RE: BMT clinical trials for Medicare Advantage plans

[Guest guest]

We also have a few that are on the Advantage plans go on clinical trials. Generally MCR picks up their 80% and then the Advantage plan pays the 20%. There is sometimes an issue where the Advantage copayment is made directly to the pt. , MSW LCSW Clinical Financial SpecialistDivision of Bone Marrow TransplantationBJH / Washington University School of Medicine660 South Euclid, Campus Box 8007St. Louis, MO 63110Phone: / Fascimile: Email: cjames@... The materials in this e-mail are private and may contain Protected Health Information. If you are not the intended recipient be advised that any unauthorized use, disclosure, copying, distribution or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this email in error, please immediately notify the sender via telephone at or by return e-mail. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Goldstein, Sent: Thursday, May 03, 2012 9:38 AMTo: TxFinancialCoordinators Subject: BMT clinical trials for Medicare Advantage plans We’re seeing more & more Medicare patients, and a portion of them have signed on to Medicare Advantage plans. If we want to transplant them on a clinical trial, that’s usually carved out and falls to straight Medicare. The problem we’re facing is that these patients don’t have Medicare supplements, so they face responsibility for the part B 20% copayment, along with deductibles, etc. It’s prevented a significant number of patients from enrolling in our trials. Is anyone else seeing this problem? Any cases where a Senior Advantage plan agreed to cover a clinical trial, or pay secondary to Medicare for clinical trial care? GoldsteinBusiness Manager, Stanford BMT Program300 Pasteur Drive , H0101Stanford, CA 94305~ - direct~650.725-3117 - fax~ - BMT office ***This email and any attachments may contain confidential information for the u se of the designated recipient(s) named above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its content is prohibited. If you have received this email in error, please immediately notify Stanford University Medical Center at . ~Thank You.***

[Guest guest]

We also have a few that are on the Advantage plans go on clinical trials. Generally MCR picks up their 80% and then the Advantage plan pays the 20%. There is sometimes an issue where the Advantage copayment is made directly to the pt. , MSW LCSW Clinical Financial SpecialistDivision of Bone Marrow TransplantationBJH / Washington University School of Medicine660 South Euclid, Campus Box 8007St. Louis, MO 63110Phone: / Fascimile: Email: cjames@... The materials in this e-mail are private and may contain Protected Health Information. If you are not the intended recipient be advised that any unauthorized use, disclosure, copying, distribution or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this email in error, please immediately notify the sender via telephone at or by return e-mail. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Goldstein, Sent: Thursday, May 03, 2012 9:38 AMTo: TxFinancialCoordinators Subject: BMT clinical trials for Medicare Advantage plans We’re seeing more & more Medicare patients, and a portion of them have signed on to Medicare Advantage plans. If we want to transplant them on a clinical trial, that’s usually carved out and falls to straight Medicare. The problem we’re facing is that these patients don’t have Medicare supplements, so they face responsibility for the part B 20% copayment, along with deductibles, etc. It’s prevented a significant number of patients from enrolling in our trials. Is anyone else seeing this problem? Any cases where a Senior Advantage plan agreed to cover a clinical trial, or pay secondary to Medicare for clinical trial care? GoldsteinBusiness Manager, Stanford BMT Program300 Pasteur Drive , H0101Stanford, CA 94305~ - direct~650.725-3117 - fax~ - BMT office ***This email and any attachments may contain confidential information for the u se of the designated recipient(s) named above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its content is prohibited. If you have received this email in error, please immediately notify Stanford University Medical Center at . ~Thank You.***

[Guest guest]

:

I asked someone in Managed Care here in Tennessee because prior to this Healthspring was our only Medicare HMO that would pick up the 20% and here is her response:

The Feds now REQUIRE all Medicare Advantage plans to pick up the 20% Medicare cost share according to the patient’s benefit plan design when patients elect clinical trial. For instance, if an MA member has a 90/10 benefit plan design and elects clinical trial, the MA plan must pay 90% of the 20% Medicare cost-share. Does that make sense?

