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How This Crisis Will Change You

Posted by www.psmbrokerage.com Admin on Wed, Mar 25, 2020 @ 07:41 PM

How This Crisis Will Change You

More Committed

Great article by Anthony Iannarino from thesalesblog.

We are in the middle chapters of our continuing crisis. Pundits and prognosticators are suggesting that our lives will never be the same, that we will be changed, altered by the events of our time, as were our parents, grandparents, and our ancestors. If this is true, then we should decide for ourselves what those changes might be.

More Grateful

If you are going to be changed by this crisis, the right place to start is by being more grateful, especially for the things we take for granted. Losing something often causes one to be more thankful for what was lost.

You might be grateful for the freedom to go where you want to go when you want to without restrictions. Until you are deprived of that freedom, it’s easy to take that freedom for granted. You might also be grateful for the unbelievable options available to you for eating, entertainment, and things you buy.

You might not have been grateful for your job, your clients, or your work family until events beyond your control disrupt those things. You may even be thankful for the grouchy guy that works in your IT Department.

The ability to gather in small and large groups, to hug people when you see them instead of bumping elbows, the ability to sit next to someone, or fly across the country or the world are all worth your gratitude.

Better Health

There are dozens of conspiracy theories about this virus, something that the human mind conjures up when it tries to explain something it doesn’t understand by creating a narrative to make sense of things it doesn’t understand or refuses to believe. The best conspiracy theory I have found is that this was a plot to get us to wash our hands. I guess that while we are dealing with a new virus, the old ones will be significantly reduced.

If you are going to be changed by the events of 2020, after gratitude, there is no better place to start than your physical, psychological, and emotional health. The importance of things like sleep and recovery, hydration, exercise, and diet are all critical to health and well-being, including your immune system. It’s also crucial to take measures to reduce your stress level, whether that be through contemplative prayer, meditation, yoga, journaling, sitting in a hot bath, or simply taking a nap and resetting yourself. The Dali Lama has suggested that the best mediation is sleep.

Crisis and disruptive events can take a toll on you emotionally.

Deeper Relationships

The essential things in life are not things. They are not a “what’s,” but instead, they are “who’s.” While you might miss your car, your house, your first edition, signed copy of some book you treasured, none of these things will come before your people, your relationships.

Many of us are calling the people we love and care about to make sure that they are okay. Some of us are delivering things to the people in our lives who are not able to acquire the things they need or take care of themselves. When we are worried and concerned, we recognize what’s most important, taking actions we wouldn’t take under different circumstances.

Allow this event to change you positively by reminding you of what is important in your life. Let it cause you to continue to value your relationships and increase the time you spend with the people that matter most and to ensure that they feel they are what you truly appreciate.

More Prepared

In 2001, two buildings fell in New York City. In 2008 and 2009, we experienced the second deepest recession in our short history. Now, in 2020, we face a health crisis to match the intensity and destruction of these events, which seem to show up every decade or so, following a period where things are good and stable.

Experiencing these events can prepare you for the next disruption or crisis. Navigating through a crisis is how you learn to find your way when there is no playbook, and when there are more unknowns than knowns. Part of the experience is learning to live with the unknowns, something that makes it is easier to accept when faced with similar challenges. The other part of the experience is making decisions, right or wrong, and learning what works and what doesn’t.

The greatest of human attributes, the linchpin of all character traits, is resourcefulness, our creativity as applied to our problems, challenges, and obstacles, our ingenuity.

If there is a trait you find in all human beings, except for those plagued by learned helplessness, it is the ability to discover and create solutions to intractable problems. I’m referring to problems like polio, measles, mumps, smallpox, traveling through space, feeding a growing population with fewer resources, and miniaturizing supercomputers to fit in your pocket allowing you to have a television, movie theater, radio, video camera, calendar, communication hub, conference calls, email, books, newspapers, notebooks, habit trackers, and a zillion other apps. All of which is to say, “We’ve got this.”

The lessons you learn now will prepare you for the next crisis, even if only preparing you to operate in a world of unknowns.

More Committed

Your goals and dreams might not have been getting the time and the energy they deserved. You might have written them down at the end of last year, only to allow them to sit collecting dust, making little or no progress on what you profess to want. Let this be a time you increase your commitment to your goals and dreams.

