Rebecca Kinney, ACL Marissa Whitehouse, ACL Future of SMP Rebecca Kinney, ACL Marissa Whitehouse, ACL

Partnership with OIG

ACL Fraud Alerts Official process to alert the OIG of concerning case trends or other widespread issues Provides an overview of the issue Excludes individual case details OIG can ask for more details if needed Not for public dissemination Inaugural Fraud Alert – Genetic Testing Sent June 13th

SMP Consumer Alerts Created in conjunction with the Fraud Alerts for the OIG Intended for public release Allows us to get the word out on scams/issues more broadly with a consistent message 1st Consumer Alert was released in June 28th on Genetic Testing

Possible Updates to OIG Report Goal: Broaden the Report to enhance the narrative No plan to remove anything from the report; discussions have only been on adding Possible additions we’re considering: Tracking Fraud Alerts to OIG, Tracking the Consumer Alert dissemination, and Including Beneficiary Survey data Report is about results; not outcomes. So how we’re doing, not what we’re seeing.

Opioid Fraud and Abuse Fighting the national opioid epidemic is one of the Administrations top priorities Please start reporting Opioid related cases to ACL via SIRS Examples of cases that should be reported: Medicare beneficiary is being over-prescribed pain medication, Pharmacies may be involved in drug diversion involving opioids, or Situations Medicare has been billed for prescriptions that that the beneficiary did not receive, or were not prescribed to the beneficiary.

New Casework Process More to come during the “Life of a Case” at 10:35 am.

Updates and Enhancements SIRS

SIRS Updates Coming Soon 90 Day Password Change Requirement – Now in Effect Individual Interaction Form Updates New Topics Discussed Genetic/DNA Testing & Opioid Fraud and Abuse - Available Now All “Other” Boxes will Require Text Explanation Claim Information will be Removed New section “Referred beneficiary to…” will be Added Beneficiary Race and Gender will be Added Individual Interaction Form Update New Topics Discussed Conditional Payments Genetic/DNA Testing (available as of 7/20) Medicare Summary Notice Medicare Card Opioid Fraud and Abuse (available as of 7/20) All “Other” Box will have a box to add additional details and will be required if Other is selected Removing Claim Information – this section was not often used and is being removed to save space on the form. The information input previously will be available through the search feature New section “Referred beneficiary to…” This section will help differentiate between actions the SMP took listed under “SMP Actions” and actions the SMP referred the beneficiary to take Beneficiary Race and Gender Added

SIRS Updates Coming Soon SIRS Team Member Form Updates Aligning Race & Gender Data Collection with STARS Adding Date of Birth Send Credentials will be relabeled “Resend” after initial sending Group Outreach & Media Outreach Forms Updates Topics Discussed Updates ACL/SMP Consumer Alert New Reports launching soon! Interaction Summary Report Team Member “all-in-one” Report Next Workgroup Meeting: August 6th at 3pm ET SIRS Team Member Form Update Aligning Race & Gender categories with what is collected in STARS Adding Date of Birth Send Credentials will be relabeled “Resend” after initial sending - Remove any send credential buttons after credentials have been sent (eFile, User Logins). Replace with a “Resend User Credentials” and “Resend eFile.” Group Outreach & Media Outreach Forms Update Topics Discussed Updates – these changes align with the updated Topics Discussed on the Individual Interaction for ACL/SMP Consumer Alert New Reports launching soon! Interaction Summary Report – will give a count of all fields on the form so that we can learn more about the beneficiaries served and hot topics/common referrals Team Member “all-in-one” Report – requested by the workgroup – will show the totals of all forms for team members

Beneficiary Survey Update

General Results Over 5000 total responses. More in Year 2 (2700) than Year 1 (2300). Over 80% of States/Territories generated over 100 responses, despite a request of 75 responses per State/Territory. Results were extremely positive, particularly for question 3 (“Useful information”), 4 (“Overall satisfaction”) and 6 (“Recommendation”). Little change from Year 1 to Year 2. Very positive in both Years.

SMP Detailed Results

Survey Breakout Year 1 - Red Year 2 - Yellow Year 3 - Blue Not Shown: AK (Year 1), HI (Year 3), PR (Year 3), and VI (Year 3)

Year 3 States New Hampshire Alabama New York Delaware Puerto Rico Florida Georgia Hawaii Idaho Iowa Maryland Montana New Hampshire New York Puerto Rico South Carolina South Dakota Texas U.S Virgin Islands Vermont Wisconsin

SMP NATIONAL RESOURCE CENTER: YEAR TO COME

Center Activities Mentor Call updates National SMP video campaign Personal Health Care Journal revamp For those of you that attend mentor calls. They will continue to be held monthly, but starting in September of this year they will be held on the third Tuesday of the month instead of the second Tuesday of the month and there will only be one call instead of two calls on that day. The call will be at 2:00 pm ET. The mentor calls will also be renamed starting in September and you will be able to vote on the new name on the August mentor call. Please look for the new call series after the August mentor calls. National SMP video campaign- The Center will be doing a national video campaign with ABC that will hit 20 major markets in the U.S. This will promote SMPs nationally and make the public more aware of the SMP program’s services and education resources that they have to offer.   PHCJ revamp –The Center will be conducting the revamp of the PHCJ and steering a network work group to get ideas and information to provide the needed input for the revamp of the PHCJ.

Center Activities Additional SMP Videos for project use SMP Foundation Manual and training resources updated Redoing SMP Complex Interactions Manual and training resources Additional SMP videos for project use: SMP mission promotional video (2 min & 30 sec) and types of Medicare fraud video (2 min & 30 sec) These videos are to provide SMPs with additional outreach and education materials and efforts for but not limited to PSAs, social  media, and education events. (Winter 2019) SMP Foundation Manual and training resources will be updated (being developed now) Additional updates of resources will include kit materials and self-paced training. Redoing SMP complex interactions manual and training resources (Spring 2020) Additional updates of resource will include kit materials and self-paced training.

Questions?