Department Liaison – Sergeant Michael Pigott (mpigott@holmdelpolice.org)

Medicare and The New Health Law

Closing the Prescription and Drug Coverage Gap

Monmouth Country Division on Aging, Disabilities & Veterans’ Interment
http://www.visitmonmouth.com/page.aspx?ID=170

AARP –

www.aarp.org

 

NJ Department of Health & Senior Services Division of Aging & Community Services
www.nj.gov/health/senior/respite.shtml
www.caregivernj.nj.gov
http://www.state.nj.us/health/senior/sanjease.shtml

 

 

Global Options (GO) for Long-Term Care

What is the GO Waiver Program?

Effective January 1, 2009, the Department of Health and Senior Services (DHSS) received approval from the U.S. Centers for Medicare and Medicaid Services to consolidate three Medicaid-supported home and community-based service programs operated by DHSS into a single program known as Global Options (GO) for Long Term Care.

The consolidation improves access to a wider range of in-home long-term supportive services for a greater number of seniors and adults with physical disabilities who meet the income, asset and nursing facility level of care requirements established by Medicaid. GO participants have the options to hire and direct their own service providers.

The move to GO gives care managers greater flexibility in modifying individual care plans as needs and preferences change over time. It also simplifies administrative processes for federal, state and local officials. Through GO, individuals have easier access to important home and community-based services.

Federal approval of GO furthers the state’s ongoing efforts to make New Jersey’s long-term care system more flexible and consumer-friendly. In 2006, he signed into law the Independence, Dignity and Choice in Long-Term Care Act that required, among other provisions, the rebalancing of Medicaid long-term care funding to improve support for in-home services.

GO is designed to supplement – not replace – the assistance already being provided by family, friends and neighbors. By providing a flexible package of services and supports, GO strengthens the ability of caregivers to continue in their vital role as primary support providers.

GO participants work with a care manager to create an individualized plan of care based on a comprehensive assessment of the participant’s healthcare needs. Once the plan of care is approved, community-based services are put in place and monitored to ensure quality and effectiveness.

Seniors, adults with physical disabilities and their caregivers seeking information and access to GO, as well as other state-funded or private pay home and community-based long-term care services, can do so by calling their local Area Agency on Aging toll-free at 1-877-222-3737, or by visiting the Division of Aging and Community Services’ website at www.aging.nj.gov.

Who is Eligible for GO?

A GO individual is a person who is a U.S. citizen or a qualified alien assessed by a State Community Choice counselor or an Aging and Disability Resource Connection (ADRC) assessor as clinically and financially eligible for Medicaid nursing facility level of care. An applicant must be 65 years or older, or between the ages of 21 and 64 who shall be determined disabled* by the Social Security Administration (SSA) or be determined disabled* by the Division of Medical Assistance and Health Services, Disability Review Section. Additionally, eligibility depends on whether there is an indication that the participant will need the level of care provided in a hospital, a nursing facility or an intermediate care facility in the near future (i.e., a month or less) unless he or she receives home and community-based services.

*Individuals between the ages of 21 and 64 who are chronically mentally ill, mentally retarded or developmentally disabled may be eligible after a service needs review by the DHSS/DHS Service Review Team.

What Services May be Provided?

GO participants are eligible for all New Jersey Title XIX Medicaid State Plan services authorized in a Plan of Care, which may include:

• Adult Day Health (Require prior authorization)
• Advanced Practice Nurse
• Chiropractic
• Clinic
• Dental
• Hearing Aid
• Home Health
• Hospital
• Hospital Outpatient
• Laboratory
• Medical Supplies & Equipment
• Nursing Facility
• Optometric
• Optical Appliances
• Personal Care Assistant (Require prior authorization)
• Pharmaceutical
• Physician
• Podiatric
• Prosthetic & Orthotic Devices
• Radiological
• Rehabilitation Therapies
• Transportation

GO enrollees must also receive Care Management services and at least one additional waiver service.  Based upon the person’s assessed level of service needs, the participant can choose among a wide selection of waiver services, which may include:

• Assisted Living/Adult Family Care
• Attendant Care
• Caregiver/Participant Training
• Care Management
• Chore Service
• Environmental Accessibility Adaptations
• Home Based Supportive Care
• Home-Delivered Meal Service
• Personal Emergency Response Systems (PERS)
• Respite Care
• Special Medical Equipment and Supplies
• Social Adult Day Care
• Transition Services and Transitional Care Management
• Transportation

Are there Limits to GO Services?

Yes. The service package is based on an assessment of the individual’s care needs and is developed in collaboration with a care manager. The service package builds on available supports, and takes into consideration the individual’s functional abilities, personal goals and preferences, risk factors, and availability of services.

Who Provides these Services?

