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Lake Cumberland Area Agency on Aging & Independent Living Policy and Procedures Manual

Section IX State Health Insurance Program Page 1

SECTION IX

STATE HEALTH INSURANCE ASSISTANCE PROGRAM (SHIP)

Administration for Community Living (ACL)

One Massachusetts Avenue NW

Washington, DC 20001

1 INTRODUCTION

The LCADD AAAIL State Health Insurance Assistance Program, or SHIP, is funded by a Federal grant program that helps enhance and support a network of local programs, staff, and volunteers. Through one-on-one personalized counseling, education, and outreach, this network of resources provides accurate and objective information and assistance to beneficiaries and their families. This allows the recipients to better understand and utilize their benefits. LCADD SHIP counselors help beneficiaries identify and understand programs and plans, including Medicare prescription drug coverage, Medicare Advantage plans, Medicare supplemental insurance policies, Medicare Savings Programs, long-term care insurance and financing, food stamps, low income heating energy assistance program and other public and private health insurance coverage options. LCADD SHIP counselors also assist eligible participants in enrolling in these programs and plans when necessary.

2 DEFINITIONS

1) Program Coordinator - an individual responsible for the overall management of the program in a given Area Development District (ADD). This person may also serve as a counselor.

2) Counselor - an individual who has received SHIP counselor training and have signed a Counselor Agreement or Memorandum of Understanding (MOU). SHIP counselors may include volunteers, paid or in-kind staff, program coordinators, etc.

3) Provider - a Title III-B Service Provider which is required by contract with LCADD AAAIL to provide SHIP benefits counseling.

4) SHIP Services - one-on-one counseling and assistance to any person regardless of age, with questions regarding Medicare, Medicaid, Social Security, prescription assistance, etc.

5) Unit - one (1) contact for SHIP counseling or one (1) event for SHIP group presentation/ media event.

6) ACL - the Administration for Community Living

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3 GREATEST ECONOMIC/SOCIAL NEED

Policy:

The Older American’s Act of 1965, as amended, requires LCADD AAAIL to provide assurances that preference will be given to providing services to person age 60 and over in the greatest economic and social need with particular attention to low-income minority and individuals residing in rural areas.

Procedures:

A. All SHIP counselors and providers must follow priorities set by LCADD AAAIL for serving older persons with the greatest social or economic needs with particular attention to low-income minority and individuals residing in rural areas. Although SHIP counseling is available to any person with need for information and/or assistance in our region, those meeting the definition of greatest economic or social need will be given priority.

B. SHIP counselors and providers will screen the person for assistance for assistance needs and will either refer the person to the appropriate resource or assist the person in completing applications/enrollments when necessary.

C. Greatest Social Need involves factors which restrict individual ability to carry out normal activities of daily living and which threaten an individual’s capacity to live an independent life may be considered in determining greatest social need. 1. Criteria for determining the social need shall be: a. low income minority;

b. low income elderly;

c. lives in isolated rural areas;

d. lives alone;

e. physical or mental limitations that restrict daily activities;

f. seventy-five (75) years of age or older.

D. Greatest Economic Need is determined solely by income level and household size. 1. Economic need shall be established by income levels for the household number at or below the poverty threshold established by the Federal Government.

4 LEVEL OF ASSISTANCE

Policy: All SHIP counselors and providers will make information, benefits counseling and assistance available at the appropriate level of assistance, i.e. post mail, e-mail, telephone, office visit or home visit.

Procedures:

Counselors will rely on their skills and training to determine which level of assistance is necessary. Any person who is homebound by reason of illness, incapacity, and disability or otherwise isolated and requires more in depth information and assistance will be served in their home unless safety reasons preclude this.

5 TARGETEDOUTREACH

 

Policy:

The LCAAAIL SHIP will provide targeted outreach and counseling to low income, dual eligible beneficiaries and hard to reach populations throughout the region by partnering with community service providers.

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Procedures:

Partnerships with the following organizations will be sought to further successfully provide assistance to the targeted populations: area ministries, senior centers, family health centers, low income housing sites, community action agencies, Departments for Community Based Services (DCBS), etc.

6 LCADDRESPONSIBILITIES Policy:

The State Health Insurance and Assistance Program shall be coordinated by an organization meeting all necessary qualifications and performing all duties as specified in the Federal Registry, 42 CFR Part 403.

Procedure:

A. Provide program and personnel management and program administration.

B. Establish and maintain a sufficient number of counselor positions, including volunteer, paid staff and in-kind staff.

C. Maintain a voicemail system utilizing different messages according to the current situation of the agency (i.e. holiday, agency shut-down, Coordinator travel, etc.).

D. Maintain a maximum limit of two (2) business days for attempting contact with individuals leaving messages.

E. Coordinate and participate in outreach and promotion efforts, especially those targeting underserved populations including but not limited to older minority persons, Native American Indians, low income/dual eligible beneficiaries, dual eligible beneficiaries with mental disabilities, rural elderly, frail elderly, older persons with severe physical disabilities, etc.

F. Publicize the toll-free number for use by anyone needing information, benefits counseling and assistance.

G. Maintain a library of printed materials in English and other languages for distribution to anyone requesting information and at outreach events.

