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Medicare News

I. New Annual Screening Mammography Benefit Under Medicare
New law signed by the President on August 5, 1997, as part of the Balanced Budget Act of 1997 provides Medicare coverage for annual screening mammograms for all Medicare eligible women age 40 and over, and waives the Part B deductible for screening mammography, effective for services provided on or after January 1, 1998.

Explanation of prior law compared to new law:

• Frequency of coverage for mammography Prior law provided coverage of annual screening mammograms for women age 50-64, and those at high risk age 40-49. However, screening mammograms for women over 64, and for women at normal risk age 40-49, were covered only biennially. The new law expands coverage to pay for annual screening mammograms for all female Medicare beneficiaries age 40 and over, for services provided on or after 1/1/98. This change removes an anomaly in the prior law that provided more frequent mammography for women age 50-64 than for those over 64, even though the risk of breast cancer increases with age. It also makes coverage consistent with the frequency recommendations of most major breast cancer authorities.
  
  
• Cost-sharing for mammography services Prior law required beneficiaries to pay the Part B deductible (to the extent not already met) and 20% coinsurance for both screening and diagnostic mammograms. The new law waives the deductible for screening mammograms for services provided on or after 1/1/98. Beneficiaries must still pay 20% coinsurance for screening mammography, and must pay both the unmet deductible and 20% coinsurance for diagnostic mammography.
  

• Mammography HORIZONS Project As part of the HCFA HORIZONS Program: Special Partnerships for Special Populations, a mammography project is being conducted to develop local partnerships for Hispanic American and African American communities in six major cities - Philadelphia, Atlanta, Cleveland, Chicago, San Antonio, and Los Angeles. Partners will work together to conduct locally planned interventions to increase the rates of mammography screening for Medicare beneficiaries in these communities. We have completed the market research phase, examining the knowledge, attitudes and beliefs of beneficiaries and health care providers to better understand the barriers to mammography utilization in those cities. One-day meetings are being held in each of the cities, including all the key stakeholders, to begin planning appropriate interventions which will be conducted by the PROs in collaboration with the partner organizations. The mammography HORIZONS project is a three year commitment by HCFA to increase the use of Medicare mammographyscreening services.
  
  
• Preventive Screening Services Project A collaborative project with the Centers for Disease Control and Prevention and Maryland’s Department of Health and Mental Hygiene is being conducted to evaluate the effectiveness of physician referral, prompted by an office reminder system for mammography and papsmears utilization (as reflected in Medicare billing data) for Medicare African-American beneficiaries age 65 and older.
  
  
• Mammography Campaign Print Materials HCFA tested mammography messages and visual designs on female Medicare beneficiaries age 65 and over in order to provide these women with relevant, understandable printed information about the importance of regular mammograms and Medicare coverage available for mammograms. Based on the results of this testing we designed postcards, posters, bookmarks and stickers. The messages and graphic design on the materials are simple and straight forward and were accepted amongst the variety of ethnic and racial groups tested. The materials are in English and Spanish and will be distributed to Medicare beneficiaries through HCFA’s contractors (Peer Review Organizations, Carriers, ICA Grantees, and HMOs) and various partners (health departments, breast cancer groups, beneficiary advocacy groups, etc.).
  
  
• Mammography Data Books HCFA has printed mammography data books for 1994-1995 Medicare mammography utilization rates. This data can also be retrieved off of HCFA’s homepage: www.hcfa.gov/stats/mamm/mammover.htm. In addition, 1995-1996 data is being released in October.
  
  
• Radio Public Service Announcements HCFA is sending English and Spanish radio PSA scripts to radio stations nationwide that target the older population. The PSAs were designed and tested by one of HCFA’s Peer Review Organizations.
  
  
• Media Campaign HCFA is in the midst of planning a media campaign to announce the expanded screening mammography benefit in January or February. A possibility is to hold a one or two day conference on breast cancer and mammography and to invite federal agencies, breast cancer leaders and the press. In addition, HCFA will update its print and video materials to reflect the message about new coverage for annual mammograms. Finally, HCFA will aggressively pursue print, tv and radio coverage of the benefit change.
  

• www.hcfa.gov/medicare/hsqb/hsqb3f.htm (abstract)
• www.hcfa.gov/medicare/hsqb/hsqb6f.htm (fact sheet)

• www.hcfa.gov/stats/mamm/mammover.htm
• HCFA’s Medicare Hotline (1-800-638-6833) provides information on Medicare coverage of mammograms.