I stumbled across this information in the spring that it became effective on January 1. I called all the payers and only one knew about it. I had to talk with the legal departments of most plans to make them understand what the change in the Medicare Managed Care Manual meant and what was expected of them. It was a big deal that few people found in the regs.

GREAT NEWS!!!!

Delashmit, Transplant Financial Coordinator

Cannon Center for Blood Cancers

Subject: BMT clinical trials for Medicare Advantage plansTo: "TxFinancialCoordinators " <TxFinancialCoordinators >Date: Thursday, May 3, 2012, 9:38 AM

We’re seeing more & more Medicare patients, and a portion of them have signed on to Medicare Advantage plans. If we want to transplant them on a clinical trial, that’s usually carved out and falls to straight Medicare. The problem we’re facing is that these patients don’t have Medicare supplements, so they face responsibility for the part B 20% copayment, along with deductibles, etc. It’s prevented a significant number of patients from enrolling in our trials.

Is anyone else seeing this problem? Any cases where a Senior Advantage plan agreed to cover a clinical trial, or pay secondary to Medicare for clinical trial care?

Goldstein

Business Manager, Stanford BMT Program

300 Pasteur Drive, H0101

Stanford, CA 94305

~ - direct

~650.725-3117 - fax

~ - BMT office

***This email and any attachments may contain confidential information for the use of the designated recipient(s) named above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its content is prohibited. If you have received this email in error, please immediately notify Stanford University Medical Center at . ~Thank You.***

[Guest guest]

:

I asked someone in Managed Care here in Tennessee because prior to this Healthspring was our only Medicare HMO that would pick up the 20% and here is her response:

The Feds now REQUIRE all Medicare Advantage plans to pick up the 20% Medicare cost share according to the patient’s benefit plan design when patients elect clinical trial. For instance, if an MA member has a 90/10 benefit plan design and elects clinical trial, the MA plan must pay 90% of the 20% Medicare cost-share. Does that make sense?

I stumbled across this information in the spring that it became effective on January 1. I called all the payers and only one knew about it. I had to talk with the legal departments of most plans to make them understand what the change in the Medicare Managed Care Manual meant and what was expected of them. It was a big deal that few people found in the regs.

GREAT NEWS!!!!

Delashmit, Transplant Financial Coordinator

Cannon Center for Blood Cancers

Subject: BMT clinical trials for Medicare Advantage plansTo: "TxFinancialCoordinators " <TxFinancialCoordinators >Date: Thursday, May 3, 2012, 9:38 AM

We’re seeing more & more Medicare patients, and a portion of them have signed on to Medicare Advantage plans. If we want to transplant them on a clinical trial, that’s usually carved out and falls to straight Medicare. The problem we’re facing is that these patients don’t have Medicare supplements, so they face responsibility for the part B 20% copayment, along with deductibles, etc. It’s prevented a significant number of patients from enrolling in our trials.

Is anyone else seeing this problem? Any cases where a Senior Advantage plan agreed to cover a clinical trial, or pay secondary to Medicare for clinical trial care?

Goldstein

Business Manager, Stanford BMT Program

300 Pasteur Drive, H0101

Stanford, CA 94305

~ - direct

~650.725-3117 - fax

~ - BMT office

***This email and any attachments may contain confidential information for the use of the designated recipient(s) named above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its content is prohibited. If you have received this email in error, please immediately notify Stanford University Medical Center at . ~Thank You.***

[Guest guest]

