DDES INFO MEMO 2005-02
February 14, 2005
STATE OF WISCONSIN
Department of Health and Family Services
Division of Disability and Elder Services
To:
Area Administrators / Human Services Area Coordinators
Area Agency on Aging Executive Directors
County Aging Unit Directors
Elderly Benefit Specialists
Older Americans Act Attorneys
County COP Coordinators
County Department of Community Program Directors
County Departments of Developmental Disabilities Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
County Waiver Coordinators
DDES Bureau Directors
DDES Section Chiefs
Tribal Chairpersons/Human Services Facilitators
From:
Sinikka Santala
Administrator, Division of Disability and Elder Services
Mark Moody
Administrator, Division of Health Care Financing
Re:
Allocation of Medicare Modernization Act Transition Grant Program Funds
to the Elderly Benefit Specialist Program for Part D-Related Assistance
Activities
Availability of Funds
We are pleased to announce the availability of funds for county
benefit specialist programs and supervising legal backup agencies to
assist Medicare beneficiaries with issues related to the new Medicare
Part D drug benefit. The funds are from a grant to the Division of
Health Care Financing (DHCF) under a provision of the Medicare
Modernization Act (MMA) that appropriates federal funds for State
Pharmaceutical Assistance Programs (SPAPs) to educate and assist
Medicare beneficiaries on prescription drug issues and choices. The
state-only SeniorCare program qualifies as a SPAP. Grant funds will be
available for 18 months, from April 2005 through September 2006. This is
one–time funding associated with the initial implementation of the
Medicare drug benefit, not a continuing appropriation.
The Department is allocating over 80% of the total grant--$1.8 out of
$2.2 million—to increase the capacity of the Elderly Benefit
Specialist Program in Wisconsin to better meet the workload of educating
and counseling Medicare beneficiaries so they can make well-informed
choices when the Medicare Prescription Drug Program is implemented.
Allocations
Attached to this memo is a chart providing allocations by county for
the 18-month period. Allocations were determined using a two-factor
formula: 70% of the amount by the county’s share of the SeniorCare
caseload; and 30% by the county’s share of the age 65 and over
population. The first factor reflects the threshold requirement of the
grant to assist persons on SeniorCare with Part D decisions. SeniorCare
enrollment is also a good measure of economic status since the majority
of enrollees have incomes under 200% of the poverty level. The second
factor measures the overall population of older persons potentially
eligible for the new Part D drug benefit and therefore for assistance. A
minimum allocation of $10,000 is used so counties whose formula
allocation is less are raised to that amount. Allocations for training
and supervision by the legal backup agencies are based on the share of
the SeniorCare caseload in each of their service areas.
In addition to the funds allocated directly to the Benefit Specialist
Program, the Department will be using some of the remaining portion of
the grant funds for training-related costs associated with increasing
capacity and for providing centralized clinical/pharmaceutical technical
assistance resources for Benefit Specialists
Conditions for Receipt of Funds
Three conditions must be met for a county program to receive funds.
First, the funds must be used to increase available benefit specialist
service hours in the county. This can be done by increasing the hours of
a benefit specialist who currently is less than full-time; increasing
the amount of time a benefit specialist who currently has other,
non-benefit specialist duties spends on benefit specialist work; or
hiring or contracting for additional part- or full-time benefit
specialist staff. These funds may not supplant any other funds
currently used to pay for the benefit specialist program.
Second, staff time paid with these funds must be used for outreach,
education and assistance to persons potentially eligible for the Part D
drug benefit to help them choose among and use a Part D plan, SeniorCare
or other possible arrangements to best meet their prescription drug
needs. This encompasses outreach, community education, one-on-one choice
counseling, enrollment assistance and post-enrollment advocacy. It also
includes the time and costs of benefit specialists funded under the
grant to receive training to provide this service. It may also include
costs in support of this additional staff time, such as space for the
worker, computer, phone, postage, copier, and so forth. However, at
least 70% of the allocation shall be used for salary and fringe.
Among the other 30%, indirect (general administrative) costs may be no
more than 5% of the total allocation.
Third, benefit specialists working under this grant, as well as
all current benefit specialists funded from other sources, will be
required to use the federal State Health Insurance Assistance Program’s
(SHIP’s) web–based reporting system to report all health benefit
related client contacts and community education activities. This is
necessary in order to document results to federal funders. You will
receive more information on this requirement in a separate memo from the
Bureau of Aging and Disability Resources in the Division of Disability
and Elder Services.
