The SMP program, also known as Senior Medicare Patrol program, helps Medicare and Medicaid beneficiaries prevent, detect, and report health care fraud. In doing so, they help protect older persons and promote integrity in the Medicare program.
What are SMPS and how do they work?
The SMP program as we know it today was made possible by the 1997 Omnibus Consolidation Appropriation Act – legislation that formally supported enlisting seniors in the fight against Medicare fraud. The SMPs have been supported by an ACL-funded national resource center since 2003.
What is a state health insurance Assistance Program (SMP)?
In addition to SMP program services, many grantees also offer State Health Insurance Assistance Program (SHIP) services which provide health insurance counseling, outreach, and training to Medicare beneficiaries, their families, and caregivers. SMPs are funded by the Health Care Fraud and Abuse Control (HCFAC) program for its antifraud activities.
How much money does the SMP program receive?
In 2019 funding for the SMP program totaled approximately $18 million. Approximately $15.6 million of the total funding available was distributed to the state SMP projects to help beneficiaries prevent, detect, and report Medicare fraud, errors, and abuse.
What is Medicare Part MSP and how does it protect Medicare?
The MSP provisions have protected Medicare Trust Funds by ensuring that Medicare does not pay for items and services that certain health insurance or coverage is primarily responsible for paying. The MSP provisions apply to situations when Medicare is not the beneficiary’s primary health insurance coverage.
What is SMP in Medicare?
The SMP mission is to empower and assist Medicare beneficiaries, their families, and caregivers, to prevent, detect, and report suspected healthcare fraud, errors, and abuse through outreach, counseling, and education. SMPs work to resolve beneficiary complaints of potential healthcare fraud in collaboration with state and federal partners, ...
What is SMP in retirement?
SMP activities also serve to enhance the financial, emotional, physical, and mental well-being of older adults, thereby increasing their capacity to maintain security in retirement and make better financial and healthcare choices.
How much is the SMP program?
SMPs are funded by the Health Care Fraud and Abuse Control (HCFAC) program for its antifraud activities. In 2019 funding for the SMP program totaled approximately $18 million. Approximately $15.6 million of the total funding available was distributed to the state SMP projects to help beneficiaries prevent, detect, and report Medicare fraud, errors, and abuse.
What is OIG SMP?
Each year, the Office of the Inspector General (OIG) completes an annual performance report on the SMP projects. The 2020 OIG SMP Performance Report#N#(link is external)#N#documents the following outcomes for 2019 activities:
When was the SMP established?
History and Structure. SMPs were authorized in 1997 under Titles II and IV of the Older Americans Act, the Omnibus Consolidated Appropriation Act of 1997 and the Health Insurance Portability and Accountability Act of 1996. SMPs began as demonstration projects in 12 states. Currently, SMP grants are provided to all 50 states, District of Columbia, ...
How many states are SMP grants?
Currently, SMP grants are provided to all 50 states, District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands. Nationally, the SMP network includes nearly 6,875 Team Members (staff and volunteers) at more than 500 local sites. SMP Team members are trained to:
What is a SNP for Medicare?
Get the right prescriptions to prevent complications. A Medicare SNP for people with both Medicare and Medicaid might use a care coordinator to help members access community resources and coordinate their different Medicare and Medicaid services. expand.
Why do Medicare SNPs use care coordinators?
Some Medicare SNPs use a care coordinator to help you stay healthy and follow your doctor's orders. A care coordinator is someone who helps make sure people get the right care and information. For example, a Medicare SNP for people with diabetes might use a care coordinator to help members do these things:
What happens if you don't have Medicare?
If you don't have both Medicare and Medicaid (or get other help from your state paying your Medicare premiums), your exact costs will vary depending on the plan you choose. In general, you'll pay the basic costs of having a Medicare Advantage plan . expand.
How long is the grace period for Medicare?
The grace period is at least one month long, but plans can choose to have a longer grace period. If you lose eligibility for the plan, you'll have a Special Enrollment Period to make another choice. This Special Enrollment Period starts when your Medicare SNP notifies you that you're no longer eligible for the plan.
Does Medicare cover SNP?
If you have Medicare and Medicaid, most of the costs of joining a Medicare SNP will be covered for you . Contact your Medicaid office for more information and to see if you qualify for Medicaid benefits.
What is the purpose of MSP?
The MSP provisions have protected Medicare Trust Funds by ensuring that Medicare does not pay for items and services that certain health insurance or coverage is primarily responsible for paying. The MSP provisions apply to situations when Medicare is not the beneficiary’s primary health insurance coverage.
What are the responsibilities of an employer under MSP?
As an employer, you must: Ensure that your plans identify those individuals to whom the MSP requirement applies; Ensure that your plans provide for proper primary payments whereby law Medicare is the secondary payer; and.
What is Medicare Secondary Payer?
Medicare Secondary Payer (MSP) is the term generally used when the Medicare program does not have primary payment responsibility - that is, when another entity has the responsibility for paying before Medicare. When Medicare began in 1966, it was the primary payer for all claims except for those covered by Workers' Compensation, ...
Why is Medicare conditional?