, That’s great news! Do you know where in the manual this change is listed? If not, I can go straight to CMS. GoldsteinBusiness Manager, Stanford BMT Program300 Pasteur Drive, H0101Stanford, CA 94305~ - direct~650.725-3117 - fax~ - BMT office ***This email and any attachments may contain confidential information for the use of the designated recipient(s) named above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its content is prohibited. If you have received this email in error, please immediately notify Stanford University Medical Center at . ~Thank You.*** From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of DelashmitSent: Thursday, May 03, 2012 10:53 AMTo: TxFinancialCoordinators Subject: Re: BMT clinical trials for Medicare Advantage plans :I asked someone in Managed Care here in Tennessee because prior to this Healthspring was our only Medicare HMO that would pick up the 20% and here is her response: The Feds now REQUIRE all Medicare Advantage plans to pick up the 20% Medicare cost share according to the patient’s benefit plan design when patients elect clinical trial. For instance, if an MA member has a 90/10 benefit plan design and elects clinical trial, the MA plan must pay 90% of the 20% Medicare cost-share. Does that make sense? I stumbled across this information in the spring that it became effective on January 1. I called all the payers and only one knew about it. I had to talk with the legal departments of most plans to make them understand what the change in the Medicare Managed Care Manual meant and what was expected of them. It was a big deal that few people found in the regs. GREAT NEWS!!!! Delashmit, Transplant Financial Coordinator Cannon Center for Blood CancersSubject: BMT clinical trials for Medicare Advantage plansTo: " TxFinancialCoordinators " <TxFinancialCoordinators >Date: Thursday, May 3, 2012, 9:38 AM We’re seeing more & more Medicare patients, and a portion of them have signed on to Medicare Advantage plans. If we want to transplant them on a clinical trial, that’s usually carved out and falls to straight Medicare. The problem we’re facing is that these patients don’t have Medicare supplements, so they face responsibility for the part B 20% copayment, along with deductibles, etc. It’s prevented a significant number of patients from enrolling in our trials. Is anyone else seeing this problem? Any cases where a Senior Advantage plan agreed to cover a clinical trial, or pay secondary to Medicare for clinical trial care? GoldsteinBusiness Manager, Stanford BMT Program300 Pasteur Drive, H0101Stanford, CA 94305~ - direct~650.725-3117 - fax~ - BMT office ***This email and any attachments may contain confidential information for the use of the designated recipient(s) named above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its content is prohibited. If you have received this email in error, please immediately notify Stanford University Medical Center at . ~Thank You.***

[Guest guest]

, That’s great news! Do you know where in the manual this change is listed? If not, I can go straight to CMS. GoldsteinBusiness Manager, Stanford BMT Program300 Pasteur Drive, H0101Stanford, CA 94305~ - direct~650.725-3117 - fax~ - BMT office ***This email and any attachments may contain confidential information for the use of the designated recipient(s) named above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its content is prohibited. If you have received this email in error, please immediately notify Stanford University Medical Center at . ~Thank You.*** From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of DelashmitSent: Thursday, May 03, 2012 10:53 AMTo: TxFinancialCoordinators Subject: Re: BMT clinical trials for Medicare Advantage plans :I asked someone in Managed Care here in Tennessee because prior to this Healthspring was our only Medicare HMO that would pick up the 20% and here is her response: The Feds now REQUIRE all Medicare Advantage plans to pick up the 20% Medicare cost share according to the patient’s benefit plan design when patients elect clinical trial. For instance, if an MA member has a 90/10 benefit plan design and elects clinical trial, the MA plan must pay 90% of the 20% Medicare cost-share. Does that make sense? I stumbled across this information in the spring that it became effective on January 1. I called all the payers and only one knew about it. I had to talk with the legal departments of most plans to make them understand what the change in the Medicare Managed Care Manual meant and what was expected of them. It was a big deal that few people found in the regs. GREAT NEWS!!!! Delashmit, Transplant Financial Coordinator Cannon Center for Blood CancersSubject: BMT clinical trials for Medicare Advantage plansTo: " TxFinancialCoordinators " <TxFinancialCoordinators >Date: Thursday, May 3, 2012, 9:38 AM We’re seeing more & more Medicare patients, and a portion of them have signed on to Medicare Advantage plans. If we want to transplant them on a clinical trial, that’s usually carved out and falls to straight Medicare. The problem we’re facing is that these patients don’t have Medicare supplements, so they face responsibility for the part B 20% copayment, along with deductibles, etc. It’s prevented a significant number of patients from enrolling in our trials. Is anyone else seeing this problem? Any cases where a Senior Advantage plan agreed to cover a clinical trial, or pay secondary to Medicare for clinical trial care? GoldsteinBusiness Manager, Stanford BMT Program300 Pasteur Drive, H0101Stanford, CA 94305~ - direct~650.725-3117 - fax~ - BMT office ***This email and any attachments may contain confidential information for the use of the designated recipient(s) named above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its content is prohibited. If you have received this email in error, please immediately notify Stanford University Medical Center at . ~Thank You.***

