Target activity means the activity for which the reward is provided to the qualifying individual by the MA plan . For all enrollees that qualify for the incentivized service, plans are. 100.2 - Non-discrimination. Strategically aligning the right members with the right incentives. Link to an amendment published at 86 FR 6096, Jan. 19, 2021. The ACA includes an array of provisions that are laying the foundation for fundamental Medicare payment reform, linking payment to patient outcomes and experiences of care, and giving providers an incentive to limit spending by rewarding reductions in the projected spending for their Medicare patients. A pleasant voice gives their first name and says Medicare Rewards. To summarize the changes at a very high level: Plans that are using HEDIS measure criteria to define incentive eligibility or including reloadable debit cards and Amazon gift cards as rewards will need to overhaul their programs or face potential penalties for non-compliance. Flexibility & Options for Medicare Rewards & Incentives Programs Convey uses a consultative approach to partner with health plans, configuring each program to achieve better quality outcomes and member satisfaction. Convey uses a consultative approach to partner with health plans, configuring each program to achieve better quality outcomes and member satisfaction. Create your My Health Rewards account to get started. For questions about the rewards program or to follow up on gift card status, please call Optima Medicare member services at 1-800-927-6048 (TTY: 711) or email at members@optimahealth.com. But in its December 2014 guidance, the agency took an entirely opposite tack on rewards and incentives for Medicare Advantage members, and the result is an opportunity which can translate into higher star-rating bonuses and other big financial gains, as well as healthier members that many MA sponsors have yet to fully recognize. Toll-free: 1-833-261-2367 (TTY: 711) Monday - Friday, 8:00 a.m. - 5:30 p.m. Email: ofc_referrals@sentara.com About Rewards The rewards maximum is $50 per member in a calendar year. Phone numbers can be accessed at (847)577-8574 contact medicare. Medicare For people 65+ or those who qualify due to a disability or special situation Medicaid For people with lower incomes Dual Special Needs Plans (D-SNP) For people who qualify for both Medicaid and Medicare Individuals and families Health insurance Supplemental insurance Dental Vision Short term health insurance Introducing Independent Health's Medicare Rewards Program Medicare members are eligible for free Medicare coverage if they receive preventive care. Rewards cannot be used to buy tobacco or alcohol. incentives for beneficiaries to use regular preventive care, change certain health behaviors, achieve personal health goals, and, in some cases, build awareness of health care costs. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Available to all Optima Medicare and Optima Community Complete members. Qualifying individual in the context of a plan-covered health benefit means any plan enrollee who would qualify for coverage of the benefit. ) You can decide how often to receive updates. However, plans today face many challenges with programs, including: nearly $5 billion in unused incentives dollars, Flexibility & Options for Medicare Rewards & Incentives Programs. Medicare Rewards They call everyday. Incentives can help with this. membership & 2022 Healthy Rewards Program Expand All Annual Wellness Visit - $25 reward Annual Physical Exam - $25 reward Annual Flu Vaccine - $10 reward Health Risk Assessment - $25 Breast Cancer Screening (Mammogram) - $25 reward Colon Cancer Screening - $25 reward Diabetic HbA1c Test - $10 reward More . Comprehensive Program Management to Drive Healthy Member Behavior. Completed forms to be returned to UHC in order to qualify for Visa debit card for $40 total for all 4 screenings. Rewards & Incentives in the Medicare Advantage 2022 regulatory structure were made stricter due to the 2021 Final Rule. The guidance in the Managed Care Manual in terms of who needs to be included in programs and how we engage with them has not really changed at all. Additional communications are permitted for those who may not initially respond. For MA-PDs, a reward and incentive associated with the Part D benefit; 3. Thats why Optima Medicare wants to reward you for your healthy behavior. If you need help, call us at 303-602-2111 or toll free at 877-956-2111. 