New York State Office for the Aging 2 Empire State Plaza, Albany, NY 12223-1251 George E. Pataki, Governor Walter G. Hoefer, Director

To:[X]Area Agency on Aging Directors [X]HIICAP Coordinators []

PROGRAM INSTRUCTION

Number: 96-PI-51

FYI: Date: November 26, 1996

Subject:Health Insurance Information, Counseling and Assistance Program Application -

10/1/96 - 9/30/97

Supersedes: 95-PI-35

Response Due Date: December 27, 1996

Programs Affected: [] Title III-B[]Title III-C-1[]Title III-C-2[]Title III-D[]Title III-G [] CSE[]SNAP[]Energy[]EISEP[X]HIICAP

Contact Person: Brendan Mooney and Fiscal Team

Telephone: (518) 473-5108 (BM) (518) 474-2379 (FT)

I. INTRODUCTION

The New York State Office for the Aging is seeking applications and renewals from Area Agencies on Aging for grant funds made available to the State Office under Section 4360 of the Omnibus Budget Reconciliation Act (OBRA) of 1990 (Public Law 101-508) administered by the Health Care Financing Administration (HCFA). The grant funds are available to support information, counseling and assistance relating to Medicare, Medicaid, Medicare supplement insurance policies, long term care insurance and other health insurance benefits. II. PURPOSE OF THE GRANT PROGRAM The purpose of the Health Insurance Information, Counseling and Assistance Program (HIICAP) is to strengthen the capability of Area Agencies on Aging to provide Medicare beneficiaries information, counseling and assistance to purchase, claim, and, if necessary, appeal decisions about health insurance coverage. The proposed program must encompass all of the following activities or assurances: •Counseling and assistance to Medicare beneficiaries and their families in need of health insurance

information -An Equal Opportunity Employer-

•Outreach programs to provide necessary information and assistance •Ensuring the availability of volunteer and/or paid staff to provide the required services •Ensuring that volunteer and paid staff members of the health insurance information counseling and

assistance program have no conflict of interest in providing information, counseling and assistance services

•Collecting and disseminating timely and accurate health insurance information •Maintaining and managing the inventory of HIICAP materials, including tracking supplies and

placing orders •Making recommendations concerning consumer issues and complaints related to the provision of

health care to SOFA to forward to agencies and departments of the State and the Federal government responsible for providing or regulating health insurance

Provision of information, counseling and assistance constitute the core activities for a health insurance information, counseling and assistance program. These three activities may be implemented through a variety of methods. Successful models for local HIICAP programs have typically included the following: 1. Information Activities •Distribution of consumer information and education materials to individuals and groups •Educational seminars and public forums •Information through a toll-free hot line or HIICAP phone number •Dissemination of insurance, managed care, MediGap and Long Term Care policy comparison

information •Dissemination of buyer's guides for health, long term care and managed care insurance •Making available materials in the languages of the community in which the program is operated 2. Counseling Activities •Establishment of individual and/or group counseling sessions at senior centers or other forums •Phone counseling assistance to serve beneficiaries who would be unable to come to a site for face-

to-face counseling •Home visits by staff or volunteers where necessary, appropriate and possible •Arranging to counsel people in their native language or through an interpreter if they are not

conversant in English 3. Assistance Activities •Referral of beneficiaries to or intervention on their behalf with other Federal, State or local agencies

or insurance carriers or companies as appropriate, to help with problems with health insurance, Medicare, Managed Care or Long Term Care

•Assistance with policy and health maintenance organization comparison, filling out forms, claims

