September 2005 Medicare Bulletin - Tennessee Insert

Posted September 2, 2005

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Table of Contents

• Tennessee Health Professional Shortage Areas

• Tennessee Mental Health Professional Shortage Areas

• The Medicare Chronic Care Improvement, “Medicare Health Support,” Program

 

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The Medicare Chronic Care Improvement, “Medicare Health Support,” Program

Provider Types Affected
Physicians and providers in any one of the nine Chronic Care Improvement Organization (CCIO) areas as follows: (Each area specified shows the name of the CCIO with which Medicare has contracted followed by the geographic area served by that CCIO.)

1. AETNA, Inc. Chicago, Illinois counties; 2. American Healthways, Maryland and the District of Columbia; 3.CIGNA, Northwest Georgia; 4. Health Dialog, Western Pennsylvania; 5. Humana, Central and South Florida; 6. Lifemasters, Oklahoma; 7. McKesson, Mississippi; 8. Visiting Nurse Service EverCare/United, Brooklyn and Queens, New York; 9. XL Health, Selected counties in Tennessee

Provider Action Needed

STOP – Impact to You
This article includes information from Change Request (CR) 3953 that describes the new Medicare Chronic Care Improvement Program also known as “Medicare Health Support Program” and identifies the nine selected CCIOs that contract with the Centers for Medicare & Medicaid Services (CMS) to provide chronic care services to certain beneficiaries enrolled in the traditional Fee-For-Service (FFS) Medicare program.

CAUTION – What You Need to Know
This is Phase I of the Medicare Health Support program and will serve approximately 180,000 Medicare beneficiaries who have congestive heart failure and complex diabetes among their chronic conditions. Eligible beneficiaries do not have to change plans or providers to participate, and participation is totally voluntary. CCI programs will not restrict access to other Medicare services and will be provided at no extra cost to beneficiaries.

GO – What You Need to Do
See the Background and Additional Information sections for more information on this new program.

Background
This article provides information on the CMS’ implementation of the Chronic Care Improvement Program now known as “Medicare Health Support”. Section 721 of the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) adds a new section 1807, “Voluntary Chronic Care Improvement Under Traditional Fee-for-Service (FFS) Medicare” to the Social Security Act. This requires Medicare to provide for the phased-in development, testing, evaluation, and implementation of chronic care improvement programs, and to expand the implementation of the chronic care improvement (CCI) programs to additional geographic areas.

This initiative also represents one of the multiple strategies developed by the Department of Health and Human Services (DHHS) to improve chronic care, accelerate the adoption of health information technology, reduce avoidable costs, and diminish health disparities among Medicare beneficiaries nationally.

Some key points of “Medicare Health Support” are as follows:

• The program will test whether providing disease management services to Medicare beneficiaries who are in traditional FFS programs leads to improved outcomes and lower total costs to Medicare.
• CCIOs contract with CMS to provide disease management to targeted Medicare FFS beneficiaries (about 20,000 beneficiaries serviced by each CCIO) who suffer from congestive heart failure and diabetes.
• The first CCI program will be phased in during 2005, operate for 3 years and be tested through randomized controlled trials. The hope is that the program or components of the program prove successful and can be expanded regionally and/ or nationally.
• The programs will offer add-on services—such as self-care guidance and support—to chronically ill beneficiaries. The goal is to help them adhere to their physician’s plans of care and assure that they seek the medical care needed to reduce their health risks. Coordination and collaboration with the participants’ providers to enhance communication of relevant clinical information is also a key component of the CCI program.
• CCI programs will not restrict access to care and will be provided at no cost to eligible beneficiaries.
  Such beneficiaries do not have to change from their existing plans, nor do they have to change physicians or providers in order to participate. Further, they may stop participating at any time.
• Each of the contracted CCIOs are paid separately by CMS, outside of the Medicare FFS claims payment system, a fixed “per member per month” (PMPM) payment.
• The CCIOs will not focus on any single disease, but will help participants manage all their health care problems.
• The CCIOs will NOT pay any claims on behalf of enrolled beneficiaries and a beneficiary’s participation will not at all affect how claims from their physicians/providers are processed by Medicare.
  The following chart identifies the CCIOs, details the specific program features of these CCIOs and delineates the geographic areas served by the CCIO:
  