11 The regulation makes it clear that using HEDIS measures for the basis of eligibility is not allowed. means youve safely connected to the .gov website. You can only receive one reward per applicable service. lock It is also possible for you to register a phone number online. Optima Preferred Provider Organization (PPO) products are issued and underwritten by Optima Health Insurance Company. Although it may have gone largely unnoticed by Medicare Advantage plans this year, a clarification regarding rewards and incentives (R&I) programs embedded in an 894-page final rule issued in January 2021 could have significant implications for plans' star ratings strategy in addition to posing compliance risks and added costs in 2022. As you earn more rewards, the reward money will be added to your account and you can keep using the same card. Members enrolled in Optima Medicare Value (HMO), Optima Medicare Prime (HMO), Optima MedicareSalute (HMO), Optima Community Complete (HMO D-SNP) in all regions are eligible for all rewards depending on qualifications. Qualifying products and requirements are a combination of any of these products: Medicare Supplement =one-for-one on production; Final Expense =two-for-one on production Over the phone. At AvMed, we value the WELLfluent lifestyle so much we offer even more incentives to our Members. 2022 Convey Health Solutions. UCare Medicare plans: Prime, Value, Essentials Rx, Standard, Complete, Classic, Value Plus and Aware. If you are eligible for the Medication Therapy Management Program, OptumRx will contact you on behalf of Optima Medicare and ask you to participate in a Comprehensive Medication Review. The Annual Wellness Visit is an appointment with someone from your primary care providers team. Sign up for our Rewards Program*. Rewards have no cash value and can only be redeemed in the Go365 Mall. Each demonstration has a distinct set of encouraged behaviors and corresponding rewards, which are collectively termed "beneficiary engagement" strategies. If you are having trouble using our site, please call our customer service team at 1-877-922-GIVE (1-877-922-4483) from Monday-Friday, 9 a.m. - 6 p.m. Some members may qualify for additional rewards, such as Breast Cancer Screening and Colorectal Cancer Screening. 9. Convey deploys a multi-channel educational strategy to engage and drive members to take ownership of their health. On December 4, 2014, CMS issued additional guidance regarding rewards and incentives programs (RI Program). Please contact your doctor to see if you need these screenings. This can happen through regular member communications provided by the plan. There are 2 ways to tell us about your completed health activities: Online, right here. TTY users call 711. . For example, a program geared toward people with diabetes would be allowed as long as everyone is included and treated the same. In Medicare Advantage, all eligible enrollees need to be informed of the availability of rewards and incentives. The HbA1c test measures how much of your hemoglobin is coated with sugar. Eligible professionals can receive up to $44,000 over five years under the Medicare EHR Incentive Program. Reward selections must be completed during the Program Period. 100.5 - Permissible Rewards and Incentives. You can complain of receiving incoming mail 30 days before registering on Do not contact lists. However, its still permissible to provide rewards and incentives to a group with a particular chronic condition. Here are the four key steps for a Medicare whistleblower reward to be paid: 1. When you look after yourself, you're rewarded with wellness and longevity. (a) General rule. Welcome to the Aetna Healthy Actions SM Rewards Program Get your reward for healthy living! Icario's Benefits Care Card ensures that health plans comply with CMS guidelines while promoting improved member satisfaction by delivering a variety of plan benefits on a single, easy-to-use card. Your reward card has restrictions and can only be used in specific retailers. website belongs to an official government organization in the United States. Enrollment in our plans depends on contract renewal. Sign in to claim your reward. These healthy actions might get rewarded: Activate your account and claim your rewards. Email Virgin Pulse or call 1-833-450-4074. This blog will give you the confidence to shape outreach in the most effective way as you drive health action and improved outcomes for your members. Share sensitive information only on official, secure websites. You could earn points for: Completing an Annual Wellness Visit(AWV) Tobacco cessation Maintaining a certain Body [] We provide the ultimate flexibility in how incentive and reward programs are delivered to members. Our Health Plan Services is available to help you submit for your reward or provide you with any missing information in order to request your reward. Finally, it is Icarios position that introducing prohibitions on retailers like Walmart, Target (and potentially others like them, e.g. Join the Rewards Program Stay healthy and