare youre coveredand you dont need to do anything related to the marketplace and I say generally becausewere going to look at other situations that individuals and Medicare may have whenthey may need to look at the marketplace to make sure that they have a thorough coverage.Now Medicare does not offer Medicare supplementinsurance, likewise announced( inscrutable) – Medicare Part B strategy or Medicare Advantage means. So many of these companies are offering privatehealth insurance in the marketplace they may have commodities across marketplaces from Medicareto Medicaid to the private health insurance and even through employer propose. However, those schemes there are offered throughthe Medicare program are not one of the purposes of the marketplace. And instead we send those individuals togo to website to find, compare and enroll in Medicare Advantage means, partD plan and also “ve been looking for” medical program and contact those policies if they would liketo enroll in a Medicare supplement plan. The last-place time we wanted to call to your attentionis that even if an individual is already enrolled in Medicare whether they are – they have PartA, which is hospital insurance or Part B it is against the law for someone who knows thatthese people enrolled in Medicare to sell them a marketplace plan.Next slide, move amount five. So were going to start by talking aboutthose individuals who are already enrolled in Medicare. As I mentioned parties with Medicare usuallyhave what we call minimum indispensable coverage. So as we probably are aware by now those individualsin 2014 that do not have minimum critical coverage, such as Medicare Part A, dontqualify for an exemption in the marketplace they may have to pay a cost when they filetheir taxes the following year because they didnt have minimum all-important coverage orthey dont qualify for an exemption. So Medicare Part A, which is the hospitalinsurance part of Medicare and is a part of coverage when an individual becomes an inpatientin a hospice is considered in the law minimum crucial coverage.Those souls too enrolled in a MedicareAdvantage plan in case anyone queries those designs are also minimum crucial coverage. Now there are for the majority of individualsin Medicare, in fact, 99% of them do qualify for premium free Medicare Part A. That isbecause they direct or theres past study and bribe into a social security system and havethe required amount of quarterss – years of work accumulated to get – or to be entitledto Medicare Part A without having to pay a fee. Now Medicare Part B on the other hand is notan entitlement program. You were not able to get Part B becauseyou dont liquidate into the system to get Part B and therefore it is voluntary for individualsto sign up. Medicare Part B is for doctor services andoutpatient fixes, laboratory tests,( inscrutable) medical gear and so on. Now there are – or there is a 1% of individualsin Medicare that do not qualify for premium free Medicare Part A. Those characters, about1% of them, may simply enroll in Medicare Part B since they are either cant render the premiumfor Medicare Part A or they simply do not want to get the hospital part.If they only have Part B – Part B by itselfis not considered minimum essential coverage and that is why I mentioned in the previousslide that if an individual is in that situation they may want to look to the marketplace tosee if they can dis-enroll from Medicare Part B and then opt a schedule in the marketplacebecause, again, Part B by itself is not considered a minimum all-important coverage. So with that there are many individuals whoare – who retired before senility 65 and those individuals may use the marketplace to buya plan that meets their needs.So will vary depending on their income and family sizethey may be able to get lower cost in the monthly fees and out of pocket expenditures. When they apply for coverage in the marketplacethey too catch out, of course, if they may be eligible for Medicaid. The Medicare annual open enrollment is notthe same as the marketplace open enrollment span that is happening right now. The Medicare open enrollment period is fromOctober 15 through December 7 and this is the opportunity for individuals in Medicare, for example, who want to enroll in a Medicare Advantage plan or to want to enroll in a MedicarePart B plan or “if youre having” their design this is their opportunity to go in and pick adifferent design. Its kind of similar to the plans in yourmarketplace. So, again, there is a difference between Medicareopen enrollment period and the marketplace open enrollment age. Next move, slip numeral 6. So those individuals who are not yet enrolledin Medicare, say they are enrolled in the marketplace plan and they are mainly aginginto Medicare. So Medicare is for individuals when they turn6 5 because of age and over, everyone else who has sure-fire disabilities apply and receivesocial security disability benefits and those who have or develop stage five of( unintelligible ). So this slide is just chiefly looking at thoseindividuals who have a marketplace plan and are aging into Medicare. So they