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filing and appeals III. MINIMUM REQUIREMENTS The minimum requirements of this program must cover the following five content areas: (a) Medicare Eligibility, Benefits, and Claims Filing: Medicare entitlement, description of Medicare benefits and limitations, availability of managed care plans in the county (to the extent they exist), basic information about the Medicare physician fee schedule, physician charge limitations and billing responsibilities, Medicare secondary payer rules, claims filing procedures (to the extent necessary), grievance and appeals processes, and Medicare demonstration project services, where available. (b) Medicaid Eligibility, Benefits, and Claims Filing: Eligibility for benefits, including Qualified Medicare Beneficiaries (QMBs) and Specified Low-Income Medicare Beneficiaries (SLMB), basic description of Medicaid benefits available in the State, basic Medicaid eligibility and benefit limitations, special benefits such as home and community-based care services and Medicaid demonstration project services, where available, spousal impoverishment protection, suspension of Medicare supplement insurance when one is eligible for Medicaid coverage, and description of claims filing procedures (as necessary) and appeals processes. (c) Medicare Supplement Insurance Comparison Information and Claims Filing: Description of the standardized Medicare supplement policies approved for sale in the State, distinction of what these policies cover compared with Medicare benefit limitations, consumer protection provisions under Section 1882 of the Social Security Act, as amended, filing procedures for Medicare supplemental insurance claims and any State specific laws including New York's community and open enrollment law. (d) Long Term Care Insurance Information: A description of the specific limitations of Medicare with respect to long term care services, a description of the basic features of long term care insurance policies, and other considerations when purchasing long term care insurance, including appropriateness of purchase by certain individuals. (e) Other Types of Health Insurance Benefits: Information shall also be made available on alternatives to individual Medicare supplement policies such as employer group and association group insurance and Medicare HMOs. A description of other types of health insurance that are available for purchase by Medicare beneficiaries, including hospital indemnity and limitations, shall also be made available. IV. REPORTING REQUIREMENTS As a condition for accepting funding under this grant program, Area Agencies on Aging are required to complete HIICAP semi-annual reports. Forms for these reports will be provided by the State Office in the near future; they conform to the requirements of the Health Care Financing

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Administration (HCFA). V. YEAR 5 ALLOCATION SCHEDULE AND YEAR 4 EXTENSION REQUESTS While HCFA has advised our Office of the amount of our Year 5 award, it has only obligated 25% of the total anticipated amount to date. SOFA expects to maintain the amount available for Area Agency allocations at the 1995-96 (Year 4) level but expenditure ceilings may be included on NGAs until HCFA has obligated the full Year 5 award to our Office. We have tentatively allocated $172,000 using the weighted population percentages from the Intrastate Funding Formula and a minimum allocation level of $2,350 ($1,175 for the Indian Reservation Area Agencies). A copy of the tentative allocation schedule for the period 10/1/96 - 9/30/97 is attached. Area Agencies may request Year 4 grant extensions beyond September 30, 1996, if additional time is needed to fully utilize Year 4 funds. Extension requests for Year 4 must be submitted to your GMBS II and received no later than December 27, 1996. Since HIICAP funding is discretionary project funding rather than formula funding such as Title III-B, and there is no guarantee of Year 6 funding, our Office is required to liquidate obligations within 90 days after the end of the project budget period (i.e., by December 27, 1997). Therefore, our Office will pro-rate the Year 5 allocation for any Area Agency requesting a Year 4 extension beyond September 30, 1996. This is necessary to ensure that our Office can comply with our HIICAP grant closeout requirements. Area Agencies requesting program period extensions for Year 4 will have their Year 5 award reduced by one twelfth for each month that the Year 4 period is extended. Area Agencies not requesting extensions beyond September 30, 1996, are reminded that SOFA vouchering procedures require the submission of the final claim within 60 days following the close of the program period. Therefore Area Agencies should finalize their Year 4 expenditures and submit their closeout claims by December 27, 1996. As indicated above, the amounts on the allocation schedule are tentative. The final allocation levels will depend on the number of Area Agencies that apply for Year 5 HIICAP funds and the amount of SOFA's total Year 5 award from HCFA. VI. REQUIRED TRAINING The State Office for the Aging will require that Grantees participate in HIICAP training conducted in 1996-97 and use all SOFA-prescribed HIICAP training material. Coordinators must oversee the training and quality of service provided by all volunteer counselors. Any costs directly related to an Area Agency's participation in such training may be paid by the Area Agency from HIICAP grant funds.