If a county is unable to increase benefit specialist staff time as
described above or to meet the other conditions for receiving these
funds, the county’s allocation shall go to the Area Agency on Aging,
which will hire or contract for staff to perform the work for that
county. A county that will be unable to meet the above conditions
should so inform their Area Agency as soon as possible, but no later
than March 15, 2005. The Area Agency shall inform the
Bureau of Aging and LongTerm Care Resources as to which, if any,
counties in its service area will not use the funds and the alternative
arrangements the Area Agency will make to provide the service in those
counties.
These funds will be distributed using the normal contracting process
that the Bureau of Aging and Disability Resources uses to distribute
funds to area and county aging units and other aging network providers,
using existing granting authority.
Additional Points of Clarification
First, though these funds are to be used for Part D-related
assistance activities, it is often neither practical nor effective to
completely restrict counseling only to such subjects. Prescription
coverage is usually part of a larger health insurance package so that
making decisions about drug coverage often entails making decisions
about other health benefits. Therefore, while work funded under this
grant should be about prescription drug coverage, it is permissible to
address closely related or connected health benefit matters, provided
time spent on such activities is not excessive. Common sense and
reasonableness should govern, but certainly no more than 20% of time
should be spent on such related, subordinate or incidental matters.
Second, while benefit specialists will bear much of the
responsibility for Part D–related assistance, it is certainly not our
expectation that they will be the only resource doing so. In particular,
we are using our State Health Insurance Assistance Program (SHIP) grant
to fund a toll-free Medicare prescription drug program helpline operated
by the Elder Law Center. The primary mission of this helpline will be to
assist beneficiaries to make decisions about Part D. This service will
complement the work of benefit specialists, providing them a place to
which they can refer Part D-related matters; in turn, this program will
make referrals to benefit specialists when locally based or
post-enrollment assistance is needed. The arrangement will be analogous
to that currently between benefit specialists and the Medigap Helpline
on insurance issues. In fact, the three programs should have a close,
triangular working relationship with each making and receiving referrals
from the other two.
Third, although persons funded through this grant will work almost
exclusively on prescription drug issues, we anticipate current benefit
specialists will also be spending a great deal of time on this work
given the impact of the changes and the size of the Medicare population.
Fourth, benefit specialists funded under this grant should follow the
current Older Americans Act policy of providing services to persons age
60 and over, including Medicare beneficiaries and those not yet eligible
for Medicare who need to plan for their near-term future.
Fifth, these funds may not be used to fund the recruitment, training
and supervision of volunteers to provide Part D-related assistance. We
believe that given the complexity of the subject area and the level of
service expected of benefit specialists, volunteer-based assistance is
not the best way of providing these services. Those local programs using
volunteers as an adjunct to the benefit specialist may, of course,
continue to do so, just not with these funds.
Finally, we will not require legal backup providers to train persons
hired under this grant on the full gamut of issues on which benefit
specialists assist clients. These staff will not be working with income
assistance programs, housing programs or consumer law issues, plus their
tenure is time-limited. They should be taught enough to spot and make
informed referrals of these matters to the regular benefit specialist or
other appropriate resources. They will need to be trained, though, not
only on Part D, SeniorCare and other drug coverage options, but also on
the rest of Medicare and other health care financing options relevant to
Medicare beneficiaries. The exact scope of training will be left to the
legal backup providers.
Additional Information
If you have questions, need clarification on anything in this memo or
require additional information, please contact Glenn Silverberg in the
Bureau of Aging and Disability Resources at (608) or silvegj@dhfs.state.wi.us.
Attachment (70k, PDF)
c:
Gordon Bond, BADR/DDES
Tom Frazier, CWAG
Judith Frye, AO/DDES
Jim Jones, BEM/DHCF
Lisa Lamkins, AARP
Donna McDowell, BADR/DDES
Cheryl McIlquham, BEM/DHCF
Russ Pederson, DHCF
John Reiser, BADR/DDES
Gail Schwersenska, BADR/DDES
Glenn Silverberg, BADR/DDES
Joanne Simpson, BEM/DHCF
CENTRAL OFFICE CONTACTS:
Glenn Silverberg
Bureau of Aging and Long Term Care Resources
1 W. Wilson St., Room 450
P.O. Box 7851
Madison, WI 53707-7851
Phone: (608) 267-3201
Fax: 608-267-3203
E-mail: silvegj@dhfs.state.wi.us
MEMO WEB SITE: http://dhfs.wisconsin.gov/partners/local.htm
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