get rewarded. The question of gift cards has been a hot topic for R&I programs, and theres been some narrowing as far as whats allowed. Year-round performance insights into the program to drive short- and long-term decisions that continually improve healthy behaviors. The Annual Physical Exam is another great way for you to engage with your doctor. The program began January 1, 2009 and provides incentives for eligible professionals who are "successful e-prescribers". The Health Risk Assessment (HRA) is a questionnaire that evaluates a members lifestyle and health status, as well as identifies possible health risks factors. All members are eligible for at least four rewards: Annual Wellness Exam, Annual Physical Exam, Annual Flu Vaccine, and completion of the Health Risk Assessment. Each Healthy Action will earn you a $25 award. UCare Basic, UCare Extended Basic and UCare $20/$50 Medicare Supplement members are not eligible for incentives. Our D-SNPs also have contracts with State Medicaid programs. Download the Guidance Document Final Issued by: Centers for Medicare & Medicaid Services (CMS) Issue Date: December 04, 2014 Log into your account Already have an account? Additional communications are permitted for those who may not initially respond. The minimum production amount required to qualify for the payout or travel credits is $225,000 and for the Agent Rewards, the minimum production amount required is $190,000. They're based on our review of feedback from health care professionals like you, and on prioritization of Star . During an Annual Physical Exam, your provider reviews your current health history and completes a comprehensive physical exam and evaluation of chronic diseases, if applicable. The template (UMCM Chapter 4.10 "Medicare-Medicaid Plan (MMP) Rewards and Incentives Template") must be completed according to the instructions provided by . CMS specifies that the reward item for a target activity must not: Does this represent a change in how Icario programs are run? 422.134 Reward and incentive programs. Participating in the review can help you make sure you are taking all of your medications safely and identify any possible medication interactions your physician may need to know about. Rewards and incentives UCare Medicare Rewards for UCare Medicare members UCare Classic (HMO-POS), UCare Complete (HMO-POS), UCare Essentials Rx (HMO-POS), UCare Standard (HMO-POS), UCare Prime (HMO-POS), UCare Value (HMO-POS), UCare Value Plus (HMO-POS) and UCare Aware (HMO-POS). With Convey, plans receive industry expertise to create an end-to-end program that drives member action and delivers the right rewards to improve health and satisfaction. Yes, Medicare Advantage is finally catching up to the rest of the health care industry, and we are now permitted to offer enrollees Rewards and Incentives. According to the Susan G. Komen Foundation, the five-year breast cancer survival rate for those diagnosed early (Stage 1) is 98-100%. No paper documents can be submitted to earn rewards dollars. Heres how you know. Talk to your doctor about COVID-19 vaccinations. Combine Gift Certificates. Members with diabetes can also earn a reward for completing a Diabetic Eye Exam, a Diabetic Kidney Function Test, or Diabetic HbA1c Testing. Getting the right care starts with an annual wellness visit with your Primary Care Physician (PCP). Then they ask can you hear me. Convey uses a consultative approach to partner with health plans, configuring each program to achieve better quality outcomes and member satisfaction. The final rule from 2021 (86 FR 5684) took the Medicare Managed Care Manual guidance for Rewards and Incentives (Chapter 4, Section 100) and put it into regulation (42 CFR 422.134), CMS codified their subregulatory guidance, and when they did, their non-discrimination requirements and requirements about who needs to be included in programs did not change, The ability to provide additional communications for members who have not yet engaged in activities is preserved, Complaints about R&I are to be handled as Grievances, CMS intends to apply sanctions for non-compliance with these regulations, Rewards must be offered to all eligible enrollees without discrimination, Rewards must not discriminate against enrollees based on race, gender, chronic disease, institutionalization, frailty, health status, or other impairments, Directly involve the qualifying individual and performance by the qualifying individual, Be specified, in detail, as to the level of completion needed in order to qualify for the reward item. Getting your Annual Flu Vaccine is an important step to keeping yourself healthy. Rewards and Incentives Program Guidance Guidance for Medicare Advantage Organizations (MAOs) on implementing a Rewards and