A positive change from a disruptive event like the one we are experiencing now is to finally take action on your goals and dreams, giving them priority over other things, including your excuses, your distractions, and procrastination. There is magic in goals so big they scare you and even more magic in doing the work that brings them life.

You can be reborn in times of turmoil and tumult. You can decide to be changed by being more, doing more, having more, and contributing more in the face of the disruption. It’s an act of defiance to live a life of your choosing and your design under ordinary circumstances, and it’s a revolution to do so in a crisis.

If you are going to be changed by this crisis, be intentional about that change and allow it to make you stronger.

Source: https://thesalesblog.com/2020/03/23/how-this-crisis-will-change-you/

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Tags: Medicare Advantage, Medicare, Medicare Supplement, Medicare Part D, COVID-19

CMS Guidance and Waivers for MA and Part D Plans Response to COVID-19

Posted by www.psmbrokerage.com Admin on Thu, Mar 19, 2020 @ 03:27 PM

CMS Guidance and Waivers for MA and Part D Plans Response to COVID-19

CMS Guidance and Waivers for MA and Part D Plans Response to COVID-19

Over the past week, the Centers for Medicare & Medicaid Services (CMS) has made a number of announcements related to Medicare coverage in connection with the Coronavirus (COVID-19) outbreak. Several of those announcements have been specific to Medicare Advantage and Part D.

IN DEPTH

Medicare Advantage Organizations

Regulations Disasters and Emergencies. Pursuant to 42 CFR § 422.100(m), “special requirements” go into effect for Part A/B and supplemental Part C benefit access during disasters and emergencies, including state declarations of emergency and a presidential declaration under the Stafford Act.

While in effect, these special requirements are that MA Plans must:

Cover Medicare Parts A and B services and supplemental Part C benefits at non-contracted facilities subject to § 422.204(b)(3)’s requirements that facilities have participation agreements with Medicare
Waive requirements for gatekeeper referrals
Provide the same cost-sharing for enrollees as if the service was furnished at a plan-contracted facility
Make changes that benefit enrollees effective immediately, without the 30-day notification requirement at § 422.111(d)(3).

Cost-Sharing Waivers and Telehealth. In a March 10 memo, CMS also advised Medicare Advantage Organizations (MAOs) of additional flexibilities for MAOs through the exercise of CMS’s enforcement discretion.

MAOs may waive or reduce enrollee cost-sharing for COVID-19-related services, such as laboratory tests, telehealth benefits or other services to address the outbreak, as long as they do so consistently for all affected enrollees.
MAOs may provide enrollees access to Medicare Part B services via telehealth in any geographic area and from beneficiaries’ homes. This flexibility is irrespective of the scope of the telehealth benefit the MA plan filed and CMS approved.
On March 17, 2020, CMS issued waivers and guidance to provide Medicare coverage of telehealth. These waivers appear to describe FFS Medicare coverage, and do not directly mention or address any requirements for Medicare Advantage plans.

CMS noted that it had consulted with the Office of Inspector General (OIG), and that plans that utilized these flexibilities would satisfy the safe harbor to the federal anti-kickback statute set forth at 42 CFR § 1001.952(l). Once the outbreak has subsided, CMS will notify MAOs and Part D sponsors through the Health Plan Management System that CMS is ending its enforcement discretion with respect to such measures.

Section 1135 Waivers. The Secretary issued a Section 1135 waiver providing that CMS may authorize Medicare administrative contractors to pay for Part C covered services and seek reimbursement from MAOs for those services retrospectively.

On March 13, CMS waived and modified requirements related to Medicare Advantage appeals and grievances.

Part D Sponsors

Expectations and Authorities. The March 10 memo also reminded Part D sponsors of provisions contained in the Prescription Drug Benefit Manual to ensure adequate emergency access for enrollees:

Part D sponsors are expected to relax their “refill-too-soon” edits if necessary to ensure access to covered Part D drugs.
If enrollees cannot reasonably be expected to obtain covered Part D drugs at a network pharmacy, sponsors must ensure that such enrollees have adequate access to covered Part D drugs dispensed at out-of-network pharmacies, although enrollees will remain responsible for any cost sharing and additional charges that exceed the plan allowance, as applicable.
For enrollees that cannot physically access a retail pharmacy (e.g., because of a quarantine), Part D sponsors may relax any plan-imposed policies that would discourage certain methods of delivery, such as mail or home delivery, for retail pharmacies that provide such services
In the event that Part D drugs are identified to treat or prevent COVID-19, Part D sponsors may waive prior authorization, as long as they do so consistently.
If a vaccine becomes available for COVID-19, Part D plans will be required to cover the vaccine if it is a Part D drug. Otherwise, it will be covered under Medicare Part B.