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VII. SUMMARY/NECESSARY ACTION Area Agencies wishing to apply for Health Insurance Information, Counseling and Assistance Program (HIICAP) Grant funds for the program period October 1, 1996 through September 30, 1997 must submit three (3) copies (at least one bearing original signature) of the completed application to be received by the State Office no later than December 27, 1996. Area Agencies not wishing to apply for HIICAP Year 5 grant funds should submit a letter to Brendan Mooney at the State Office by December 27, 1996 indicating they do not wish to apply. Letters and completed applications should be submitted to: Mr. Brendan Mooney Benefits & Entitlements Unit New York State Office for the Aging 2 Empire State Plaza, 4th Floor Albany, NY 12223-1251 If you have any programmatic questions, please contact Brendan Mooney at (518) 473-5108. Fiscal questions should be addressed to your Fiscal Team at (518) 474-2379.

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(Filename: HIICAPPI.967) (Rev. 11/26/96/tbm) HEALTH INSURANCE INFORMATION, COUNSELING & ASSISTANCE PROGRAM INSTRUCTIONS: Please forward four (4) copies of this application including ONE copy with the original signature to: Mr. Brendan Mooney New York State Office for the Aging Division of Policy and Program Development Benefits & Entitlements Unit 2 Empire State Plaza, 4th Floor Albany, NY 12223-1251

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CONTENTS: Page 1. Title Page 2 2. Standard Assurances 3 3. Project Narrative 4 4. Budget Narrative 6 (Non NYC HIICAP Application Form)

(sr/11/26/96)

(Filename: c:\wpfiles\tbmhic\HICAPP97.NYS)

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APPLICATION COVER PAGE HEALTH INSURANCE INFORMATION, COUNSELING AND ASSISTANCE PROGRAM Funded Under the Health Care Financing Administration (HCFA) Area Agency Director Address Zip Phone ( ) Fax ( ) HIICAP Coordinator Number of HIICAP Volunteer Counselors Number of HIICAP Paid Staff Counselors Amount Requested PROGRAM PERIOD: October 1, 1996 - September 30, 1997 TERMS AND CONDITIONS: The undersigned agrees with respect to any funds received under this grant to comply with all applicable federal, State and local laws, Program Instructions, regulations and standards, and that the project will be administered in accordance with the programmatic and fiscal data and descriptions provided in the approved application. The person authorized to enter into Agreement with the New York State Office for the Aging should sign below. Print Name Signature Title Date

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STANDARD ASSURANCES NOTE: In addition to the standard assurances which are included as part of the Four Year Plan, Annual Implementation Plan, the following assurances apply: 1.The Area Agency agrees that the Agreement or any part thereof may

not be assigned or transferred without the prior written consent of the State Office for the Aging.

2.The Area Agency agrees that the Project Narrative and Budget

attached hereto are part of the Agreement and may not be modified without the written consent of the State Office for the Aging.

3.The Area Agency agrees to designate a HIICAP Coordinator to be

responsible for the grantee's performance under this Agreement. The HIICAP Coordinator shall be the grantee's representative and contact person for all matters arising under this Agreement. The Coordinator is charged with overseeing the training of volunteer counselors and managing the inventory of training and consumer education supplies. A list of all HIICAP volunteers and staff must be submitted to the State Office for the Aging with this application .

4.The Area Agency agrees that expenditures will be made only for

items of expense that are applicable to the Health Insurance Information, Counseling and Assistance Program. Such expenditures must be allowable and reasonable in accordance with the applicable Federal Office of Management and Budget Circular A-87 or A-122 and necessary for carrying out the activities described in the approved application.

5.Upon approval of this application and issuance of a Notification

of Grant Award, the Area Agency is eligible to request an advance of up to fifty percent (50%) of its award. The Area Agency shall submit appropriate State Vouchers for reimbursement of expenses incurred in the conduct of this Agreement in such form as required by the State Office for the Aging. The final voucher for expenses incurred in the conduct of this Agreement will be submitted to the State Office for the Aging within sixty (60) days after the ending date of the grant period.

6.The Area Agency understands and agrees that all payments to be

made hereunder are subject to the availability of Federal funds, and the State Office for the Aging shall have no liability to the Area Agency beyond the amounts made available to the State Office for the Aging.

7.The Area Agency agrees that State Vouchers submitted for

reimbursement of expenses incurred in the conduct of this Agreement will not include any expenses which have been, or will be, reimbursed from other sources (e.g., other Federal or State funds).