CCIO	Program Features	Geographic Area
AETNA, Inc.	Advance Practice Nursing Program for home health and nursing homes Customized care plans Caregiver education Blood pressure monitors and weight scales provided based on participant need Physician communication Physician Web access to clinical information 24-hour nurse line	Chicago IL counties
American Helathways	Personalized care plans Direct-mail and telephonic messaging Supplemental telephonic coaching Gaps in care generate physician prompts Intensive case management services as necessary Remote monitoring devices (weight, blood pressure(bp), and pulse) based on participant need Physician Web access to clinical information Physician communication 24-hour nurse line	MD and DC
CIGNA	Personalized plan of care Telephonic nurse interventions Oral and written communication in addition to telephonic coaching Home monitoring equipment (weight, bp, and glucometers) based on participant need Intensive case management for frail elderly and institutionalized participants, as required Data exchange with physicians, 24-hour nurse line	Northweat GA
Health Dialog	Personal health coaches develop individual care management plans Health education materials (Web- based, faxed or mailed) In-home biometric monitoring Behavioral health case management and intensive casemanagement as needed Data exchange with physicians, Active involvement of other community agencies 24-hour nurse line	Western PA
Humana	Trademarked Personal Nurse (PN) program model Group education and support sessions Biometric monitoring equipment, including glucometers andweight scales as necessary Core telephonic support supplemented with RNs, socialworkers and pharmacists in the field interacting with providersand beneficiaries with complex needs Data exchange with physicians, On-site meetings with physicians and CME (continuing medical education) programs Physician Web access to clinical information Electronic medical recordkeeping systems will be piloted in fivesmall physician-group practices Active involvement of other community agencies 24-hour nurse line	Central and South FL
Lifemasters	Single nurse as primary contact for beneficiary Supported self-care model including education, medication compliance, behavior change Home visits as appropriate Team of local and call center- based nurses, physicians, pharmacists, and health educators Digital weight scale and bp monitors Physician communication including customized care plans,alerts, decision ` support applications; access to patient care record and biometric monitoring data Physician outreach includes in-person orientation for highvolume physician practices Physician Web access to clinical information Active involvement of other community agencies 24-hour nurse line	OK
McKesson	Extensive physician involvement, including on-site staff support Data exchange with physicians, Physician Web access to clinical information Telephonic outreach Mail, fax, workbooks Remote monitoring and biometric equipment for selected high risk participants Pharmacist review of medications and collaboration with physicians Management of long-term care residents and intensive case management, including end-of-life 24-hour nurse line	MS
Visiting Nurse Service	Home health agency leading EverCare / United outreach in community Management of high-risk participants who require extensive in home management Telephonic outreach and health risk assessments Use of SmartCards to use at physician visits and hospital admissions to track service use and convey embedded information to providers Physician Web access to clinical information Active involvement of other community agencies 24-hour nurse line	Brooklyn and Queens NY
XL Health	Biometric monitoring including glucometers and weight scalesas necessary RNs, social workers, and pharmacists in the field, interactingwith providers and beneficiaries with complex needs Selected counties in TNCCIO Program Features Geographic Area Medication counseling sessions by pharmacists at retailpharmacies Specialized program for higher risk patients Medication management and compliance Data exchange with physicians, Physician Web access to clinical information 24-hour nurse line

Physicians and providers with questions regarding the program can find additional information at http://www.cms.hhs.govmedicarereform/ccip/ on the CMS Web site, or they may direct their inquiries directly to the following CCIO Contacts:

AETNA:Kathleen Giblin	LifeMasters:
Aetna Health Management, LLC	Ron Lau, c/o Mel Lewis
151 Farmington Avenue, RT11	LifeMasters Supported Care
Hartford, CT 06156	5000 Shoreline Court S#300 South
Or call 888.713.2836 or visit http://www.aetna.com	San Francisco, CA 94080 Or call 888.713.2837 or visit http://www.lifemasters.com
American Healthways:	McKesson:
Michael Montijo, M.D., American Healthways	Sandeep Wadhwa
American Healthways, Inc.	McKesson Health Solutions
3841 Green Hills Village Drive	335 Interlocken Parkway
Nashville, TN 37215	Broomfield, CO 80021
Or call 866.807.4486 or visit http://www.medicarehealthsupport.com	Or call 800.919.9110 or visit http://www.mckesson.com
Health Dialog:	XL Health:
Molly Doyle	Paul Serini
Health Dialog Services Corporation	XLHealth
60 State Street, Suite 1100	351 West Camden Street, Suite 100
Boston, MA 02109	Baltimore, Maryland 21201
Or call 800-574-8475 or visit http://www.myhealthsupport.com (available August 2005)	Or call 877.717.2247
Humana:	VNS/Evercare:
Heidi Margulis	Paul Roth
Humana, Inc.	VNS CHOICE
500 West Main Street,	5 Penn Plaza, 19th Floor
6th Floor Louisville, KY 40202 Or call 800.372.8931 or visit http://www.greenribbonhealth.com	New York, NY 10001-1810
CIGNA HealthCare: David Post CIGNA 900 Cottage Grove, B227 Bloomfield, CT 06002 Or call 866.563.4551 or visit www.mhsgeorgia.com (available August 2005)

Implementation
The implementation date for this instruction is October 20, 2005.

Additional Information
For complete details of CR 3953, please see the official instruction issued by going to: http://www.cms.hhs.gov/manuals/transmittals/comm_date_dsc.asp

From that Web page look for CR 3953 in the CR column on the right and click on the file for that CR. The Medicare Fact Sheet that describes the Medicare Chronic Care Improvement, “Medicare Health Support,” program may be found on the Web at: http://www.cms.hhs.gov/medicarereform/ccip/. This document is an excellent overview of the program.

Medlearn Matters Article MM3410 provides some background information on the “Use of Group Health Plan Payment System to Pay Capitated Payments to Chronic Care Improvement Organizations Serving Medicare Fee-For-Service Beneficiaries Under Section 721 of the MMA” and can be viewed by going to: http://www.cms.hhs.gov/MedlearnMattersArticles/downloads/MM3410.pdf.

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Tennessee Mental Health Professional Shortage Areas (HPSAs)

Designated Geographic Areas

COUNTY AREA NAME/PARTS RURAL/URBAN Bedford MHCA 19 Bedford Rural Benton MHCA 21 Benton Rural Bledsoe MHCA 12 Bledsoe Rural Bradley MHCA 10 Bradley Rural Cannon MHCA 9 Cannon Rural Carroll MHCA 21 Carroll Rural Cheatham Catchment Area 14 Cheatham Rural Chester MHCA 24 Chester Rural Claiborne MHCA 5 Claiborne Rural Clay MHCA 9 Clay Rural Cocke MHCA 5 Cocke Rural Coffee MHCA 19 Coffee Rural Crockett Catchment Area 22 Crockett Rural Cumberland MHCA 9 Cumberland Rural Decatur MHCA 24 Decatur Rural Dekalb MHCA 9 Dekalb Rural Dickson Catchment Area 14 Dickson Rural Dyer Catchment Area 22 Dyer Rural Fayette MHCA 25 Fayette Rural Fentress MHCA 9 Fentress Rural Franklin MHCA 19 Franklin Rural Gibson MHCA 21 Gibson Rural Giles MHCA 20 Giles Rural Grainger MHCA 5 Grainger Rural Greene MHCA 4 Greene Rural Grundy MHCA 12 Grundy Rural Hamblen MHCA 5 Hamblen Rural Hancock MHCA 4 Hancock Rural Hardeman MHCA 24 Hardeman Rural Hardin MHCA 24 Hardin Rural Hawkins MHCA 4 Hawkins Rural Haywood Catchment Area 23 Haywood Urban Henderson Catchment Area 23 Henderson Urban Henry MHCA 21 Henry Rural Hickman MHCA 20 Hickman Rural Houston Catchment Area 14 Houston Rural Humphreys Catchment Area 14 Humhreys Rural Jackson MHCA 9 Jackson Rural Jefferson MHCA 5 Jefferson Rural Lake Catchment Area 22 Lake Rural Lauderdale MHCA 25 Lauderdale Rural Lawerence MHCA 20 Lawerence Rural Lewis MHCA 20 Lewis Rural Lincoln MHCA 19 Lincoln Rural McMinn MHCA 10 McMinn Rural McNairy MHCA 24 McNairy Rural Macon MHCA 9 Macon Rural Madison Catchment Area 23 Madison Urban Marion MHCA 12 Marion Rural Marshall MHCA 20 Marshall Rural Maury MHCA 20 Maury Rural Meigs MHCA 10 Meigs Rural Montgomery Catchment Area 14 Montgomery Rural Moore MHCA 19 Moore Rural Obion Catchment Area 22 Obion Rural Overton MHCA 9 Overton Rural Perry MHCA 20 Perry Rural Pickett MHCA 9 Pickett Rural Polk MHCA 10 Polk Rural Putman MHCA 9 Putman Rural Rhea MHCA 12 Rhea Rural Robertson Catchment Area 14 Robertson Rural Sequatchie MHCA#12 Sequatchie Rural Smith MHCA 9 Smith Rural Stewart Catchment Area 14 Stewart Rural Sumner MHCA 31 Sumner Urban Tipton MHCA 25 Tipton Rural Trousdale MHCA 31 Trousdale Urban Union MHCA 5 Union Rural Van Buren MHCA 9 Van Buren Rural Warren MHCA 9 Warren Rural Wayne MHCA 20 Wayne Rural Weakley Catchment Area 22 Weakley Rural White MHCA 9 White Rural Wilson MHCA 31 Wilson Urban