[Guest guest]

Found it! Medicare Managed Care ManualChapter 4 – Benefits & Beneficiary ProtectionsSection 10.13 http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads//mc86c04.pdf Thanks again! From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Goldstein, Sent: Thursday, May 03, 2012 11:16 AMTo: TxFinancialCoordinators Subject: RE: BMT clinical trials for Medicare Advantage plans , That’s great news! Do you know where in the manual this change is listed? If not, I can go straight to CMS. GoldsteinBusiness Manager, Stanford BMT Program300 Pasteur Drive, H0101Stanford, CA 94305~ - direct~650.725-3117 - fax~ - BMT office ***This email and any attachments may contain confidential information for the use of the designated recipient(s) named above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its content is prohibited. If you have received this email in error, please immediately notify Stanford University Medical Center at . ~Thank You.*** From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of DelashmitSent: Thursday, May 03, 2012 10:53 AMTo: TxFinancialCoordinators Subject: Re: BMT clinical trials for Medicare Advantage plans :I asked someone in Managed Care here in Tennessee because prior to this Healthspring was our only Medicare HMO that would pick up the 20% and here is her response: The Feds now REQUIRE all Medicare Advantage plans to pick up the 20% Medicare cost share according to the patient’s benefit plan design when patients elect clinical trial. For instance, if an MA member has a 90/10 benefit plan design and elects clinical trial, the MA plan must pay 90% of the 20% Medicare cost-share. Does that make sense? I stumbled across this information in the spring that it became effective on January 1. I called all the payers and only one knew about it. I had to talk with the legal departments of most plans to make them understand what the change in the Medicare Managed Care Manual meant and what was expected of them. It was a big deal that few people found in the regs. GREAT NEWS!!!! Delashmit, Transplant Financial Coordinator Cannon Center for Blood CancersSubject: BMT clinical trials for Medicare Advantage plansTo: " TxFinancialCoordinators " <TxFinancialCoordinators >Date: Thursday, May 3, 2012, 9:38 AM We’re seeing more & more Medicare patients, and a portion of them have signed on to Medicare Advantage plans. If we want to transplant them on a clinical trial, that’s usually carved out and falls to straight Medicare. The problem we’re facing is that these patients don’t have Medicare supplements, so they face responsibility for the part B 20% copayment, along with deductibles, etc. It’s prevented a significant number of patients from enrolling in our trials. Is anyone else seeing this problem? Any cases where a Senior Advantage plan agreed to cover a clinical trial, or pay secondary to Medicare for clinical trial care? GoldsteinBusiness Manager, Stanford BMT Program300 Pasteur Drive, H0101Stanford, CA 94305~ - direct~650.725-3117 - fax~ - BMT office ***This email and any attachments may contain confidential information for the use of the designated recipient(s) named above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its content is prohibited. If you have received this email in error, please immediately notify Stanford University Medical Center at . ~Thank You.***

[Guest guest]