may exclusively have two selections. They have the choice, for example, to takethe Medicare Part A and B and offset their mart program as soon as the Medicare takeseffect. Now the second option is that they could, of course, keep their Medicare plan and they likewise keep their marketplace plan.Keeping in brain that those individuals whodecide to keep their marketplace plan when they age and they get enrolled into Medicare, if they were receiving any financial assistance that financial assistance would be terminatedupon eligibility for Medicare part A. Those individuals who, for example, decideor who do not get enrolled in Medicare automatically they need to keep in mind that there is awindow by which they have to obey if they want to access Medicare, solely theirseven month window around their 65 th birthday to sign up for Medicare. Three months before, the month and then threemonths after. Those individuals who is not get automaticallyenrolled in Medicare and decide not to enroll in Medicare during that time it is importantto remind them that they may face a late enrollment sanction exclusively for Medicare Part B ifthats the side theyre not entitled if they decide to enroll last-minute. Next slither, slide digit seven, choose a marketplace plan instead of Medicare.Lets focus now on three different groupsof individuals in terms of how they get enrolled in Medicare. The first one I mentioned it is that 1% ofindividuals out there that is not qualify for premium free character A because themselvesor their spouse should not have the required amount of approval in information systems. So even someones out there in this situationthey could keep their marketplace plan after they age into Medicare, they dont haveto enroll in Medicare and they are also qualify for premium taxation ascribe if thats the waythey want to go. If those individuals are currently enrolledin Medicare Part A and B they could also dis-enroll from Medicare Part A and B and instead choosethe marketplace plan and they could qualify for premium excise credit. So this is the only group of individuals whoreally have the option to pick between the marketplace plan and Medicare and be ableto keep the premium tax credit. Now the second group, as I mentioned, arethose who have end stage renal canker. So they have a medical condition that wouldqualify them to get Medicare and individuals in this group could be at any age.So it could be a child, it could be a youngadult, it could be anyone who is – who developed resolve theatre renal infection. They could get Medicare through either theirown piece record or for a( illegible) through( AS Powers) or in case of a childthey can get it through a undertaking autobiography of their parents. So when they become eligible for Medicarebecause of end stage renal sicknes “theyre not” in an obligation to enroll in Medicare. If they have a marketplace plan, of course, they dont have to enroll in Medicare and they can save that mean vanishing. The third group of individuals are those whoare not collecting social security retirement benefits before they turn 65. As we all know retirement age have gone upso many parties are full retirement age is actually over 65. So numerous people are deferring – applyingfor social security retirement benefits. If thats their example when they turn 65 theyhave an option to apply and enroll in Medicare even though theyre not applying for socialsecurity retirement benefits more. Now those individuals have the option notto apply for Medicare altogether at persons under the age of 65 and keep their marketplace plan departing. Obstructing in sentiment that in either suit when theindividual becomes eligible to receive Medicare Part A or free Medicare Part A their premiumtax credit will be suspended. So although women dont “re going to have to” enroll inMedicare they can keep their marketplace plan get. They may lose the assistance that they getor the premium tax credit in the marketplace. We always caution individuals who decide todelay enrollment in Medicare of the fact that they may face a late enrollment disadvantage ifthey decide to enroll later on solely for Medicare Part B. Normally individuals or generally individualsare qualified for free Medicare Part A. They can enroll anytime in the future and therewould be no sanction for Medicare Part A, but the Part B is the one that individuals arenot generally entitled to receive it and they may face the penalty if they tried to do it later.They can only do so from January 1 to March3 1 of each year and the coverage usually will not begin until July 1 of that time. So thats another thing that we wanted tohighlight and bring to your attention in turn so that the options whether or not to getMedicare and to keep their marketplace croaking. Now tells look at the slip digit 8, whichis the one that address parties with physical disabilities on Medicare. So I as I mentioned before individuals whoapply for Social Security benefits and are noticed eligible for those benefits usuallythey will get those benefits after five months of waiting period and there after they receivethe tax benefit they have to