Medicare makes this conditional payment so that the beneficiary won’t have to use his own money to pay the bill. The payment is “conditional” because it must be repaid to Medicare when a settlement, judgment, award or other payment is made. Federal law takes precedence over state laws and private contracts.
How long does ESRD last on Medicare?
Individual has ESRD, is covered by a GHP and is in the first 30 months of eligibility or entitlement to Medicare. GHP pays Primary, Medicare pays secondary during 30-month coordination period for ESRD.
What age does GHP pay?
Individual is age 65 or older, is covered by a GHP through current employment or spouse’s current employment AND the employer has 20 or more employees (or at least one employer is a multi-employer group that employs 20 or more individuals): GHP pays Primary, Medicare pays secondary. Individual is age 65 or older, ...
What age is Medicare?
Retiree Health Plans. Individual is age 65 or older and has an employer retirement plan: Medicare pays Primary, Retiree coverage pays secondary. 6. No-fault Insurance and Liability Insurance. Individual is entitled to Medicare and was in an accident or other situation where no-fault or liability insurance is involved.
When did Medicare start offering SNPs?
Medicare first offered SNPs in 2006, and, as such, they are a relatively new type of Medicare Advantage plan. They aim to provide care for those who often have the most significant or most targeted medical needs.
What is Medicare Advantage?
Through a Medicare Advantage plan, a person gets their Part A (hospital benefits), Part B (medical benefits), and in many instances, Part D (prescription drug benefits). Private insurers rather than the Centers for Medicare and Medicaid services administer these bundled plans. Medicare Advantage programs offer SNPs to individuals who have ...
What is a dual eligible SNP?
Enrollees to a Dual Eligible SNP (D-SNP) are intended for those who have both Medicare and Medicaid coverage. According to the Integrated Care Resource Center, this group represents people with the highest medical costs as they often have complex medical needs.
What are the different types of SNP?
Ideally, offering specialized plans can provide the most targeted care for those in need. There are three different SNP types: chronic conditions. dual eligible.
How old do you have to be to get SNP?
An individual would usually qualify for these through being 65 years of age or having a disability.
What are some examples of Medicare plans?
Examples include: access to in-network providers that treat their condition. clinical case management programs that help a person manage their condition.
What is an HMO plan?
Being a part of an HMO means a person has a primary care doctor that acts as a central point of care. The primary care doctor will make a referral to a specialist as needed. These plans typically require a person to choose from a list of in-network providers that help to save money on healthcare costs.
What can I do with my Medicare Advantage Plan?
What can I do? Join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan. Switch from your current plan to another Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan. Drop your Medicare Advantage Plan with drug coverage and return to Original Medicare .
When does Medicare change coverage?
You can’t use this Special Enrollment Period from October–December. However, all people with Medicare can make changes to their coverage from October 15–December 7, and the changes will take effect on January 1.
What is a special enrollment period?
Special circumstances (Special Enrollment Periods) You can make changes to your Medicare Advantage and Medicare prescription drug coverage when certain events happen in your life, like if you move or you lose other insurance coverage. These chances to make changes are called Special Enrollment Periods (SEPs).
What is the difference between Medicare and Original Medicare?
Original Medicare. Original Medicare is a fee-for-service health plan that has two parts: Part A (Hospital Insurance) and Part B (Medical Insurance). After you pay a deductible, Medicare pays its share of the Medicare-approved amount, and you pay your share (coinsurance and deductibles).
What to do if you made wrong choice on Medicare?
Call center representatives can help you throughout the year with options for making changes.
Purpose
- Billions of federal dollars are lost annually due to healthcare fraud, errors, and abuse. The Administration for Community Living (ACL) Office of Healthcare Information & Counseling manages the Senior Medicare Patrol (SMP) grants. The SMP mission is to empower and assist Medicare beneficiaries, their families, and caregivers, to prevent, detect, and report suspected he…
History and Structure
- SMPs were authorized in 1997 under Titles II and IV of the Older Americans Act, the Omnibus Consolidated Appropriation Act of 1997 and the Health Insurance Portability and Accountability Act of 1996. SMPs began as demonstration projects in 12 states. Currently, SMP grants are provided to all 50 states, District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands. Na…
Funding
- SMPs are funded by the Health Care Fraud and Abuse Control (HCFAC) program for its antifraud activities. In 2019 funding for the SMP program totaled approximately $18 million. Approximately $15.6 million of the total funding available was distributed to the state SMP projects to help beneficiaries prevent, detect, and report Medicare fraud, errors,...
SMP Performance Outcomes
- Each year, the Office of the Inspector General (OIG) completes an annual performance report on the SMP projects. The 2020 OIG SMP Performance Report(link is external)documents the following outcomes for 2019 activities: 1. Community Outreach Events: In 2019, SMP projects reached 1.6 million people through 28,146 group outreach and education events. 2. One-on-One …
Resources and Useful Links
- The Senior Medicare Patrol Resource Center(link is external)(SMP Resource Center) provides training and technical assistance to SMP grantees. The SMP Resource Center also provides key consumer services such as fraud alerts and maintains the SMP locator, which helps consumers find their local SMP program. Volunteer Risk and Program Management (VRPM) Policies: ACL h…