Found it! Medicare Managed Care ManualChapter 4 – Benefits & Beneficiary ProtectionsSection 10.13 http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads//mc86c04.pdf Thanks again! From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Goldstein, Sent: Thursday, May 03, 2012 11:16 AMTo: TxFinancialCoordinators Subject: RE: BMT clinical trials for Medicare Advantage plans , That’s great news! Do you know where in the manual this change is listed? If not, I can go straight to CMS. GoldsteinBusiness Manager, Stanford BMT Program300 Pasteur Drive, H0101Stanford, CA 94305~ - direct~650.725-3117 - fax~ - BMT office ***This email and any attachments may contain confidential information for the use of the designated recipient(s) named above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its content is prohibited. If you have received this email in error, please immediately notify Stanford University Medical Center at . ~Thank You.*** From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of DelashmitSent: Thursday, May 03, 2012 10:53 AMTo: TxFinancialCoordinators Subject: Re: BMT clinical trials for Medicare Advantage plans :I asked someone in Managed Care here in Tennessee because prior to this Healthspring was our only Medicare HMO that would pick up the 20% and here is her response: The Feds now REQUIRE all Medicare Advantage plans to pick up the 20% Medicare cost share according to the patient’s benefit plan design when patients elect clinical trial. For instance, if an MA member has a 90/10 benefit plan design and elects clinical trial, the MA plan must pay 90% of the 20% Medicare cost-share. Does that make sense? I stumbled across this information in the spring that it became effective on January 1. I called all the payers and only one knew about it. I had to talk with the legal departments of most plans to make them understand what the change in the Medicare Managed Care Manual meant and what was expected of them. It was a big deal that few people found in the regs. GREAT NEWS!!!! Delashmit, Transplant Financial Coordinator Cannon Center for Blood CancersSubject: BMT clinical trials for Medicare Advantage plansTo: " TxFinancialCoordinators " <TxFinancialCoordinators >Date: Thursday, May 3, 2012, 9:38 AM We’re seeing more & more Medicare patients, and a portion of them have signed on to Medicare Advantage plans. If we want to transplant them on a clinical trial, that’s usually carved out and falls to straight Medicare. The problem we’re facing is that these patients don’t have Medicare supplements, so they face responsibility for the part B 20% copayment, along with deductibles, etc. It’s prevented a significant number of patients from enrolling in our trials. Is anyone else seeing this problem? Any cases where a Senior Advantage plan agreed to cover a clinical trial, or pay secondary to Medicare for clinical trial care? GoldsteinBusiness Manager, Stanford BMT Program300 Pasteur Drive, H0101Stanford, CA 94305~ - direct~650.725-3117 - fax~ - BMT office ***This email and any attachments may contain confidential information for the use of the designated recipient(s) named above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its content is prohibited. If you have received this email in error, please immediately notify Stanford University Medical Center at . ~Thank You.***

[Guest guest]

Awesome! Thank you for the link!!!

Subject: BMT clinical trials for Medicare Advantage plansTo: "TxFinancialCoordinators " <TxFinancialCoordinators >Date: Thursday, May 3, 2012, 9:38 AM

We’re seeing more & more Medicare patients, and a portion of them have signed on to Medicare Advantage plans. If we want to transplant them on a clinical trial, that’s usually carved out and falls to straight Medicare. The problem we’re facing is that these patients don’t have Medicare supplements, so they face responsibility for the part B 20% copayment, along with deductibles, etc. It’s prevented a significant number of patients from enrolling in our trials.

Is anyone else seeing this problem? Any cases where a Senior Advantage plan agreed to cover a clinical trial, or pay secondary to Medicare for clinical trial care?

Goldstein

Business Manager, Stanford BMT Program

300 Pasteur Drive, H0101

Stanford, CA 94305

~ - direct

~650.725-3117 - fax

~ - BMT office

***This email and any attachments may contain confidential information for the use of the designated recipient(s) named above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its content is prohibited. If you have received this email in error, please immediately notify Stanford University Medical Center at . ~Thank You.***