wait 24 months back they become eligible for Medicare. Now this happens automatically. So if an individual is over receiving socialsecurity disability benefits, entitlement to Medicare will happen at the 24 month andthey will be automatically signed off for Medicare at that time. Those 24 months that theyre waiting toenroll for Medicare entitlement, of course, they can access the marketplace and even applyfor premium duty ascribe, payment share reduction, but keeping in mind that once they stumbled the2 4 month they will receive their Medicare card in the mail from social security whichhave a Medicare Part A and Part B and at that time if they choose to keep that marketplaceplan although they become enrolled in Medicare if they were receiving any tax recognition or costshare in reduction they will lose that at that time.The 24 month – I just wanted mention realquick that the 24 month doesnt apply to everybody. For pattern, there is an exemption or an exceptionfor those who have Amyotrophic Lateral Sclerosis or the so called Lou Gehrigs disease. If an individual qualified for social securitybecause of the Lou Gehrig disease they dont sitting up here the 24 months. So what it means is that they will get Medicareright away. Slide number 9 residences those individualswho are working for a small employers and those are smaller employers maybe purchasinghealth insurance through the small business health option program. We just wanted to call to your attention thatthis will not be – having a coverage through a small employer through the marketplace thatdoesnt truly convert the traditional principles with Medicare.Meaning that if you have an employer grouphealth plan through yourself or a spouse and that is based on current employ that typicalMedicare secondary payer governs apply and those individuals qualify for a special enrollmentperiod. That meant that if you are currently workingyou dont “re going to have to” enroll in Medicare Part B when you turn 65. You can enroll in Medicare Part B any timethe individual or spouse is working or if they lose that schedule or they retire we givethem 8 months special enrollment date to sign up for Medicare Part B without havingto pay the premium penalty. So anyone who is getting health insurancethrough a small employer, again, whether it is through the market place, small businessoption or outside of the marketplace – this special enrollment period regulates apply andthe traditional Medicare secondary payer regulations apply to those boss. Slide number 10, Medicare and prescriptiondrug coverage. As I mentioned and likewise those individualsseeking to enroll in the standalone dental contrive through the marketplace. So with regards to Medicare prescription drugcoverage while the treat coverage in the essential – is an essential health benefit in the marketplacea prescription drug coverage in the marketplace or the small business mean isnt requiredto be at least as good as Medicare Part B coverage or “whats called” credible coverage.Meaning that if “youve had” believable coverageor believable prescription drug coverage you dont genuinely need to enroll in the PartB plan. You can always do so later on and you willnot be penalise. Nonetheless all private insurers offering prescriptiondrug coverage including marketplace and the small business proposes are required to determineeither prescription drug coverage is believable every year and cause the individuals know. So in other words there have been regulates goingall the way back to 2003 when the prescription drug benefits was put into law that requiresanyone who offers prescription drug benefits to characters in Medicare to let them knowwhether that strategy is credible or compared against Medicare Part D project. The marketplace schemes dont have to be credible, nonetheless, they do need to tell an individual whether the coverage theyre provide iscompared to the Medicare Part D plan. So if you dont recruit – if you donthave a credible coverage and you dont enroll in Medicare Part D scheme during initial enrollmentperiod you may have to pay a penalty.The sanction is usually 1% per month that youwent without the prescription drug coverage and you could have enrolled. Now in matters relating to a standalone dental plan- in most cases you may not be able to purchase standalone dental plan through the marketplace. If the marketplace in your country is run bya federal government you wont be able to buy a standalone dental program through the marketplaceunless youre buying a health plan, however, if your commonwealth is running their own marketplaceyou may be able to join a standalone prescription drug plan.Slide number 11. So we have a couple of – kind of a typicalscenario that represents the majority of the questions that were coming from the marketplaceand the first case situation we have is( Jim) who has Medicare Part A simply, often thatsthe conventional approaching – individual, because Part A is usually free. They think that Part A and they decide topostpone enrollment in Medicare Part B.He did enroll in Medicare Part B during his initialenrollment interval. He signed off for Medicare