Services may be provided by traditional Medicaid community agencies, new qualified non-traditional entities, or qualified Participant-Employed Providers (individuals hired by the participant).  All service providers must demonstrate competence in the service to be provided and must meet qualification requirements, which have been approved by the federal government. 

The Participant-Employed Provider service option allows a participant to work collaboratively with his/her care manager to employ his/her own provider and direct his/her own care.  Prior to participating in the Participant-Employed Provider option the care manager will discuss the responsibilities and complexities to ensure this option is appropriate.

Is there a Cost Share for GO?

There is no co-pay for GO except for the Assisted Living or Adult Family Care service.  For those services, a person is always responsible to pay room and board fees.  Those participants with income above the SSI (Supplemental Security Income) amount may have a cost share, based upon his or her gross monthly income and allowable deductions.  The Care Manager calculates the cost share.

For Additional Information Contact:

Monmouth Office on Aging at 732- 431- 7450 or NJ Ease: 1-877-222-3737.

Global Options (GO) for Long Term Care brochure. [pdf 244k]

Jersey Assistance for Community Caregiving (JACC)

What is JACC?

JACC is a State-funded program that provides a broad array of in-home services to enable an individual, at risk of placement in a nursing facility and who meets income and resource requirements, to remain in his or her community home. By providing a uniquely designed package of supports for the individual, JACC delays or prevents placement in a nursing facility.

What services may be provided?

Based on the results of a clinical assessment, a Plan of Care (POC) is developed collaboratively by the participant and his/her Care Manager. All JACC participants receive Care Management services. In addition, the POC specifies other services to be delivered, which may include:

• Respite Care
• Homemaker Services
• Environmental Accessibility Adaptations
• Personal Emergency Response Systems (PERS)
• Home-Delivered Meal Service
• Caregiver/Recipient Training
• Social Adult Day Care
• Adult Day Health Services
• Special Medical Equipment and Supplies
• Transportation
• Chore Services
• Attendant Care
• Home-Based Supportive Care

Are there limits to JACC services?

Yes. Cost caps are applied to specific services under JACC as well as to the cost per person per month. JACC services are limited to a maximum of $600 per month or $7,200 annually. The service package provided is based on an assessment of the individual’s needs, unique care plan, and availability of services and funding.

Who provides these services?

Services may be provided by traditional Waiver service providers, new non-traditional qualified entities, or qualified Participant-Employed Providers. All service providers must demonstrate competence in the service to be provided, and must meet qualification requirements.

The Participant-Employed Provider service option allows a participant to work collaboratively with his/her Care Manager to employ his/her own provider and direct his/her own care. The ability to direct one’s own care will be confirmed prior to participation as the employer of one’s providers.

Is JACC a Medicaid program?

No. JACC serves individuals who are not eligible for Medicaid or Medicaid waiver services. JACC is a program supported totally with State funds.

Who is eligible for JACC services?

A JACC eligible individual is a New Jersey resident who:

• Is 60 years of age or older;
• Resides in a home that he/she owns or rents, or lives in an unlicensed home of a relative or friend;
• Has no alternate means available to secure needed services and/or supports;
• Has been determined to be clinically eligible for nursing facility level of care; and
• Is a United States citizen or a Qualified Alien.

Meets financial eligibility by:

• Being financially ineligible for Medicaid or Medicaid waiver services;
• Having a countable monthly income that is no more than 365% of the Federal Poverty Level ($3,296 monthly in 2010); and
• Having countable resources at or below $40,000 for an individual or $60,000 for a couple

Is there a co-pay in JACC?

JACC participants may contribute to the cost of their services. The co-pay obligation is based on countable income applied to a sliding scale. Co-pay is payable directly to the designated Billing Agent, which will bill the JACC participant.

How do I apply for JACC?

Individuals interested in receiving services through JACC may contact the NJ EASE site in their county. NJ EASE is the Easy Access Single Entry point for senior service information, and can be reached toll free by dialing 1-877-222-3737. NJ EASE workers will assist callers and refer individuals to the proper application point.

For additional information contact:

Monmouth COunty Office on Agibng – 732-431-7450 or NJ Ease – 1-877-222-3737.

 Please consider the environment before printing this e-mail

Thomas F. Pivinski

Executive Director – Monmouth County Division on Aging, Disabilities & Veterans Interment

Tel:     (732) 308-3770  Ext 7453

           (732) 431-7450

Fax:    (732) 303-7649

e-mail:  thomas.pivinski@co.monmouth.nj.us

NOTICE OF CONFIDENTIALITY
This message, including any prior messages and attachments, may contain advisory, consultative and/or deliberative material, confidential information or privileged communications of the County of Monmouth. Access to this message by anyone other than the sender and the intended recipient(s) is unauthorized. If you are not the intended recipient of this message, any disclosure, copying, distribution or action taken or not taken in reliance on it, without the expressed written consent of the County, is prohibited. If you have received this message in error, you should not save, scan, transmit, print, use or disseminate this message or any information contained in this message in any way and you should promptly delete or destroy this message and all copies of it. Please notify the sender by return e-mail if you have received this message in

FEMA Encourages Seniors And People With Special Needs To

 

Injuries Among Older Adults

In the United States, one of every three persons aged 65 years and older falls each year. 

