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Volume 14 Issue 3, March 2017

CMS Proposes 2018 Payment and Policy Updates for Medicare Health and Drug Plans
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The Centers for Medicare & Medicaid Services (CMS) released proposed changes for the Medicare Advantage and Part D Prescription Drug Programs in 2018 that will, if finalized, provide stable and fair payments to plans.

“Medicare Advantage is an essential, growing part of the Medicare program” said Dr. Patrick Conway, CMS Acting Administrator. “These proposals will continue to keep Medicare Advantage strong and stable and provide high quality, affordable care to seniors and people living with disabilities."

The net payment impact of the proposed updates would result in a modest increase of 0.25 percent on average for Medicare Advantage plans, although individual plans’ experiences will vary. This moderate growth is consistent with last year’s update and reflects a similar pattern in Medicare fee-for-service. Plans that improve the quality of care they deliver to enrollees can see higher updates and can grow and enhance the benefits they offer to enrollees.... Read More

Source: cms.gov

March is National Colorectal Cancer Awareness Month

Awareness Ribbon

Among cancers that affect both men and women, colorectal cancer is the second leading cancer killer in the U.S. But it doesn’t have to be. There is strong scientific evidence that screening for colorectal cancer beginning at age 50 saves lives!

What is Colorectal Cancer?
Cancer is a disease in which cells in the body grow out of control. Cancer is always named for the part of the body where it starts, even if it spreads to other parts of the body later. Colorectal cancer is cancer that occurs in the colon or rectum. The colon is the large intestine or large bowel. The rectum is the passageway that connects the colon to the anus.

Who gets colorectal cancer?
Colorectal cancer occurs most often in people aged 50 years or older. The risk increases with age. Both men and women can get colorectal cancer. If you are 50 or older, talk to your doctor about getting screened... Read More

Source: www.cdc.gov 


Medicare Coverage of Colorectal Cancer Screenings

How often is it covered?
Medicare Part B (Medical Insurance) covers several types of colorectal cancer screening tests to help find precancerous growths or find cancer early, when treatment is most effective. One or more of these tests may be covered:

  • Screening barium enema: When this test is used instead of a flexible sigmoidoscopy or colonoscopy, Medicare covers it once every 48 months if you're 50 or over and once every 24 months if you're at high risk for colorectal cancer.
  • Screening colonoscopy: Medicare covers this test once every 24 months if you're at high risk for colorectal cancer. If you aren't at high risk for colorectal cancer, Medicare covers this test once every 120 months, or 48 months after a previous flexible sigmoidoscopy.
  • Screening fecal occult blood test: Medicare covers this lab test once every 12 months if you're 50 or older.
  • Multi-target stool DNA test: Medicare covers this at-home test once every 3 years for people who meet all of these conditions:
    • They’re between 50–85.
    • They show no signs or symptoms of colorectal disease including, but not limited to, lower gastrointestinal pain, blood in stool, positive guaiac fecal occult blood test or fecal immunochemical test.
    • They’re at average risk for developing colorectal cancer, meaning:
      • They have no personal history of adenomatous polyps, colorectal cancer, inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis.
      • They have no family history of colorectal cancers or adenomatous polyps, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer.
  • Screening flexible sigmoidoscopy: Medicare covers this test once every 48 months for most people 50 or older. If you aren't at high risk, Medicare covers this test 120 months after a previous screening colonoscopy.

Who's eligible?
All people age 50 or older with Part B are covered. People of any age are eligible for a colonoscopy.

Your costs in Original Medicare

  • For barium enemas, you pay 20% of the Medicare-approved amount for the doctor's services. In a hospital outpatient setting, you also pay a copayment.
  • You pay nothing for a multi-target stool DNA test.
  • If a screening colonoscopy or screening flexible sigmoidoscopy results in the biopsy or removal of a lesion or growth during the same visit, the procedure is considered diagnostic and you may have to pay coinsurance and/or a copayment, but the Part B deductible doesn't apply.
  • You pay nothing for the screening fecal occult blood test. This screening test is covered if you get a referral from your doctor, physician assistant, nurse practitioner, or clinical nurse specialist.
  • You pay nothing for the screening colonoscopy or screening flexible sigmoidoscopy, if your doctor accepts assignment.
  Source: medicare.gov
AppleFor more information on covered preventive and screening services, call GeorgiaCares at 1-866-552-4464 (option 4) or visit www.medicare.gov.