Incentives Program (RI Program) for their Part C enrollees. A rewards and incentives program specific to participation in a disease management or Diabetic retinopathy is a common diabetes complication, and it is the leading cause of blindness in adults in the United States. First, schedule an appointment with an in-network provider for the service. mail them their reward(s). Traditional gift card programs are not directed towards products and services that will contribute positively towards a members health. According to the Centers for Disease Control and Prevention, regular screening is key to preventing colorectal cancer. HHSC and CMS will we provide marketing incentives in the form of gift certificates and vouchers that are redeemable for a variety of items such as: discount travel, smart device products, restaurant incentives , golf discounts and more to thousands of businesses around the world who use them to create exciting marketing promotions and giveaways, customer loyalty It is common for gift cards to go unused or be given away. The use of rewards and incentives programs to drive member engagement is a proven strategy to impact star ratings that has helped plans to put the focus on closing gaps in care. Incentives can help with this. Devoted Health complies with applicable Federal civil rights laws and does not . Members must also: Be a member on the date they complete their preventive care. 100.7 - Reporting to CMS United Healthcare medicare advantage REWARDS FOR 4 SCREENINGS rec'd brochure with forms for wellness exam, mammogram, colon cancer, glaucoma screening to be completed by member and doctor, along with results of various lab tests. Your HRA must be completed within 90 days of enrollment, and then annually after the first year of enrollment. As Senior Director of Government Programs, James ensures that Healthmines solutions have a strong positive impact on performance by acting as a subject matter expert on government programs including Medicare Advantage, Medicaid, and ACA/Commercial. For most women, a mammogram is the best way to detect breast cancer. Sign up to get the latest information about your choice of CMS topics. It is the responsibility of the Participant to ensure that the mailing address You receive one reward per Healthy Action per year. Register now Registration tips: Have your Medica ID card ready and enter your name exactly as it is on your Medica ID card Questions about registration? Rewards and Incentive: We make it easy for you to earn rewards just for being active in your wellness journey. Icario can also send program notification postcards. Rewards cannot be converted to cash. But, the CMS takes fraud very seriously, and has been pushing to expand the MIRP. You can easily complete your HRA by calling the Optima Medicare Outreach Team at 1-833-771-1427. Make sure to keep your rewards card in a safe place! 2022 Healthmine, Inc. All rights reserved. All Optima Health plans have benefit exclusions and limitations and terms under which the policy may be continued in force or discontinued. This reward is available to Apple Health (Medicaid) members ages 6 months and older. In the context of a non-plan-covered health benefit, qualifying individual means any plan enrollee (42 CFR 422.134). Restaurant or coffee shop gift cards do not address social determinants of health in the same way as a Walmart card does. 100.1 - Health Related Services and Activities. Plans incur 100% of the cost of issued gift cards, regardless of whether they are used by the member. However, allowable incentives have changed, and well review the impact in this article. Icario can also send program notification postcards. In the Medicare Program; Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program Final Rule (hereinafter referred to as the April 2018 final rule), we codified the methodology for the Star Ratings system for the . When it comes to the types of health actions or target activities that can be tied to R&I offerings, there are a few considerations to keep in mind. Meet the eligibility requirements. All Optima Medicare and Optima Community Complete members are eligible for at leastfour rewards, Annual Wellness Exam, Annual Physical Exam, Annual Flu Vaccine, and completion of the Health Risk Assessment. Annual diabetic eye exams are an important part of managing your diabetes and health. or Incentive (s), R&I, and rewards and incentives mean the same things as reward (s). Call Member Services and ask if your plan is eligible to earn rewards. More Information: Aflac - Q4 Incentive (Oct. 1, 2022 - Dec. 31, 2022) Qualify with just three issued policies in a month. Nothing helps!! * Whether it's scheduling your annual wellness visit or getting your flu shot, you can earn rewards while taking care of your health. If this is news to you, you're not aloneHealthmine has prepared a list of frequently asked questions from our conversations and seminars with numerous health plans that you can download by filling out the form on the right. Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes a new and separate incentive program for eligible professionals who are successful electronic prescribers (e-Prescribers) as defined by MIPPA. ( Recently, Icario expert Sara Ratner, SVP of Government Markets & Strategic Initiatives, unpacked CMS Final Rule on permissible rewards and incentives. Log in at the link below or download the mobile app. understand the impact of these new rules and what actions plans must take to avoid sanctions from CMS. An official website of the United States government Learn how a Medicare incentiveprogram can benefit your plan and your members. 422.134 Reward and incentive programs. In early 2021, the Centers for Medicare & Medicaid Services (CMS) released the Contract Year 2022 Medicare Advantage (MA) and Part D Final Rule with sweeping changes to reward and incentive programs for MA plans that mostly flew under the radar. One-size-fits-all engagement strategies yield subpar results, limiting the potential to improve health and quality outcomes. 2. Once Optima Medicare receives the claim, a gift card will be mailed to you within8 - 10 weeks. Preventive care and staying on top of your healthare important to healthy aging. UCare Advocate Choice and UCare Advocate Plus I-SNP members are not eligible for 2022 incentives. You can only receive one reward per applicable service. Optima Health Medicare, Medicaid, and FAMIS programs are administered under agreements with Optima Health and the Centers for Medicare and Medicaid Services (CMS) and the Virginia Department of Medical Assistance Services (DMAS). Rewards not redeemed before Dec. 31 st will be forfeited. Taking an active role in managing your health is important. Available to Optima Medicare and Optima Community Complete members with diabetes. Many Medicare plans are launching reward and incentive plans. The reward(s) should arrive within 32 days of UPMC for Life receiving the preventive care claim. The program offers a bounty to those who report Medicare fraud - a cash payout of 10% of the money recovered from any fraud settlements, up to a cap of $1000. All Healthy Actions are covered by the benefits in your plan. Earning rewards is as easy as taking good care of yourself. Icarios compliance experts break down what you need to know to ensure your Medicare member outreach strategy aligns with CMS Final Rule regarding rewards and incentives (R&I). Once I tried to respond only to find it's a robocall. The Medicare EHR Incentive Program will provide incentive payments to eligible professionals, eligible hospitals, and CAHs that demonstrate meaningful use of certified EHR technology. *Additional restrictions apply to this reward and it can only be used at limited grocery stores. Another new term that showed up in the regulation that caused some questions was the idea of uniformly offering rewards and incentives. A maximum of $100 in gift cards is rewarded yearly. These activities could include administrative tasks like filling out a health risk assessment (HRA) survey or signing up for a patient portal. Medicare Incentives Medicare E-Prescribing Incentive Program Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes a new and separate incentive program for eligible professionals who are successful electronic prescribers (e-Prescribers) as defined by MIPPA. To convince the government to take a Medicare fraud case requires . (a) General rule. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call 1 (877) 459-3352 (TTY 711) or consult the online pharmacy directory at CignaMedicare.com . Based on members clinical activities, Convey initiates and delivers rewards via flexible channels that are closely-aligned with plan objectives. Optima Health 2022, 4417 Corporation Lane, Virginia Beach, VA 23462-3162. The Medicare Managed Care Manual (MCM), Chapter 4 Section 100, was the subregulatory guidance Icario relied upon when designing R&I programs. Icario has always done this and continues to build in this strategy for optimum engagement. There has been some limited enforcement action in the marketplace regarding continued use of Walmart cards that CMS finds unacceptable. The Final Rule took that guidance and codified it into regulation. Official websites use .govA The 2022 regulatory structure for Rewards & Incentives (R&I) in MA planswhich represents the first major changes since 2014will push MA plans toward greater equity across their populations and . Programs vary. Please see your program details for specific rules. You can