Area Agency

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PROJECT NARRATIVE

A. Program Design Describe the Health Insurance Counseling activities currently provided by the Area Agency. Be sure to indicate if they are provided by staff or volunteers.

Area Agency

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PROJECT NARRATIVE (Continued)

B.Program Outcomes Clearly state how the Health Insurance Information, Counseling and

Assistance funds will be used to provide health insurance counseling services as set forth in Sections II and III of the Program Instruction transmitting this application. Identify specific activities and outcomes and indicate the expected impact on your efforts to serve the targeted elderly.

Area Agency

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BUDGET NARRATIVE SECTION HEALTH INSURANCE INFORMATION, COUNSELING, AND ASSISTANCE PROGRAM ($10,000 and Under)

Program Costs 1.Describe below the types of anticipated charges the Area Agency will

incur in carrying out activities under the HIICAP. Be specific. Include the names of any subcontractors or consultants to be funded under HIICAP and a brief description of their responsibilities.

2.Attach your current list of HIICAP staff or volunteer counselors and

coordinators in the format below. List only those people who have been approved by your HIICAP Coordinator as qualified to provide HIICAP services. Approval should be based on satisfactory completion of the State HIICAP training curriculum. As changes occur, updated lists should be submitted to the State Office attention: Shannon Raducci.

NameRole Date of List: Preparer:

Area Agency

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3.Briefly describe the system your agency has in place for ordering and tracking the HIICAP training and consumer education supplies.

Area Agency

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HEALTH INSURANCE INFORMATION, COUNSELING & ASSISTANCE PROGRAM INSTRUCTIONS: Please forward four (4) copies of this application including ONE copy with the original signature to: Mr. Brendan Mooney New York State Office for the Aging Division of Policy and Program Development Benefits & Entitlements Unit 2 Empire State Plaza, 4th Floor Albany, NY 12223-1251 CONTENTS: Page 1. Title Page 2 2. Standard Assurances 3 3. Project Narrative 4 4.Budget 7 11/26/96 Rev. Filename: wpfiles\tbmhic\HICAPP97.NYC

Area Agency

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APPLICATION COVER PAGE HEALTH INSURANCE INFORMATION, COUNSELING AND ASSISTANCE PROGRAM Funded under a grant from the Health Care Financing Administration (HCFA) Area Agency Director Address Zip Phone ( ) Fax ( ) HIICAP Coordinator Number of HIICAP Volunteer Counselors Number of HIICAP Paid Staff Counselors: Amount Requested PROGRAM PERIOD: October 1, 1996 - September 30, 1997 TERMS AND CONDITIONS: The undersigned agrees with respect to any funds received under this grant to comply with all applicable federal, State and local laws, Program Instructions, regulations and standards, and that the project will be administered in accordance with the programmatic and fiscal data and descriptions provided in the approved application. The person authorized to enter into Agreement with the New York State Office for the Aging should sign below. Name Signature Title Date

Area Agency

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STANDARD ASSURANCES NOTE: In addition to the standard assurances which are included as part of the Four Year Plan, Annual Implementation Plan, the following assurances apply: 1.The Area Agency agrees that the Agreement or any part thereof may

not be assigned or transferred without the prior written consent of the State Office for the Aging.

2.The Area Agency agrees that the Project Narrative and Budget

attached hereto are part of the Agreement and may not be modified without the written consent of the State Office for the Aging.

3.The Area Agency agrees to designate a HIICAP Coordinator to be

responsible for the grantee's performance under this Agreement. The HIICAP Coordinator shall be the grantee's representative and contact person for all matters arising under this Agreement. The Coordinator is charged with overseeing the training of volunteer counselors and managing the inventory of HIICAP materials. A list of all HIICAP volunteers and staff must be submitted to the State Office for the Aging with this application and updated as changes occur.

4.The Area Agency agrees that expenditures will be made only for

items of expense that are applicable to the Health Insurance, Information, Counseling and Assistance Program. Such expenditures must be allowable and reasonable in accordance with the applicable Federal Office of Management and Budget Circular A-87 or A-122 and necessary for carrying out the activities described in the approved application.