5 Ways to Become an Informed Medicare Consumer

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Each day, you make decisions about your finances, health, privacy, and more. It’s important to protect yourself and make the best choices for you, especially when it comes to your Medicare. Here are five things you can do.... Read More

Source: blog.medicare.gov

GeorgiaCares Spotlight

The GeorgiaCares Program is pleased to welcome Pam Popham as the new GeorgiaCares Volunteer Coordinator and MIPPA Specialist for the Southern Georgia Regional Commission's (SGRC) Area Agency on Aging (AAA). Pam has worked as a volunteer for GeorgiaCares since 2012 and transitioned to her new role in January.  

Pam Popham Photo

Pam was enrolled in Albany State University’s (ASU) Social Work Program in 2012 when she began volunteering with the GeorgiaCares Program. She assisted with volunteer recruitment, community outreach, and helped organize events for GeorgiaCares. Pam graduated cum laude with her bachelor’s degree in social work in December of 2014 while volunteering with GeorgiaCares and also completing an internship with the Money Follows the Person (MFP) Program at the AAA. Pam briefly left the AAA and GeorgiaCares to work in the private sector but has recently returned to her passion of assisting senior citizens and adults with disabilities.   

Pam's education, abilities, and desire to serve the Medicare beneficiaries within her community is a valuable addition to the GeorgiaCares Program. 

We Are Looking for Volunteers


Learn how you can become a GeorgiaCares volunteer and make a difference in the lives of seniors and persons with disabilities in your area.
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Owner of DTS Medical Supply Sentenced to 27 Years in Connection with $3.5 Million Health Care Fraud Scheme

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In San Antonio today, 55-year-old Daniel Thomason Smith was sentenced to 324 months in federal prison for his role in an estimated $3.5 million Health Care Fraud scheme announced United States Attorney Richard L. Durbin, Jr., FBI Special Agent in Charge Christopher Combs and Texas Attorney General Ken Paxton.

On June 28, 2016, a federal jury convicted Smith and his co-defendant, Kathleen Marina Kelly-Tuorila of one count of conspiracy to commit Health Care Fraud, one count of aiding and abetting Health Care Fraud, eleven counts of aiding and abetting aggravated identity theft and eight counts of aiding and abetting false statements related to a Health Care matter.

Evidence presented during trial revealed that between May 2006 and January 2010, the defendants conspired to submit numerous false and fraudulent benefit claims to Medicaid and Medicare seeking compensation for powered wheelchairs. Smith employed Robin Renee Haigler, a third defendant in this case, on a commission basis to recruit customers primarily in the Waco area. Kelly-Tuorila used the collected customer information from Haigler to generate and submit fraudulent claims for reimbursement to Medicaid and Medicare for powered wheelchairs... Read More

Source: www.justice.gov

Inside This Issue
News
Medicare Preventive Services
Counseling Tips
GeorgiaCares Spotlight
Fraud in the News
GeorgiaCares Outreach Events
Mar. 11th in Tifton
Mar. 18th in Macon
Mar. 25th in Blakely

map of Georgia

Contact your local GeorgiaCares office for additional outreach events in your area.
Current Events
Jan. 1 - Mar. 31
Medicare General Enrollment Period
Volunteering Hands
Volunteer Opportunities!
You can make a difference for people with Medicare. Visit our website for more info.
GeorgiaCares
Volunteer of the Month
March 2017

Brenda C. Photo
Brenda C.
Brenda C. has been a volunteer counselor with the GeorgiaCares Program for over 5 years. She has dedicated herself to assisting the Medicare beneficiaries of Dekalb County. She conducts Medicare presentations at 4 different counseling sites in Dekalb. Brenda is a great asset to the GeorgiaCares team and often goes above and beyond the call of duty to ensure that the beneficiaries are fully educated regarding their Medicare coverage. Brenda says she volunteers for GeorgiaCares because "I enjoy working with seniors and anyone who needs assistance. This is what I do as a Social Worker...The program gives me great information which I share all the time with my family and friends as well."
We would like to hear about your experience with GeorgiaCares. Please email your comments to
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 GeorgiaCares @dhs.ga.gov
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If you suspect fraud, errors, or abuse when you use Medicare or if someone tries to sell you a product or service you don't need, report it by calling GeorgiaCares at 1-866-552-4464 (Option 4)
Copyright © 2017 Georgia Dept. of Human Services/Division of Aging Services/GeorgiaCares Program
All rights reserved.



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This publication was supported by the Georgia Department of Human Services/Division of Aging Services/GeorgiaCares Program with financial assistance, in whole or in part, through a grant from the Administration for Community Living (ACL) and the Centers for Medicare and Medicaid Services (CMS).