Part B in January2 014 during the general enrollment period and his coverage began July 1. So the question is can he enroll in the marketplaceplan while he waits for his Medicare Part B coverage to take effect. Go to the next slide, move crowd 12, toanswer that question. So the question – the answer is no. Medicare Part A, as I mentioned before, isconsidered minimum indispensable coverage. He cannot get a marketplace plan since healready – hes enrolled in Medicare Part A and is a minimum critical coverage andremember it is illegal for anyone to sell him a marketplace plan knowing that he hasMedicare.The next pattern, the next slither – slide number1 3. So this is( Barbara) “whos working” part-time andisnt getting social security retirement benefits hitherto. Remember that I informed the committee that many peopleretirement age are beyond 65 and this is an example.( Barbara) who is still working – here employerdoesnt proposal health insurance coverage so she enrolled in a marketplace plan. Her Medicare initial enrollment period endsnext month, but she decided to keep her mart programme and wait to sign up for Medicare.So she basically contacted 65. Shes going a marketplace plan. She decided Im not getting social securityretirement benefits yet. Im just going to go ahead and maintain my marketplaceplan ongoing. So will( Barbara) have a late enrollment periodwhen she signs up for Medicare Part B? And what about Part D? And what else should we tell( Barbara) tokeep in mind as she makes her decision? Next slide, move number 14 has some rebuts. So( Barbara ), in fact, can choose a marketplacecoverage if shes eligible for Medicare, but hasnt enrolled in it more because, aswe have just mentioned, she would have to pay premium for example and because shes notcollecting social security benefits, which is her dispute. But before uttering her preference there are twoimportant things that she needs to keep in mind. If she enrolls in Medicare after the initialenrollment period purposes she may have to pay a late enrolment period as long as she hasMedicare as we mentioned before.Generally she knows how enroll in Medicare onlyduring the Medicare general enrollment point so in January 1 through March 31 and her coveragewill not begin until July 1 of that time. Next move, quantity 15, exactly is still on( Barbara ). If the marketplace plan drugs drugcoverage reliable she may also have to pay a late enrollment sanction for Medicare PartD if she decides to enroll later on. SO( Barbara) we should tell Barbara that sheshould consider enrolling in Medicare to be sure she doesnt face a late enrollmentpenalty for Medicare Part B or D.S can also choose to keep our marketplace coverage andalso enroll in Medicare as we have just mentioned. In that case( Barbara) wouldnt be eligiblefor tax credit and there is no coordination of benefits between Medicare and the marketplace. So in January – in general even though anindividual is in the marketplace they get Medicare, the government has two different programmes. Those marketplace contrives are not designed tosupplement Medicare except in very limited circumstances. Next move, list 16. Have some information – or perhaps a websitemarketplace thats, which has a lot of information in there about Medicareand the marketplace and other topics. You can keep on going to slide 17, which providesseveral ways that an individual can go about accessing more information and slide 18 weregoing to suspension here a little as we finish that topic to see if anyone has any questionsso far with regards to Medicare and marketplace coverage.( Alicia Mcentire ): Operator, can you open- give instructions on how to ask a question? Coordinator: Thank you. At this time if youd like to ask a questionplease press sun 1 on your touchtone phone.To withdraw your question at any time pleasepress star 2. One instant for our first issue. Again, if youd like to ask a question pleasepress star 1. Im showing now questions at this time. Oh, we do have one that just came in. Our first question is from( Beth Shaken ). Your line is now up.( Beth Shaken ): Hi, yes, I was necessary to time clarifyin terms of Medicare and then a marketplace plan. You had mentioned theres no coordinationof benefits. So would that precisely be an instance of a personthey have two separate guarantee programmes that they would then choose who to submit a claimto?