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- Victoria Allison
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33 ATTESTATION OF SHIP MINIMUM REQUIREMENTS The State Health Insurance Assistance Program (SHIP) grant is intended to strengthen the capability of states to provide all Medicare eligible individuals information, counseling and assistance on health insurance matters. The grant from the Centers for Medicare & Medicaid Services (CMS) helps ensure that states have a network of staff and volunteers to provide accurate and objective health insurance information and assistance in making informed health coverage decisions and understanding related rights and protections. Although states have adopted a variety of methods to provide such services to individuals, Section 4360 of the Omnibus Budget Reconciliation Act of 1990 requires that each state program must encompass all of the following activities: 1. Counseling and assistance to eligible individuals in need of health insurance information including: a. Information that may assist individuals in obtaining benefits and filing claims under Titles XVIII and XIX of the Social Security Act. b. Policy comparison information for Medicare supplemental policies (as described in section 1882(g)(1) of the Social Security Act, as amended) and information that may assist eligible individuals with filing claims under such Medicare supplemental policies. c. Information regarding long-term care insurance. d. Information regarding Medicaid programs, including Medicare Savings Programs. e. Information regarding other types of health insurance benefits that may be provided to eligible individuals in the state. f. Information regarding health insurance coverage options created under the Balanced Budget Act of 1997 and subsequent amendments under the Balanced Budget Refinement Act of 1999, the Benefits Improvement and Protection Act of 2000, and the Medicare Prescription Drug, Improvement and Modernization Act (DIMA) of Outreach programs to provide health insurance information, counseling and assistance to eligible individuals. 3. Systems of referral to appropriate Federal or State departments or agencies that provide assistance with problems related to health insurance coverage (including legal problems). 4. Establishing a sufficient number of staff positions (including volunteers) necessary to provide the services of a health insurance information, counseling and assistance program.
34 Page 2 Minimum Requirements 5. Assuring that SHIP staff members (including volunteers) have no conflict of interest in providing health insurance information, counseling and assistance, and assuring the safeguarding of confidential beneficiary information (see attached guidelines, which have useful concepts). 6. Collecting and disseminating timely and accurate health insurance information to staff members (including volunteers). 7. Training programs for staff members (including volunteers). 8. Coordinating the exchange of health insurance information between the staff of departments and agencies of the state government, other pertinent federal agencies including CMS, and SHIP staff (including volunteers). 9. Making recommendations concerning consumer issues and complaints related to the provision of health care to agencies and departments of the state and federal government responsible for providing or regulating health insurance. As the duly authorized representative of the applicant, I certify that the applicant will fulfil the minimum requirements as stated above. Signature of Authorized Certifying Official Title Applicant Organization Date
35 State Health Insurance Assistance Program (SHIP) Useful Concepts Regarding Safeguarding Client Information Keeping Client Information Safe Because SHIP counselors help Medicare beneficiaries handle billing problems, claims disputes, and in making important health insurance decisions, it is not only important that we protect their personal information, but it is also the law! The Health Insurance Portability and Accountability Act of 1996 (HIPAA, Title II), directed by the US Department of Health and Human Services, was developed to meet the growing need for stronger safeguards for maintaining an individual's health privacy. Included among the many procedura1 standards is the "Privacy Rule" which bans the release of certain individually identifiable health data without prior written authorization. In general, the HIPAA Privacy Rule requires that states ensure that individually identifiable health care information remains confidential and secure. Failure to comply exposes the violator to civil and criminal penalties, as well as loss of federal matching funds. Securing Computer and Paper Records All client information should be protected, both on computer files and in paper files. Documentation of counseling sessions and/or interactions with beneficiaries should be saved onto a secure system. Each sponsoring agency should have in place written procedures to protect electronic data. Paper files should be kept in locked filing cabinets. When leaving a work station for any length of time, files should be closed and locked with the key kept in separate place. When leaving a work station, documentation containing personal client date should not be left out in open view. Place client documents in a file and lock them inside. Sharing Information When is it okay to share personal client information? Sometimes sharing information is necessary to resolve problems. In this case, the counselor must have permission from the Medicare beneficiary. There are three ways this can happen: 1) The beneficiary (or legal representative) is physically present with the counselor while discussing personal information with other entities and the beneficiary grants verbal pennission; 2) The beneficiary is present while on a 3-way conference call and gives verbal permission to discuss personal information or 3) The beneficiary gives written permission for the counselor to discuss personal information to resolve problems being discussed with counselor. In addition, SHIP counselors with ''Unique ID numbers" (a CMS-developed system) may access specific health insurance information from certain agencies for the purpose of assisting individual consumers.
36 Enforcement Measures Each sponsoring agency for SHIP and SMP programs is responsible for training staff, monitoring, and enforcing security and safety procedures and policies established specifically for the individual agency. Why is this so important? May 23 rd, 2006 The Department of Veterans Affairs (VA) has recently learned that an employee, a data analyst, took home electronic data from the VA, which he was not authorized to do. This behavior was in violation of VA policies. This data contained identifying information including names, social security numbers, and dates of birth for up to 26.5 million veterans and some spouses, as well as some disability ratings. Importantly, the affected data did not include any of VA's electronic health records nor any financial information. The employee's home was burglarized and this data was stolen. The employee has been placed on administrative leave pending the outcome of an investigation. Keeping our clients safe and secure is of UTMOST IMPORTANCE!
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Blue Cross MedicareRx SM Medicare Prescription Drug Plan Individual Enrollment Form Please contact Blue Cross MedicareRx if you need information in another language or format (Braille). To enroll in Blue