     Among older adults, falls are the leading cause of injuries, hospital admissions for trauma, and deaths due to injury.  And approximately 250,000 hip fractures, the most serious fracture, occur each year among people over age 65.  Many of these falls and resulting injuries can be prevented.  Strategies to prevent falls among older adults include exercises to improve strength, balance, and flexibility; reviews of medications that may affect balance; and home modifications that reduce fall hazards such as installing grab bars, improving lighting, and removing items that may cause tripping.

Safety Tips for Preventing Falls in the Home

    Falls can occur at any age, but the rates of injury and death resulting from falls are greatest among seniors.  This can happen because of changes in muscle and bone strength, vision, hearing, and coordination that take place with aging.  But there are steps you can take to reduce the likelihood of falls.  The following are guidelines you can use to make your home safer:

All Areas:

• Contrast in paint, furniture and carpet colors are helpful.
• Ensure that stairways have sturdy handrails.
• Keep halls, stairways, and pathways well lighted and free of clutter and obstacles.  Keep walk areas clear.
• Apply slip strips on the edges of steps to reduce slick stair surfaces.
• Remove throw rugs or tack down securely with double sided adhesive tape.  Tape down carpet edges.
• Place electrical cords and telephone wires away from walking paths.
• Post emergency numbers at every telephone.  Carry a portable phone.

Bathroom:

• Apply non-skid appliqués on tub and shower floors.
• Install grab bars in the tub and around toilet.  Consider a shower chair.
• Avoid throw rugs or tack rugs down securely.
• Keep bathrooms well lighted.

Kitchen:

• Keep commonly used items within easy reach.
• Avoid using floor polish or wax to reduce slick surfaces on floors.

Bedroom:

• Keep a telephone and light within easy reach of the bed.
• Rise slowly from bed to sitting position.  Dangle your legs for a few minutes prior to standing and walking.

Outdoor Home Safety Measures:

• Keep walk areas clear of clutter, rocks and tools.  Keep well lighted at night.
• Keep walkways clear of snow and ice.
• Make sure walkways are level, free of cracks, loose gravel, holes, and constructed with slip resistant materials.

Steps You Can Take To Reduce Your Risk Of A Fall:

• Have regular vision and hearing check-ups.
• Clean eye glasses often to improve visibility.
• Wear proper fitting, supportive shoes with low heels or rubber soles.
• A proper diet and moderate exercise are essential.
• Use walking aids when necessary.
• See your doctor for the diagnosis, management, and treatment of underlying diseases.
• Talk to your pharmacist about side effects of your medications.

PRESCRIPTION DRUG DISCOUNT PROGRAM

For Senior Citizens

The Monmouth County Board of Chosen Freeholders has approved participation in a Prescription Drug Discount Program designed to provide special discounts on prescription drugs.  The program will benefit senior citizens and disabled citizens who are residents of Monmouth County.

            There is an annual registration fee of $20.00.  There are no income limitations nor are there any exclusions for pre-existing conditions.  Also, there are no exclusions for participating in other prescription programs.

            Participants must enroll in the program by completing a form that can be obtained by calling the Monmouth County Office on aging, at the toll-free number: 1-877-222-3737.  Eligible members will then receive a personalized Monmouth County Prescription Discount Identification Card.  The Card must be presented at a pharmacy along with all prescriptions.  The discounts will be applied automatically.  Eligible members of the Prescription Drug Discount Program will receive discounts on both brand name products and generic drugs, as well.  Savings can amount from 10% to 50%.

            The Prescription Drug Discount Program is neither a managed care program nor an insurance program.  Membership gives one access to approximately 55,000 chain and independent pharmacies.  While enrollment forms can be obtained through the Monmouth county Office on Aging, the completed forms must be sent, along with the membership fee of $20.00, to GSPO Provider Services Corp., 44 West Taylor Avenue, Hamilton, New Jersey 08610.  For additional information, please call the Office on Aging at 1-877-222-3737.