( David Santana ): Great question.So if they have Medicare – if they have amarketplace plan and then they become eligible for Medicare and they choose to enroll inMedicare and impede that strategy told me about individual state plans now. So “re not” talking about a small business. So if you have an individual policy Medicareis your primary health insurance. By law Medicare is your primary health insuranceif you decide to keep that mart hope. So Medicare will compensate and when we say theresno coordination of benefits its actually no – an official agreement between Medicareand those contrives in the marketplace to coordinate benefits. Meaning that we would process the claim, wevepaid out claims and we stimulate cross over those claims to those companies so they can paythe residue. What we order private individuals to do inour situation is they decide to keep those plans is to contact their propose and find outhow exactly would they succeed when you enroll in Medicare.They – the first thing they will tell youis that Medicare will be your primary health insurance. They may tell the individual formerly Medicareprocesses the claim you can always forward to us and we may help you with whats left, but again, it is important for individuals to contact their proposal and asking questions becausetheres an official coordination of benefits between Medicare and the contrive and they mayas well say, you know , now you have Medicare that will be primary its up to you to keepthe plan. We may or may not compensate after Medicare paysas a primary .( Beth Shaken ): Thank you.( David Santana ): Youre welcome. Coordinator: Your next question comes from( Sandy Spies ). Your line is now up.( Sandy Spies ): Hi, expressed appreciation for. I was wondering if you have a client thatis a vet and they get business from VA and then they come eligible for Medicare. How does that work?( David Santana ): If an individual who hasVA benefits and becomes eligible for Medicare, of course, they have the option if theyregetting social security retirement benefits, as I have just mentioned, when they turn 65 theywill get automatically enrolled in Medicare. They will receive the card in the mail andthey will have the option to keep Medicare Part B or wane Part B.If they are not get Social security retirementbenefits when they turn 65 then they are faced with a selection. Should I enroll in Medicare during my initialenrollment stage or should I defer enrollment in Medicare? If they decide to postpone enrollment in Medicarealthough they have a VA coverage VA would not entitle that individual for a specialenrollment period. So what( inscrutable) is that individualwill have to pay a penalty later on if they decide to enroll in Medicare. Coordinator: Our next question comes from( Kim Glawn ). Your line is now open.( Kim Glawn ): Hi, I think you had mentionedthat some people who age into Medicare may, with a marketplace plan, that they might endup delaying Part B coverage or Medicare coverage in general and that there were questions theycould encounter with enrollment ages and disadvantages but that for parties with premiumfree Proportion A or without – that specific mortals like people with – who dont qualify forpremium free Part A, some of those individuals might be – well, in the best position notto have to choose to go into Medicare and drop their qualified health insurance plan.We were just wondering – this goes back to coordinationof benefits, but if a person chooses to stay in their qualified health plan and not enrollin Medicare could the qualified health plan say have a clause in their policy that dictatesthat the program doesnt have to pay for benefits as primary if the person failed to enrollin Medicare? So meaning like would the person think thatthey have modified health insurance, you are well aware, through the marketplace thinking thatthey were okay, but then later find out that theres a rider that would allow insurenot to pay as primary.( David Santana ): Yes, that is a great question. Traditionally individuals who are enrolledin private health – individual private plans or enrolled in a small group health insuranceplan, signifying less than 20 works, those programmes ever have the right – only the coordinationof benefits laws to tell an individual now that you are qualified for Medicare you mustenroll otherwise we only help you pay for what Medicare would have left.Meaning that we will pay like Medicare wasthere all along. And that ordinance expires – as far as I know thelaw hasnt converted with regards to the Affordable Care Act. The Act does tell those designs that they haveto be guaranteed renewable. Meaning that they couldnt terminate thepolicy simply because a person is becoming eligible for Medicare, however, the coordination ofbenefits rules that exist before the Affordable Care Act do allow those hopes either smallgroup health plans less than 20 employees and those individual policies to employed( illegible) in place saying you must enroll in Medicare otherwise were just going to pay what Medicarewould have left behind. And thats a great question.( Kim Glawn ): Thank you. Coordinator: There are no more questions inqueue at this time .