Source: https://www.natlawreview.com/article/cms-guidance-and-waivers-ma-and-part-d-plans-response-to-covid-19

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Tags: Medicare Advantage, Medicare, Medicare Supplement, Medicare Part D, COVID-19

Will Medicare Pay For The Coronavirus?

Posted by www.psmbrokerage.com Admin on Thu, Mar 19, 2020 @ 03:13 PM

Will Medicare Pay For The Coronavirus?

Will Medicare Pay For The Coronavirus

Beginning Tuesday, March 17th, all local Social Security offices nationwide were closed to in-person visits and have asked those who need assistance to call your local Social Security office or Social Security’s 800 number at 1-800-772-1213 for assistance by phone. There is not a specified re-open date for local Social Security offices currently.

Toni: I must have missed this when listening to the national media coverage of the Coronavirus, but no one has explained how Medicare is covering the testing, vaccinations or quarantined in a hospital if anyone in my family that is on Medicare becomes infected with the virus.

My husband and I have recently retired and are covered by Original Medicare with a Medicare Supplement and a stand-alone Medicare Part D plan. Our parent’s situations are different as they both are covered by Medicare Advantage plans. My parents are both Texas retired teachers covered by TRS Medicare Advantage plan and my husband’s parents are covered by his father’s employer retiree Medicare Advantage plan.

How will Medicare pay for these different situations? I’d like to know what to do if I must take one of my family members or myself to the doctor or hospital. Thanks, Sheila from Bellaire, TX.

Sheila: We are witnessing a healthcare crisis that no one can be sure if they are safe. Especially the 60+million Medicare beneficiaries frightened of COVID-19, the disease caused by Coronavirus.

Let me discuss the various ways that Medicare will cover the testing and medical care for the 2 different Medicare plans…Original Medicare and Medicare Advantage plans:

Original Medicare with Stand-alone Part D and COVID-19 (Coronavirus) testing began on or after February 4, 2020. You will pay nothing for Medicare covered clinical diagnostic laboratory testing provided. Your medical provider will have to wait until April 1, 2020, to be able to submit a claim to Medicare for this test. **it is very important to verify that your Medicare facility, provider or medical professional is accepting Medicare assignment for Medicare to pay for COVID-19. When a vaccine is available for the Coronavirus, then all Medicare Part D plans will carry the vaccine and copays may apply. Telehealth is offered with Original Medicare. Medicare Part A (In-patient Hospital) and Part B (Medical Benefit) deductibles and copays may apply.
Medicare Advantage plan with Medicare Part D and COVID-19: Medicare beneficiary will have access to the same Medicare benefits. Medicare allows Medicare Advantage plans to waive cost-sharing for COVID-19 lab tests. Check with your Medicare Advantage plans to verify your coverage and costs. Telehealth coverage and additional coverage maybe offered. Once a vaccine for COVID-19 is available, then Medicare Advantage Prescription Drug plan copays apply. It is advised that the medical provider or facility be in network to receive your lowest cost for medical and vaccine costs.

Toni: After April 1 when the medical community that is accepting Medicare assignment begin to file claims regarding COVID-19 (Coronavirus), then we will really know how claims will be paid. Remember accepting Medicare assignment and not just billing Medicare is the key to how a COVID-19 claim will be paid. Since you and your husband are covered by Original Medicare with a Medicare Supplement and stand-alone Medicare Part D, you may pay a certain amount for your claim and your parents which are both covered by a Medicare Advantage plan with Part D may pay a completely different amount or co pays because these are two different types of Medicare plans.

Toni King, author of the Medicare Survival Guide® is giving a $5 discount on the Medicare Survival Guide® Advanced book to the Toni Says Medicare column readers at www.tonisays.com.

Source: https://www.canyon-news.com/will-medicare-pay-for-the-coronavirus/106437