Five Actions for Emergency Preparedness

According to the American Red Cross, in today’s climate, it is more important than ever that all of us be prepared for possible emergencies. Natural or other disasters can strike suddenly at any time and anywhere. There are five actions everyone can take that can help make a difference. They are:

• Make a plan – Planning ahead is the first step to a calmer and more assured disaster response.
• Build a kit – What you have on hand when a disaster happens can make a big difference. Plan to store enough supplies for everyone in your household for at least three days. Items such as water, food, flashlights, a first aid kit, medications, a battery operated radio, tools, clothing, personal items and a map should be part of your emergency kit.
• Get trained – Learning simple first aid techniques can give you the skills and confidence to help anyone in your home, your neighborhood and at work.
• Volunteer – Volunteering with organizations such as the American Red Cross help to serve the needs of many communities.
• Give blood – Blood is needed in times of emergency, but the ongoing need is also great.

Popularity of Social Security Online Services Growing…

Today, with just a click of your computer’s mouse button, you can bypass highway traffic and office waiting lines and conduct business with Social Security. Not surprisingly, this electronic service option is rapidly becoming a preferred way of doing business.

The numbers tell the story. In 2002, about 220,000 people completed Socisl Security transactions online; last year, that number rose to 611,000. The reason for this rapid growth of online business is clear – convenience , speed and security.

Here are just a few of the things that people can do when they visit un online at www.socialsecurity.gov<http://socialsecurity.gov>

• Screen for benefits. Many people come to our website to see whether or not they qualify for benefits. This can be done quickly by using our Benefit Eligilility Screening Tool. You just need to answer a series of questions to determine if you are eligible for retirement, disability or Supplemental Security Income (SSI) program benefits. You can also find out if you might be eligible for Medicare benefits. The entire process only takes about 5 to 10 minutes.
• Apply for benefits. You now can apply for retirement, disability and spouse’s benefits over the Internet. Thousands of people have taken advantage of this convenient, easy way to apply for benefits.
• Forecast your financial future. Social Security’s Benefits Planner is a convenient way to help plan your retirement or determine what benefits you or your family may qualify for in the unfortunate event of disability or death. Simply enter the estimated income for the years ahead to get an idea of what your benefit payments could be.
• Get a Medicare card replaced. If your Medicare card has been lost, stolen or damaged, a new one is needed and can be replaced by visiting our website. This eliminates the need to call or visit an office.
• Remember, if you have business with Social Security any time in the near future, do yourself a favor and check out Social Security’s online office before battling traffic and possible waiting lines.

Protect Yourself from Healthcare Fraud…

Healthcare fraud is more common than you think. Take these 12 steps to protect yourself from healthcare fraud:

1. Only visit your personal doctor, hospital or clinic for medical help. Only they should make referrals for special equipment, services or medicine.
2. Never show anyone your medical or prescription records without first talking to your doctor or pharmacist.
3. If someone calls and tries to threaten or pressure you into something, simply hang up the phone.
4. If someone comes to your door and says that they are from Medicare or some other healthcare company shut the door. It’s shrewd to be rude!
5. Do your homework and talk to your healthcare provider before buying or investing in Internet cure or miracle products or services.
6. Do not keep mail in your mailbox for more than one day. People steal personal information right out of your mailbox.
7. Rip or shred your Medicare or other healthcare papers and other important documents before throwing them away. Crooks go through the trash.
8. Treat your Medicare and Social Security numbers like credit cards. If someone offers to buy your Medicare or social security number, do not do it. It is simply not worth it.
9. Remember that Medicare does not sell anything.
10. Follow your instincts. If it seems too good to be true, it probably is.
11. If you suspect an error, fraud or abuse related to healthcare, gather the facts and report it.
12. Always read your Medicare Summary Notice (MSN) or health care billing statement. Your Medicare Summary Notice is the place pf mail stamped, “This is not a Bill,” that comes in after you seek medical care. Look for three things on your billing statement:
1. Charges for something that you didn’t get
2. Billing for the same thing twice
3. Services that were not ordered by the doctor

WARNING:
DO NOT DIAL 90# FOR TELEPHONE REPAIR WIRING

 

This can happen at home and at work and everyone should be aware of this scam. A woman received a telephone call from an individual identifying himself as an AT&T Service Technician who was running a test on the telephone line. He stated that in order to complete the test the woman receiving the call should touch nine (9), zero (0) and the pound sign (#) and hang up. Luckily, the woman refused to execute the orders. Upon contacting the telephone company, the woman was informed that by pushing 90#, you end up giving the individual who called you, access to your telephone line and allows them to place a long distance telephone call with the charges appearing on your telephone bill.

Upon further investigation, this scam has been originating from many of the local jails and prisons. It has been verified by UCB Telecomm that it actually happens and ends up costing innocent victims hundreds of dollars. So remember, DO NOT PRESS 90# for ANYONE who calls and asks you to do so. Share this information with your friends and family and do not become a victim of telephone fraud.