( David Santana ): Great , thank you so much. And so were going to go on and jump throughthe slips, digit 18. And during this part of the presentation wewill focus Medicare and mental health services. Exclusively what Medicare coverage for thoseindividuals who are suffering from mental health issues necessity. So mental health conditions like depressionor anxiety can happen to anyone at any time and can affect a person of any age, race, belief or income for that matter. However, mental health illness, as we allknow, are treatable. So the following on that slide are signs thatan individual may want to speak to a doctor or mental health professional if theyreexperiencing any of those indications. Were going to go on to slide number 20. Diving into specifically what an individualwill get under Medicare Part A with regards to mental health services. So Medicare Part A, which is a hospital insuranceand weve talked a little about it once helps pay for mental health care if you arean inpatient in a general or psychiatric hospital.Once the individual is in the hospital – andthis applies pretty much for everyone not solely to mental condition, but we willsay, for example, office and committee, snacks, general hold attend, prescription drug and oral relatedservices and renders. Pretty much all the services that an individualwill get as an inpatient hospice. Now the last bullet in there is kind of likethe unique treatment of those individuals who are in the hospital to treat psychiatricconditions.So there is a lifetime maximum of 190 dayson inpatient mental hospital services allowable to any beneficiary enrolled in Medicare. Therefore, once the individual receive benefitsfor 190 epoches of care in a psychiatric hospital no further the advantages of that type are allowableunder the Medicare program for that individual. Payment may not be made for more than 100 or a total of 190 daytimes of inpatient mental hospital business during the patients lifetime. Again, this is a lifetime benefit. This limitation applies only to services, for instance, in a mental hospital. So, again, it only applies to service thatan individual will receive in a mental institution. This shortcomings do not apply to inpatientpsychiatric work( incoherent) in a distant proportion psychiatric unit of an acu-carehospital or critical access hospital. So, again, let me repeat that because I knowwe get a lot of these questions. The restraint does not apply to inpatientpsychiatric works. For speciman in a distance part of the psychiatricunit of an acute upkeep hospice or in a critical access hospital. The period they devote in a psychiatric hospitalprior to entitlement does not count towards this limitation.Although this( illegible) appear thatan individual spends in a mental hospital before they become entitled for Medicare maybe counted in terms of a limit for the first initial coverage period in Medicare and thenext slide Im going to talk a little bit about that. Im going to go on and move to slide 21. So move 21 shows the way we actually reimburseon the Medicare Part A services.So we refund Medicare Part A business basedon benefits period. To understand these numbers we have to firstunderstand what a benefit period is. So a benefits period begins when an individualon Medicare becomes an inpatient in a hospice. So thats when they – benefits( meaningless) begins and that interval will end when the individual has been out of the hospital or skilled nursingfacility for two months or 60 daytimes. So every time an individual goes into thehospital to waste a certain period of time and they get out of the hospital for two months.That benefit point will recycle again andthere is no restrictions in a benefits period. Thats an individual and Medicare( incoherent ). “Youre seeing” on each benefit age, for example, from one day up to 60 epoches in the hospital the individual in 2015 is responsible to paya deductible and Medicare remunerates the residue. From day 61 to daylight 90 if the individual remainsin the hospital for that long then the individual would be responsible to pay a co-payment of $315 a era Medicare compensates the rest.Now formerly a person touches that 90 eras consecutivedays in research hospitals or in a benefits period that individual will follow what we call 60 lifetime reserve dates. So they do have 60 epoches lifetime stockpile thatthey can use after they use – after – in a benefits period they have exerted that 90 daytimes. And, as you can see, they have to pay halfof the deductible per day if they decide to use those 60 days lifetime modesty periods. Now once “theyre using” it theyre proceeded. So if the individual expended those 60 epoches lifetimeand they come back to the hospital they have to be aware that Medicare benefits will goup to a 90 daylights in the hospital and there after Medicare coverage for hospital careat that point will end.Now something that is distinct with referenceto individuals who are – or who have some Medical condition that they were receivingcare in a psychiatric hospital. So when an individual becomes eligible forMedicare for the first time if they are an in-patient and been actively involved in Psychiatrichospitals on that first date of entitlement to hospital insurance the number of inpatientbenefits, you are well aware, in a first benefits period is the subject to reduction. So, again, were looking at 150 epoches andwere saying that if that individual was an inpatient in a psychiatric hospital whilethey became entitled to Medicare that 150 daylights will be reduced. So that days , not necessarily consecutive, in which the individual was an inpatient of a mental institution in the 150 days periodimmediately before the first year of allowance must be subtracted from the 150 days of theinpatient hospital busines for which it would be eligible