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Tennessee Health Professional Shortage Areas (HPSAs)

Designated Geographic Areas

COUNTY AREA NAME/PARTS RURAL/URBAN Anderson Briceville - Lake City Lake City West City Division New River City Division Lake City East City Division Urban Bledsoe Dayton/Pikeville/Decataur/Bledsoe Rural Cheatham All Rural Chester3 All Rural Claiborne1 All Rural Crockett All Rural Decatur All Rural Dickson Vanleer/Shiloh Vanleer CCD Urban Fayette All Urban Giles4 All Rural Grainger2 All Urban Greene Baileyton Baileyton CCD Jearoldstown Division Rural Grundy All Rural Hamilton Middle Valley Soddy Daisy Division Middle Valley Division Sale Creek Division Urban Hancock All Rural Hardeman All Rural Hawkins All Urban Haywood All Rural Henderson2 All Rural Hickman All Rural Jackson All Rural Johnson All Rural Knox Mechanicsville - Census Tracts 1, 2, 3, 4, 5, 6, 7, 11, 12, 13, 14, 20, 28 Urban Lake2 All Rural Lauderdale All Rural Lincoln3 Cash Point - Blanche Cash Point/Blanche CCD Rural Macon5 All Rural Madison East Jackson - Census Tracts 5 and 8-12 Rural Maury Fairview/Boston/Santa Fe/Santa Fe Division Rural Meigs Dayton/Pikeville/Decatur Rural Montgomery Vanleer/Shiloh Palmyra/Shiloh CCD Urban Moore All Rural Morgan All Rural Obion Hornbeak/Samburg Hornbeak/Samburg CCD Dixie Division Elbridge-Cloverdale Division Rural Perry All Rural Pickett All Rural Polk1 Benton/Parkville Benton Division Parkville Division Rural Rhea Dayton/Pikeville/Decatur/Rhea Rural Rutherford Eagleville Eagleville CCD Bethesda/Eagleville Urban Unicoi All Urban Union All Urban Van Buren All Rural Williamson Bethesda/Eagleville Bethesda Division/Fairview/Boston/Santa Fe/Fairview Division /Boston Division Rural

¹ Classified as a HPSA, effective March 1, 2002.
² No longer classified as a HPSA, effective March 1, 2002.
³ Classified as a HPSA, effective June 1, 2002.
⁴ Classified as a HPSA, effective February 1, 2004.
⁵ No longer classified as a HPSA, effective February 1, 2005

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