October 2005 Medicare Bulletin - Tennessee Insert

Posted October 4, 2005

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Table of Contents

• B-12 Injection - LCD
• MMA - Medicare Health Support Programs (Formerly Known as Medicare Chronic Care Improvement Programs)

• Tennessee Health Professional Shortage Areas

• Tennessee Mental Health Professional Shortage Areas

 

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MMA - Medicare Health Support Programs (Formerly Known as Medicare Chronic Care Improvement Programs)

Note: This article was revised on August 23, 2005, due to a revision to CR3953. The changes to the article are the new CR release date and transmittal number shown above, and updates to the information below. Also, please note that the implementation date of CR3953 is not tied to the implementation dates for Medicare Health Support Organizations (MHSOs)

Provider Types Affected
Physicians and providers in any one of the nine geographic areas described below

Organization Selected by CMS to Provide Program	Geographic Areas to be Served
1. Aetna Life Insurance Company, LLC	Chicago, Illinois counties
2. American Healthways	Maryland and the District of Columbia
3. CIGNA Health Support	Northwest Georgia
4. Health Dialog Services Corporation	Western Pennsylvania
5. Humana, Inc.	Central and South Florida
6. LifeMasters Supported SelfCare, Inc	Oklahoma
7. McKesson Health Solutions	Mississippi
8. Visiting Nurse Service of New York/EverCare	Brooklyn and Queens Boroughs, New York City
9. XLHealth Corporation	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 Health Support Programs (MHSPs), formerly known as Chronic Care Improvement Programs, and identifies the nine organizations selected by the Centers for Medicare & Medicaid Services (CMS) to provide MHSPs to certain beneficiaries enrolled in the traditional Fee-For-Service (FFS) Medicare program.

CAUTION – What You Need to Know
CMS is implementing Phase I: Developmental of the medicare health support initiative. The nine MHSOs selected by CMS will serve approximately 180,000 Medicare beneficiaries who have congestive heart failure and/or diabetes among their chronic conditions. Eligible beneficiaries do not have to change plans or providers to participate, and participation is totally voluntary. Participation in an MHSP does 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 about CMS’ implementation of the Medicare Health Support Programs (MHSPs), formerly known as Chronic Care Improvement Programs. 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 section requires Medicare to provide for the phased-in development, testing, evaluation, and implementation of chronic care improvement programs (now known as MHSPs) and to proceed with expansion regionally or possibly nationwide if the pilot programs (or program components) are successful. This initiative represents one of multiple strategies developed by the Department of Health and Human Services (DHHS) to help chronically ill beneficiaries stay healthier, accelerate the adoption of health information technology, reduce avoidable costs and diminish health disparities among Medicare beneficiaries nationally.

Some key points about the MHS initiative are as follows:

• The MHSPs will test whether or not providing additional health education and support services for targeted chronically ill Medicare beneficiaries who are in traditional FFS Medicare will lead to improved clinical quality and satisfaction and lower costs to Medicare.
• CMS has entered into agreements with selected organizations (MHSOs) to provide MHSPs to targeted Medicare FFS benefi ciaries (about 20,000 beneficiaries serviced by each MHSO) who have congestive heart failure and/or diabetes.
• The first MHSPs will be phased in during 2005, operate for three years, and be tested through comparative analysis to beneficiaries randomly assigned to regional control groups. The statute provides for expansion of the MHS initiative if the pilot programs or program components are successful.
• The programs will offer support services—such as self-care guidance and answers to questions about medications—for chronically ill beneficiaries who are invited by CMS to participate. The goal is to help them adhere to their prescribed treatment plans and ensure that they seek the medical care they need to reduce their health risks. Coordination and collaboration with participants’ healthcare providers to enhance communication of relevant clinical information are also key
  components of the MHSPs.
• Participation in MHSPs 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.
• MHSOs will be paid by CMS, outside of the Medicare FFS claims payment system, a fixed administrative fee per participant per month.
• The MHSOs will not focus on any single disease, but will help participants manage their health holistically.
• The MHSOs will not pay any claims on behalf of enrolled beneficiaries and a beneficiary’s participation will not affect how claims from their physicians/providers are processed by Medicare.