submit the form (s) to us in any of the following ways: Mail It can be easy to earn a reward! Our team of experts support all benefit inquiries to simplify member experience and improve clinical, quality, and risk outcomes. Be health-related by doing at least one of the following: Promoting the efficient use of health care resources, Be provided with accommodations consistent with the goal of the target activity to otherwise qualifying individuals who are unable to perform the target activity in a manner that satisfies the intended goal of the target activity, Consist of points or tokens that can be used to acquire tangible items, Are offered in the form of a gift card that can be redeemed only at specific retailers or retail chains or for a specific category of items or services, Be offered identically to any qualifying individual who performs the target activity, Be a direct tangible benefit to the qualifying individual who performs the target activity, Be provided, to the enrollee, such as through transfer of ownership or delivery, for a target activity completed, Is convertible to cash (such as a check); or, Can be used like cash (such as a general-purpose debit card), Have a value that exceeds the value of the target activity itself, Involve elements of chance (such as a raffle or drawing), Eliminate unrestricted Amazon cards, but continue to offer an Amazon voucher that can be used only for health and wellness items, Preserve the Walmart ATF (alcohol, tobacco and firearms) restricted card, as that appears not to be a cash equivalent, Preserve the offer of Target cards as these have not been specifically identified as cash equivalents in any of the guidance Icario has reviewed. All Rights Reserved. have quality programs, STARs, RAF, that financially reward efficiencies and improved quality metrics. The gift card is mailed to the address we have on record. Medicare members must earn and redeem their rewards within the same program year. Icario has reached out to both the OIG and CMS to explore this unintended impact and to hopefully resolve this issue. This guidance elaborates on whether an RI Program can target members with specific . Medicare For people 65+ or those who qualify due to a disability or special situation Medicaid For people with lower incomes Dual Special Needs Plans (D-SNP) For people who qualify for both Medicaid and Medicare Individuals and families Health insurance Supplemental insurance Dental Vision Short term health insurance (b) Offering an R&I program. When you complete the screening, exam, or vaccine, a claim is submitted to us from the provider. In the context of a non-plan-covered health benefit, qualifying individual means any plan enrollee. We want to make this as easy as possible! Some members may qualify for additional rewards, such as Breast Cancer Screening and Colorectal Cancer Screening. Managed care / health plans (Medicare Ad vantage, Medicaid Programs, etc.) It defines specific health actions that you want qualified members to take and offers tangible incentives for completing them. Go Shop. You may be eligible to earn rewards when you complete certain preventive health screenings. The Final Rule came out Jan. 19, 2021, and CMS put into regulation what has consistently been present in the prior Medicare Managed Care Manual guidance. Permissible reward items for a target activity may be reward items that: CMS, following guidance from the OIG, has explicitly included a prohibition on Amazon gift cards that are not limited to a specific health and wellness category, and they have clearly prohibited general purpose debit cards (such as VISA and American Express). These retailers are often the stores of choice for underserved populations who live in rural or urban areas with limited access to food and other daily living items. FAQ on New CMS Regulations for Rewards & Incentives in Medicare Advantage, exclusions for items such as alcohol, tobacco, and firearms, Contract Year 2022 Medicare Advantage (MA) and Part D Final Rule. Check Balance. Earn Healthyperks Rewards for Leading a Healthy Life Earn Incentives Earn gift card rewards for completing activities to keep you healthy with Healthyperks. It is Icarios intent to support our clients in providing our interpretation of these regulations, while respecting the fact that clients may reach different conclusions regarding the guidance and will expect Icario to be a supportive partner in managing this potential risk for them. This means the path Icario has always followed in terms of designing client programs that include R&I is unchanged. We deliver an integrated experience for your health plan through advanced analytics, technology, and market-leading services. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services.