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Fact Sheet
MEDICARE’S PROPOSED REGULATION TO IMPLEMENT NEW PREVENTIVE SERVICES UNDER MEDICARE MODERNIZATION ACTToday’s Action: The Centers for Medicare & Medicaid Services (CMS) proposed regulations to implement the preventive benefits provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). These provisions reflect modern medical practice by expanding the number of preventive services available to Medicare beneficiaries. Adding these services will continue Medicare’s evolution into a truly preventive care program.
Beginning in 2005, all newly enrolled Medicare beneficiaries will be covered for an initial physical examination, all beneficiaries will be covered for cardiovascular screening blood tests, and those at risk will be covered for a diabetes screening test in order to increase early detection and treatment of this life-threatening condition.
These benefits are in accordance with guidelines from the United States Preventive Services Task Force. These benefits are in line with and complement several administrative initiatives such as Healthy People 2010, Steps to a Healthier US, Secretary’s Diabetes Detection Initiative, and Healthy Communities.
Background: Each year, hundreds of thousands of Americans die prematurely as a result of diseases that often are preventable, such as heart disease, cancer, and diabetes. Evidence suggests that catching a disease in its early stages brings better prognosis for the patient. The course of many of these chronic diseases can be dramatically slowed with proper behavioral modifications and lifestyle changes. This points to the need for the early detection that screening provides.
The number of Americans with these diseases is staggering. Heart disease and stroke—the principal components of cardiovascular disease—are the first and third leading causes of death for both men and women in the United States, accounting for nearly 40% of all deaths. In addition, according to CDC, one in five adults age 65 and over has diabetes. A third of people with diabetes don’t know they have it. The costs of these diseases to both individuals and to society are staggering. The economic impact of cardiovascular disease on the U.S. health care system continues to grow as the population ages. The cost of heart disease and stroke in the United States is projected to be $368 billion in 2004, including health care expenditures and lost productivity from death and disability. Approximately 129 million U.S. adults are overweight or obese which costs between $69 billion to $117 billion per year. Smaller amounts might be spent preventing these conditions. There is accumulating evidence that much of the morbidity and mortality associated with these chronic diseases may be preventable. These new benefits can be used to screen Medicare beneficiaries for many illnesses and conditions that, if caught early, can be treated and managed, and can result in far fewer serious health consequences.
OTHER CMS PREVENTIVE BENEFITS
When Medicare was established in 1965, it only provided services for the diagnosis and treatment of illness or injury. Preventive services were not covered. As the value of preventive services has become better understood, Congress has amended the Medicare law in an effort to expand coverage of preventive benefits.
Both the Balanced Budget Act of 1997 (BBA) and the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) significantly added to the preventive benefits covered by Medicare. These benefits include:
CMS’ PREVENTIVE BENEFITS OUTREACH
We can demonstrate the benefits of preventive health care services, but we also know that simply offering these services is not always enough to guarantee that Medicare beneficiaries take advantage of the benefits that they provide. CMS is taking significant steps to reach out and educate beneficiaries about these new benefits and encourage participation. We strive to use efficient and cost-effective approaches by partnering with other agencies and organizations, utilizing Medicare contractors to educate people with Medicare about covered preventive services and encouraging beneficiaries to use these services. Several initiatives are planned to inform new enrollees about the initial physical exam benefit.
Medicare & You 2005 Handbook Beginning October 2004, this publication will include information about this new benefit. Copies are mailed directly to new enrollees each month. Beginning in January 2005, CMS will add prominent, targeted information about the physical exam to the versions that are mailed to new enrollees.
“Guide to Medicare’s Preventive Services” publication In Fall 2004, this publication will explain the new benefit. Beneficiaries, caregivers, health care professionals, and information intermediaries can request a free copy from www.medicare.govand 1-800-MEDICARE.
2-page Preventive Services Fact Sheet In late Fall 2004, a 2-page fact sheet will provide an overview of this benefit. It will be available from www.medicare.gov and 1-800-MEDICARE.
Initial Enrollment Period (IEP) Package Work has started on an update and redesign of the Initial Enrollment Period Package, which may include information about this new benefit. CMS expects to begin mailing the new package after September 2005 to newly eligible beneficiaries.
Ongoing meetings and presentations with advocacy and outreach groups CMS staff will take advantage of existing opportunities to share information about the physical exam with these groups.
1-800-MEDICARE Call center operations staff will add relevant scripts to all call center desktops. Call center operations staff will add tips to relevant call center scripts that will cue customer service representatives to inform new enrollees of benefit.
Educating the providers CMS will provide primary care physicians and other health care professionals with materials via various channels, including MedLearn website, to help them communicate this benefit to beneficiaries.
We include health promotion information as a part of many education campaigns that address different aspects of the Medicare program or Medicare Advantage options. We have established partnerships with other HHS agencies to carry out health promotion initiatives ranging from limited distributions of outreach kits to national multi-media, multi-year campaigns involving numerous partners at the local and national level. Preventive service use is growing and CMS hopes that these changes to Medicare encourage our beneficiaries to take advantage of these health-promoting activities and ultimately increase the length and quality of life for our senior Americans. # # #
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Centers for Medicare & Medicaid Services
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