Administration for Community Living Grant: Enhancing SMP and SHIP Programs

Program History
The Administration for Community Living (ACL) was created in order to achieve several important objectives: to reduce the fragmentation that currently exists in Federal programs addressing the community living service and support needs of both the aging and disability populations; to enhance access to quality health care and long-term services and supports for all individuals; to promote consistency in community living policy across other areas of the Federal government; and to complement the community infrastructure, as supported by both Medicaid and other Federal programs, in order to better respond to the full spectrum of needs of seniors and persons with disabilities. In order to better serve Medicare beneficiaries the Office of Healthcare Information and Counseling was created. The Office of Healthcare Information and Counseling (OHIC) currently oversee two unique programs, the Senior Medicare Patrol (SMP) program and the State Health Insurance Assistance Program (SHIP) that each have their own distinctive histories.

The SMP program was created under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) which established a national Health Care Fraud and Abuse Control (HCFAC) Program designed to coordinate federal, state, and local law enforcement activities with respect to health care fraud and abuse. Now in its seventeenth year of operation, the program continues to demonstrate its success in protecting beneficiaries by identifying and prosecuting the most egregious instances of health care fraud and preventing future fraud, errors, and abuse. As a partner in these fraud control initiatives, ACL funds the SMP program, where grantees recruit, train, and support a network of volunteers who provide outreach and education to Medicare beneficiaries on preventing, identifying, and reporting health care fraud. There are 54 SMP projects nationally, one in every state, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands.

Since 1997, SMP projects have made great progress in recruiting and training volunteers on Medicare fraud, errors, and abuse. Based on the June 2014 OIG SMP Performance Report, there were over 5,400 active SMP volunteers in 2013. These volunteers work in their communities, senior centers, and elsewhere to educate Medicare beneficiaries, their family members, and caregivers to actively protect themselves against fraudulent and abusive health care practices by reviewing their Medicare benefit statements and reporting suspected errors, fraud, and abuse.

The State Health Insurance Assistance Program (SHIP) was created under Section 4360 of the Omnibus Budget Reconciliation Act (OBRA) of 1990 (Public Law 101-508). This section of the law authorized the Secretary of the Department of Health and Human Services to make grants to States to establish and maintain health insurance advisory service programs for Medicare beneficiaries. Initially administered by the Centers for Medicare & Medicaid Services (CMS), grant funds were made available to support information, counseling, and assistance activities related to Medicare, Medicaid, and other related health insurance options such as: Medicare supplement insurance, long-term care insurance, managed care options, and other health insurance benefit information.

In FY 2014 the SHIP program was transferred from CMS to ACL. This transfer reflects the natural synergies between the SHIP programs and the networks that ACL serves. About two-thirds of the 54 State SHIP programs are already administered by State Units on Aging, with most of the remaining programs administered by State Insurance Commissions. At the community level, many SHIPs are either housed in or create local partnerships with Area Agencies on Aging. Similarly, almost 50 percent of the SHIPs are co-located with the Senior Medicare Patrol program, which is also administered by ACL.

Now administered by the Administration for Community Living, the purpose of the SHIP program is to strengthen the capability of states to support a community-based, grassroots network of local SHIP offices that provide personalized counseling, education, and outreach to assist Medicare beneficiaries with their Medicare questions. SHIP project grantees provide community education and one-on-one assistance to Medicare beneficiaries and their families to help them make educated and informed decisions on their health benefit options. There are currently 54 active SHIP grantees nationally, one in every state, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands.

Priority Activities

The overall goal of this grant opportunity is to develop innovations that can be successfully replicated by SMP and SHIP grantees to expand and integrate program coverage to better serve traditionally hard-to-reach populations through new, efficient and sustainable approaches for ensuring high quality and culturally competent service delivery.

The purpose of the grant is to:

Expand the reach of the SMP and SHIP programs to more effectively serve Medicare beneficiaries in the targeted population with high quality and culturally competent services thus increasing community engagement;
Provide assistance to the SMP and SHIP project grantees through the development of materials and/or training on best practices to successfully serve the targeted population;
Ensure that SMP project grantees have fraud prevention messages and materials available to them to help reach targeted hard-to-reach Medicare beneficiaries and their families, thus increasing beneficiary awareness and empowerment to prevent healthcare fraud among the populations generally underserved by the program; and
Provide technical assistance to SHIP project grantees to help them increase beneficiary understanding and awareness among populations generally underserved by the SHIP program to date, of available health benefit options, thus empowering them to make informed healthcare decisions.

Applications are sought from entities with expertise and experience in reaching Medicare beneficiaries in the applicant identified target population through a variety of partnerships, collaborative approaches, use of technology, or other innovative strategies. The applicant may select one of the following priority populations for their targeted approach or may submit an application for a different target group if they can provide rationale and data to support the need for that targeted population (Applicants that wish to target more than one of the priority populations must submit separate applications for each population):

Medicare Beneficiaries under the age of 65
Lesbian, Gay, Bisexual and Transgender (LGBT) Medicare Beneficiaries
American Indian/Alaska Native (AI/AN) Medicare Beneficiaries
Medicare Beneficiaries in Rural Areas
Limited-English Speaking Beneficiaries
Medicare Beneficiaries of Racial/Ethnic Minority Communities
Medicare Beneficiaries of Other Hard-to-Reach Populations

Applicants under this announcement are required to design and implement activities which enhance SMP and SHIP grantee efforts. Specifically, applications will be evaluated on how they propose to do the following:

Clearly identify and describe the priority population their activities will target.
Provide a plan to assist the SMP and SHIP project grantees through the development of materials and/or training on best practices to successfully serve the targeted population including:

Identifying and enhancing understanding of the priority population needs;
Identifying effective and culturally competent materials and methods for educating the targeted hard- to-reach population;
Assisting SMP and SHIP projects in identifying local collaborative partners;
Developing methods for recruiting and training volunteers who can best serve the target population; and
Identifying any problems or barriers that may impact the success of the project in assisting the SMP and SHIP project grantees in reaching the target population

Specify methodology for measurement and tracking of project outcomes.
If applicable, describe any Medicare coverage rules that are specific to the target population and any barriers or challenges these may bring to the success of the project.
Describe the role and activities of partner organizations in achieving strategies for expanding health care education and awareness within the targeted beneficiary population.
Describe proposed project activities, including documented approaches for collaboration with partner organizations, outreach materials and strategies, media tools, tailored approaches for volunteer recruitment and support, and other innovations developed.
Develop effective and culturally competent guidance and/or a toolkit to assist SMP and SHIP projects in reaching the identified target population.
Provide an ongoing plan for broadly disseminating the outreach strategies, approaches and materials developed for serving the target population to the broader SMP and SHIP national networks, which should include attendance at annual SMP and SHIP grantee training meetings and applicable SMP and SHIP webinar trainings
Develop effective and culturally competent guidance and/or a toolkit to assist SMP and SHIP projects in reaching the identified target population.
Provide an ongoing plan for broadly disseminating the outreach strategies, approaches and materials developed for serving the target population to the broader SMP and SHIP national networks, which should include attendance at annual SMP and SHIP grantee training meetings and applicable SMP and SHIP webinar trainings.