H. The Program Coordinator will attend the Annual SHIP training and other meetings required by DAIL.

I. Calls received by LCADD ADRC are referred to SHIP Coordinator within 48 hours.

7 PROVIDER/COUNSELORRESPONSIBILITIES Policy:

Benefits counseling through the State Health Insurance Assistance Program shall be shall be delivered by a person meeting all necessary qualifications and performing all duties as specified by LCADD, DAIL and ACL.

Procedures:

A. All dedicated counselors, including volunteers, shall be made aware of their counselor duties and have signed a Volunteer/Counselor Agreement form.

B. All dedicated counselors, including volunteers, shall protect the confidentiality of those seeking assistance and have signed an Employee Confidentiality/Security agreement.

C. Dedicated counselors will be encouraged to commit to 5 SHIP service hours monthly.

D. Criminal records checks will be completed on all SHIP counselors, including volunteers.

E. Title III-B Providers will provide an area equipped with a computer with internet access for private and confidential benefits counseling.

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F. Provide home visits and/or telephone counseling assistance to those unable to visit a site for face-to-face counseling. Track and report these visits as required by the Program Coordinator.

G. All SHIP counselors will have an ID and Password for www.SHIPTalk.org.

H. All SHIP Counselors will complete a Client Contact Form using www.SHIPTalk.org for each one-on-one client contact concerning SHIP services.

I. Submit completed Client Contact Forms using www.SHIPTalk.org by the 7th of each month for the previous month.

J. All SHIP Counselors will complete SHIP Public and Media Activity Forms using www.SHIPTalk.org for each group presentation and/or media activity concerns SHIP services. Public/media activities could include but are not limited to Newsletter articles, advertisements, presentations, health fairs, group discussions, etc.

K. Submit completed SHIP Public and Media Activity Forms using www.SHIPTalk.org by the 7th of each month for the previous month.

L. Counselor time and mileage, if funded directly by the LCADD AAAIL, including benefits counseling, outreach, training, meetings, and report preparation will be recorded and reported to the Program Coordinator on the SHIP Time and Mileage Log. This log will be provided to LCADD monthly by the 7th of the following month.

M. Provide additional information as required by the Program Coordinator, DAIL or ACL.

N. Ensure the accuracy and completeness of the information contained in all reports submitted.

O. All SHIP Dedicated counselors to attend required SHIP meetings.

P. Failure of providers/counselors to report 100% of all client contact or public/media contacts may result in counselor status change to inactive. All Title III-B providers are required by contract to have at least one active SHIP counselor at their site or center.

8 TRAININGREQUIREMENTS Policy:

The State Health Insurance Assistance Program shall provide on-going training and technical assistance for new and existing benefits counselors. Information can be obtained at any time upon request. New provider staff/volunteers are required to be trained either by the provider supervisor or by LCADD AAAIL.

Procedures:

A. All new SHIP counselors, including volunteers, will complete eighteen (18) hours of training within thirty (30) days of their start date in order to meet ACL requirements for Counselor Certification.

B. All active SHIP counselors, including volunteers, shall complete twelve (12) hours of update training annually to maintain Counselor Certification.

C. LCAAAAIL/SHIP will provide one full day (7 hour) annual training to assist in meeting certification requirements.

D. Notification of other training opportunities will be provided and participation encouraged through ACL Forum Calls, HAP Network, On-line Training, etc.

E. One-to-one education, information and/or technical assistance will be provided to counselors as necessary to ensure accurate information is available to beneficiaries. This will be provided as needed by telephone, e-mail or in person.

F. A training log with topics, dates and times of completed training will be kept for each counselor, including volunteers by the Program Coordinator. If training is provided by agencies other than LCAAAIL, proof of attendance and topics covered shall be made available to the Program Coordinator

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and included in the training log.

G. Training topics shall include but are not limited to: 1. Medicare a. Eligibility

b. Enrollment

c. Fraud and Abuse

d. Claims

e. Appeals

f. Secondary Payer Issues

2. Medicare Advantage a. original Medicare vs. Medicare Advantage

b. enrollment/disenrollment

c. eligibility

d. plan comparisons

e. plan changes

f. appeals

3. Supplemental Insurance a. standard plans/plan benefits

b. Medicare Select

c. Pre-standardized plans

d. enrollment

e. guaranteed renewability

f. pre-existing conditions

g. guaranteed issue protections

h. premiums

i. claims

j. appeals

4. Long Term Care Insurance a. appropriations

b. benefits

c. enrollment

d. underwriting

e. tax qualified/non-tax qualified

f. benefit triggers

5. Medicaid (SSI, QMB, SLMB, QDWI, Q1, Spend Down) a. eligibility

b. benefits

c. referrals

d. resources

6. Other Health Insurance Options a. employer health plans

b. specified disease plans

c. indemnity policies

7. Counseling a. techniques

b. confidentiality

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Section IX State Health Insurance Program Page 6

LCADD Contact Info

Lake Cumberland Area Development District
P.O. Box 1570
(mailing address)
2384 Lakeway Dr.
(street address)
Russell Springs, KY 42642
Phone: 270-866-4200
Toll Free: 800-264-7093
TDD: 800-648-6056
Fax: 270-866-2044
info@lcadd.org

LCADD Calendar

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