May 12 2020 Marina Diaz MHSA Centers for Medicare amp Medicaid Services Puerto Rico amp Virgin Islands Background A Little Bit Of History Parts ABCD Medicare Then Now Puerto Rico By The Numbers ID: 927206
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Slide1
Medicare ABCD
Presentation to the San Juan Rotary Club
May 12, 2020
Marina Diaz, MHSA
Centers for Medicare & Medicaid Services
Puerto Rico & Virgin Islands
Slide2Background: A Little Bit Of History
Parts ABCD
Medicare Then / Now
Puerto Rico By The NumbersThe Medicare Advantage ProgramNew Technologies – Blue BottomMy MedicarePlan ComparePuerto Rico State Insurance AssistanceAppendix – Detailed History
Presentation Structure
Slide31965- Titles XVIII and XIX of the Social Security Act
Signed into law by President Lyndon B Johnson Coverage for people 65 and older- MEDICARE Coverage for people at certain poverty level - Medicaid1972- Extended to individuals under 65 with dissabilities1977- Health Care Financing Administration(HCFA)
1982- Agency delegates payments of hospitals and creates the Quality Oversight
Historical Background
Slide42000- Benefits improvement Protection Act
Increased Medicare payments to managed Health Care organizations2001- Secretary Tommy Thompson change name from HCFA to Centers for Medicare and Medicaid Services2003- Prescription Drug benefit: Foster competition among Health plan Impulse innovation Covered prevention services2007- Beneficiaries with higher income were asked to pay greater share of part B
Medicare Milestones
Slide5Number of Beneficiaries % of Federal Expenditure
1965 - 19 million 2.3%
2019 - 61 million 23.5%
Then and Now
Slide6A – HOSPITAL SERVICES
B – OUTPATIENT SERVICES ( Not automatic in Puerto Rico)C – MEDICARE ADVANTAGED – PHARMACY SERVICES
ABCD of Medicare
Slide7Medicare Beneficiaries - 745,471
Medicare Advantage - 593,337 (79.6%)New Beneficiaries Monthly - 1,000Puerto Rico 2019
Slide8There are two options to elect in Medicare:
Traditional Medicare – An open network accepted by all providers who accept Medicare, ORMedicare Advantage Organizations (MAO) which is a managed care plan through a specific carrier: In Puerto Rico, there are 4 options of MAO carriers:Humana,
MMM
MCS d) Triple-S Categorized by a star rating (1-5)Open Enrollment - Oct 15-Dec 7Jan 1-March 31st, -you can change plans or return to Traditional MedicareMedicare – Traditional and Medicare Advantage
Slide9Medicare Advantage VS. Traditional Medicare
Slide10Efffort to improve the relationship between the beneficiary and Medicare with “user friendly” technology
My Medicare-provides access to your information, re-print card, get your utilization report What is Covered; you know if a procedure or service is covered
Plan Compare: tool designed to assist in decision making –comparing the different Health plans benefit packageseMedicare
Slide11Staff is trained to provide coaching on comparing plans and deciding between traditional Medicare and Advantage
San Juan Office is in Bus Stop 18- Santurce (Marshall’s Blg)SHIP1-877-725-4300State Health Insurance Assistance Program
Slide12Local Engagement and Administration:
Obtain and Provide clarity on CMS Rules and RegulationsDisseminate InformationBridge Conversations between PR Stakeholders and Subject Matter ExpertsOutreach and Education to providers and beneficiariesPuerto Rico/USVI Office
Slide13prfo@cms.hhs.gov – Local Contact
marina.diaz@cms.hhs.gov Medicare.gov1-800-633-4227
Questions
Slide14Thank you!
Slide151965- Titles XVIII and XIX of the Social Security Act
Signed into law by President Lyndon B Johnson Coverage for people 65 and older- MEDICARE Coverage for people at certain poverty level - Medicaid1972- Extended to individuals under 65 with dissabilitiesHistorical
Background
Slide161980’s Medigap (
supplemental coverage) under federal oversightProspective payment system for hospitals1997-Balanced Budget Act (BBA)Established a new array of Managed care and other private Health plan choicesNeed to slow rate of spending growth to extend life of trust fundTesting innovative models of payment
Medicare Milestones
Slide172000- Benefits improvement Protection Act
Increased Medicare payments to managed Health Care organizations2001- Secretary Tommy Thompson change name from HCFA to Centers for Medicare and Medicaid Services2003- Prescription Drug benefit: Foster competition among Health plan Impulse innovation Covered prevention services2007- Beneficiaries with higher income were asked to pay greater share of part B
Medicare Milestones
Slide182015- Alternative payment models-encourage quality and efficiency
2020- In response to pandemic: Expand telemedicine Increase workforce Hospital without walls Expand testingMedicare Milestones