to look at.To further explain this a little bit, becauseI know this is kind of – its a lite ticklish principle that only applies to those individualswho are inpatient in a psychiatric hospital. The first date that they become entitled forMedicare. So, for example, I really gave you two examples. A being was admitted into a Medicare participatingpsychiatric hospital. Let say in January 20. The person entitled for Medicare began February1, but you can see there were 12 epoches in there. So the 12 daylights of inpatient psychiatric careprior to entitlement are subtracted from the 150 epoches available for that first benefitsperiod. So that tells us that that individual have1 30 days left in that benefits period. So what that conveys is if an individualsremains in hospital for that 130 epoches at that point Medicare coverage will stop and whenan individual has been out of the hospital for 60 epoches in a row then they will begina brand-new benefits period from that place forward.So I hope that this part that only appliesto those individuals who were inpatient in a psychiatric hospital when they become eligiblefor Medicare is understood and thats because you probably may get questions from types. I became eligible for Medicare and theyreonly paying for this much hospital care from this point forward because they are talkingabout some reduction on that benefits period because I was an inpatient in a psychiatrichospital. Ill be happy to talk a little bit moreif anyone has questions about that. Causes move on to slide number 22. Now gives make quick look at Medicare PartB business. So Part B help cover for mental health servicesprovided by doctors and other health care professionals if you are admitted as hospitalinpatient – also covers outpatient mental health services that the individually generallygets as a infirmary outpatient or outpatient hospital.Including trips – inspects with those typesof health care professionals such as Psychiatrists or other doctors, clinical psychologists, critical social workers and certain other health care professionals. Tells move on to slide number 23. So proportion B likewise cures pay for those coverage, for example, one depress screening every year and this – we will cover for one depressionscreening every 12 months. So although the individual is entitled tothis benefit we careful types that they cannot become unless 11 full months have lapsedfor Medicare to cover for the services.If they proceed most frequently asked than that we wouldlikely deny the claim. And so we started this coverage back in October2 011 and basically we will cover annual screening up to 50 times for Medicare beneficiaryin primary care settings that have established this for depression care support in placeto assure accurate diagnosis, effective medicine and follow up care. So various screening tools are available forscreening for dip and I wanted to call to your attention a question that we oftentimes get is that( inscrutable) does not identify specific a depression screeningtools.So very the decision to use the specifictool is at the discretion of the clinician in the primary care setting and as I mentionedbefore a screening for hollow is not covered when its played more than 1 time inthe twelve-month period. Another thing that I wanted to call to yourattention is that Medicare co-insurance and Medicare Part B deductible are weighed forthese specific preventive works that we are mentioning here on this slip. So there are a lot someones on radical rehabilitation, pedigree advise, psychiatric evaluation, prescription the managers and sure-fire prescriptiondrugs and infusions. The last bullet in there speaks to in somecases a Medicare Part B are also welcome to pay for part hospitalization, which is an intensive structureprogram of outpatient psychiatric service provided to cases that – as an alternativebrief patient psychiatric care. So to explain this a little further – so patientsadmitted to this program must be under the care of a physician who attests the needfor partial hospitalization and requires a minimum of 20 hours per week therapeutic servicesas well as evidenced by their contrive of care.He patient also requires comprehensive instructionaltreatment requirements, medical oversight and coordination provided under the individualizedplan of upkeep because of a mental disturbance, which just encroaches with multiple areasof daily living, including social locational and educational( unintelligible ). So generally cases gratifying the meetingthe benefits category for this specific coverage are two groups of patients. Those case who are accomplished from an inpatienthospital treatment program and this intervention – this same deal continues in patient treatmentor( unintelligible) in the absence of incomplete hospitalization would be reasonably at riskof requiring inpatient hospitalization.So, again, I wanted to highlight that lastbullet and imply that we too get many questions about the partial hospitalization coverageunder Medicare. Lets move on to slide 2, which talks alittle bit about how much private individuals paid for Medicare Part B. often for