The following chart identifies the MHSO, provides information about selected program features of the MHSPs to be offered, and delineates the geographic areas served by the MHSOs:

MHSO	Selected Program Features	Geographic Area
Aetna Life Insurance Company, LLC	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 Healthways	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 Health Support, LLC	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	Northwest GA
Health Dialog Services Corporation	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 case management as needed Data exchange with physicians Active involvement of other community agencies 24-hour nurse line	Western PA
Humana, Inc.	Trademarked Personal Nurse (PN) program model Group education and support sessions Biometric monitoring equipment, including glucometers and weight scales as necessary Core telephonic support supplemented with RNs, social workers and pharmacists in the field interacting with providers and benefi ciaries 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 five small physician-group practices Active involvement of other community agencies 24-hour nurse line	Central and South FL
LifeMasters Supported SelfCare	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 high volume physician practices Physician web access to clinical information Active involvement of other community agencies 24-hour nurse line	OK
McKesson Health Solutions	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 of New York/Evercare	Home health agency leading outreach in community Management of high-risk participants who require extensive inhome 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 Boroughs of NY
XLHealth Corporation	Biometric monitoring including glucometers and weight scales as necessary RNs, social workers, and pharmacists in the field, interacting with providers and beneficiaries with complex needs Medication counseling sessions by pharmacists at retail pharmacies Specialized program for higher risk patients Medication management and compliance Data exchange with physicians Physician web access to clinical information 24-hour nurse line	Selected counties in Tennessee

Physicians and providers with questions regarding the programs can find additional information at http://www.cms.hhs.gov/medicarereform/ccip/ on the CMS web site, or they may direct their inquiries directly to the following MHSO contacts:

Aetna Life Insurance Company, LLC: Kathleen Giblin Aetna Health Management, LLC 151 Farmington Avenue, RT11 Hartford, CT 06156 Or call 888.713.2836 or visit http://www.aetna.com	LifeMasters Supported SelfCare: Ron Lau, c/o Mel Lewis LifeMasters Supported SelfCare 5000 Shoreline Court S#300 South San Francisco, CA 94080 Or call 888.713.2837 or visit http://www.lifemasters.com
American Healthways: Michael Montijo, M.D., American Healthways American Healthways, Inc. 3841 Green Hills Village Drive Nashville, TN 37215 Or call 866.807.4486 or visit http://www.medicarehealthsupport.com	McKesson Health Solutions: Sandeep Wadhwa McKesson Health Solutions 335 Interlocken Parkway Broomfield, CO 80021 Or call 800.919.9110 or visit http://www.mckesson.com
Health Dialog Services Corporation: Molly Doyle Health Dialog Services Corporation 60 State Street, Suite 1100 Boston, MA 02109 Or call 800.574.8475 or visit http://www.myhealthsupport.com (available August 2005)	Visiting Nurse Service of New York/Evercare: Paul Roth VNS CHOICE 5 Penn Plaza, 19th Floor New York, NY 10001-1810
Humana, Inc.: Heidi Margulis Humana, Inc. 500 West Main Street, 6th Floor Louisville, KY 40202 Or call 800.372.8931 or visit http://www.greenribbonhealth.com	Visiting Nurse Service of New York/Evercare: Paul Roth VNS CHOICE 5 Penn Plaza, 19th Floor New York, NY 10001-1810
CIGNA Health Support: 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 the instruction is August 23, 2005.

Additional Information
For complete details of CR3953, please see the official instruction issued by going to: http://www.cms.hhs.gov/manuals/transmittals/comm_date_dsc.asp on the CMS web site. From thatweb page look for CR3953 in the CR column on the right and click on the file for that CR.The Medicare Fact Sheet that describes the Medicare Health Support programs may be found on the Web at http://www.cms.hhs.gov/medicarereform/ccip/ on the CMS Web site. 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 on the CMS Web site.

 

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B-12 Injection - LCD

B-12 Injection - LCD

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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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