5.Upon approval of this application and issuance of a Notification

of Grant Award, the Area Agency is eligible to request an advance of up to twenty-five percent (25%) of its award or $2,500, whichever is greater. The Area Agency shall submit appropriate State Vouchers for reimbursement of expenses incurred in the conduct of this Agreement in such form as required by the State Office for the Aging. The final voucher for expenses incurred in the conduct of this Agreement will be submitted to the State Office for the Aging within sixty (60) days after the ending date of the grant period.

6.The Area Agency understands and agrees that all payments to be

made hereunder are subject to the availability of Federal funds, and the State Office for the Aging shall have no liability to the Area Agency beyond the amounts made available to the State Office for the Aging.

Area Agency

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7.The Area Agency agrees that State Vouchers submitted for

reimbursement of expenses incurred in the conduct of this Agreement will not include any expenses which have been, or will be, reimbursed from other sources (e.g., other Federal or State funds).

Area Agency

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PROJECT NARRATIVE

A.Program Design Describe the Health Insurance Counseling activities currently provided by the Area Agency. Be sure to indicate if they are provided by staff or volunteers.

Area Agency

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PROJECT NARRATIVE (Continued)

B.Program Outcomes 1.Clearly state how the Health Insurance Information, Counseling

and Assistance funds will be used to provide health insurance counseling services as set forth in Sections II and III of the Program Instruction transmitting this application. Identify specific activities and outcomes and indicate the expected impact on your efforts to serve the targeted elderly.

2.On a separate piece of paper provide a current list of HIICAP

personnel (counselors and coordinators) in the format below. List only those people who have been approved by the county by virtue of their HIICAP training as qualified to provide HIICAP services. Approval should be based on satisfactory completion of the State HIICAP training curriculum. As changes occur, updated lists should be submitted to the State Office attention: Shannon Raducci.

NameRole Date of list: Preparer:

Area Agency

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PROJECT NARRATIVE (Continued)

3.Briefly describe the system your agency has in place for tracking HIICAP training and consumer education materials and how you manage those supplies.

Area Agency

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AREA AGENCY SUMMARY BUDGET HEALTH INSURANCE INFORMATION, COUNSELING AND ASSISTANCE PROGRAM (Greater than $10,000)

BUDGET CATEGORY

BUDGET AMOUNT

1. Personnel

$

2. Fringe Benefits

3. Equipment

4. Travel

5. Maintenance & Operations

6. Other Expenses

7. Subcontracts

8. Total Budget (Lines 1-7)

$

9. Federal Funds Requested

$

Area Agency

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SUPPORTING BUDGET SCHEDULE HEALTH INSURANCE INFORMATION, COUNSELING, AND ASSISTANCE PROGRAM

1. Personnel

Name (If Known) & Title Annual Salary

Amount Chargeable to Program

$ $

TOTAL:

2. Fringe Benefits - Composite Percentage: % TOTAL: $

3. Equipment: (Equipment items having a unit cost of $1,000 or more must be described in detail. Other equipment items with a unit cost of less than $1,000 can be described in narrative form at the bottom of this section.)

Item and Description (Unit Cost of $1,000 or More)

Quantity Unit Purchase Price

Annual Unit Rental Price

Amount Chargeable to Program

SUBTOTAL:

Briefly describe equipment items with a unit cost of less than $1,000.

SUBTOTAL:

TOTAL:

5. Maintenance and Operations

Rental Costs (describe briefly): $ Other Maintenance & Operations Costs (e.g., communications, printing, supplies) $ TOTAL:

Area Agency

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SUPPORTING BUDGET SCHEDULE HEALTH INSURANCE INFORMATION, COUNSELING, AND ASSISTANCE PROGRAM

6. Other Expenses: (List Specific Item and Cost)

Item Cost

TOTAL: $

7.Subcontracts: List each contract and amount. A copy of each contract must be submitted to the State Office for the Aging before reimbursement will be made.

Subcontractor Amount SOFA Use ONLY Cont. Rec.

Total Number of Subcontracts: A. SUB-TOTAL: $

Consultant (List Name & Title for Each Entry)

Type of Service

Unit Cost (Rate/Hr)

No. of Units (Hr/Sessions)

Amount

N T

N T

B. SUB-TOTAL: $

TOTAL (A+B): $

9. Federal Funds TOTAL: $