mental healthservices provided by doctors or other health professional the individual user usuallypays – Medicare paid 80%, the individual paid generally 20%. We wanted to call to your attention that ifan individual goes business in a hospital outpatient clinic or hospital enterprise departmentthey may have to pay an additional co-payment of co-insurance.That added co-payment co-insurance mayrange between 20% and 40% and this is, again, if they received the service in an outpatientclinic or hospital outpatient agency. Slide 25 talks about whats covered underMedicare prescription drug hopes. So the Part D project helps cover for treats thatmay need to treat mental health conditions and this slither precisely addresses whatwe call involved coverage or protective categories of drugs that are covered by each of everyplan that furnish prescription drug benefits. Those protected lists are frequently fiveof them. The first one is cancer medication, HIV-Aidstreatment anti-depressant, anti-psychotic, anti-convulsion and also immune suppressantdrugs. So those are three categories in there inwhich relate specifically to mental health conditions are required to recover by eachand every Medicare Part D plan.Slide number 26 in terms of how much individualusually pay for Part D schedules. Of trend, these plans are private plans andthey may – the cost may motley. It depends on the project that you enroll inthe coverage. Those individuals who have limited incomeand resources could qualify for assistance for their payment as well as the out of pocketexpenses.Slide 27 and 28 and actually 29. Theyre time more informational resourcesthere that you can go through the information with regards to coverage for mental healthservices. And that concludes my very quick over viewabout Medicare coverage for mental health services. And I would be more than happy to take questionsif you have any question about that given topic. Coordinator: Again, if youd like toask a question delight press hotshot 1 on your touchtone phone. To withdrawal your question at any time pleasepress star 2. One time for our first question. Again, if youd like to ask a question pleasepress hotshot 1. Im not showing any questions in queue atthis time.( Alicia Mcentire ):( David) this is( AliciaMcentire) and while were maybe waiting for any further audience questions I justwas wondering what you think is maybe one of these sorts of biggest barriers to enrolling- enrollment and how we might be able to further engage and contact, you know this eligible populationthat weve talked about today.( David Santana ): With regard to Medicare populationI mean there are many venues already in place I entail the program has been around since 1965 so theres certainly a broad range of groups and agencies and advocacy organization thathelped those individuals navigate through their options. Specific I will refer if anyone wantedto assist those individuals exclusively when it comes to choosing, for example, shouldI – mean I am becoming eligible for Medicare what are my options? Did I be entered in the Medicare Advantage plan? Should I get a supplemental plan.Should I get a Part B programme? We have the elderly health insurance programsthat are spread throughout the commonwealth and we have individuals in each and every countyin the US that accommodates one on one counseling to types in Medicare. To sit with them and help them navigate throughtheir options. I dont have their specific phone numberlisted in there, but private individuals could ever, you know, bellow 1800 -medicare and askfor the switch platform. Senior Health Insurance Recipient programin their position and they would be able to get, again, one on one personalized assistanceto help them with their options. One of the things that individuals usuallyask exclusively to this small group that I was addressing that have the option to, you are well aware, scorn Medicare and keep the marketplace plan and payment taxation credit. We tell individual not to jump into conclusionand time because they have that option that may be the best option for them. Because the program has been around for toolong there was still options for those individuals who cannot afford Medicare premium.We call Medicare Savings Programs and thoseplans are allowable in each and every state in the person and those programs may helpfor Medicare Part D premium, Medicare Part A fee and likewise out of pocket outlays. Does the individual have a comprehensive healthinsurance. They dont have to pay anything out of pocket. So I encourage them before prancing to a conclusionand say oh this is the best I can to evaluate their options.( Alicia Mcentire ): Thank you.( David Santana ): Thank you. Coordinator: There are no questions in queueat this time.( Alicia Mcentire ): All title, well we areat the end of the hour.So if there are no questions I would liketo, again, thank( David Santana) from CMS and thank everyone for their participationtoday. This concludes the webinar, thank you. Coordinator: This does conclude todaysconference. All members may undo at this time ..

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