1. 1 Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) VICAP Fall Training October 23, 2008 Kathy Nguyen CMS Health Insurance Specialist

2. 2 The Medicare Improvement for Patients & Providers Act, 2008 History H.R. 6331 introduced in the House on June 20, 2008; passed on June 24 by a vote of 355-59 Senate failed to act on June 26 Payment cuts scheduled to go into effect July 1 CMS delayed processing claims at fee-cut level until July 15 Senate passed package on July 9 after cloture vote of 69-30 President Bush vetoed bill on July 15 Congress overrides veto on same day; bill becomes law

3. 3 The Medicare Improvement for Patients & Providers Act, 2008 MIPAA Highlights Maintains physician payments Reinstates therapy cap exceptions process Reduces beneficiary copayment for mental health services Additional preventive services to be considered –“Welcome to Medicare” initial physical examination period extended to first 12 months of new bene eligibility; no longer counted toward deductible in 2009 Requires all Medigap carriers to offer C and F

4. 4 The Medicare Improvement for Patients & Providers Act, 2008 Other MIPAA Highlights Benzodiazepines and barbiturates will be covered under Part D for certain conditions Increase in low-income assistance for Medicare beneficiaries Permanently waives Part D late enrollment penalty for LIS-eligible individuals Increases SSA assistance with Medicare Savings Program applications

5. 5 The Medicare Improvement for Patients & Providers Act, 2008 Medicare Advantage and Prescription Drug Plan Marketing Provisions Prohibits unsolicited direct contact Prohibits cross-selling Enforces scope of appointment Limits sales/marketing in healthcare settings Prohibits sales/marketing at educational events Prohibits meals Limits nominal gifts

6. 6 The Medicare Improvement for Patients & Providers Act, 2008 Medicare Advantage and Prescription Drug Plan Marketing Provisions Prohibits co-branding Requires state appointed agents/brokers Defines agent/broker training and testing Defines agent/broker compensation Requires plan reporting of terminated agents Eliminates File & Use Eligibility