Beneficiary Risk Planning

1
Sensitivity and Awareness Training
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Objectives

• Understand the goals of the Centers for Medicare
  Medicaid Services related to this technical
  assistance.
• Define the impact of mental illness on people
  with Medicare.
• Recognize strategies for improving benefit
  counseling with people who have a mental illness.

3
Partnering with SHIPs

• The Ombudsman is charged with working with
  the SHIPs to facilitate the provision of
  information to beneficiaries.

4
Goals for SHIP Assistance

• Goal of the CMS Office of the Medicare Ombudsman
  (OMO)
• To assist SHIPs and other community partners to
  build bridges and expand the network of help to
  beneficiaries with mental illnesses,
  disabilities, HIV/AIDS and other vulnerable
  populations.
• Pathway to Goal Fulfillment
• Collaboration with Partners.
• Development and implementation of a technical
  assistance program (TAP) focused on sensitivity
  and awareness of underserved populations and
  network expansion.

5
Your Contributions Matter

• This training today is a conversation
• Share your experiences
• Brainstorm successful techniques
• Conversation not just a presentation

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Definitions

• Mental Illness
• Health conditions that are characterized by
  alterations in thinking, mood, or
  behaviorassociated with distress and/or impaired
  functioning.Mental Health A Report of the
  Surgeon General, 1999
• No bright line separating health from illness,
  distress from disease. National Alliance on
  Mental Illness
• Mental Health
• Mental Health refers to the successful
  performance of mental function, resulting in
  productive activities, fulfilling relationships
  with other people, and the ability to adapt to
  change and to cope with adversity.Mental
  Health A Report of the Surgeon General, 1999
• Manifestations of mental disorders vary with
  age, gender, race, and culture. Healthy
  People, 2010

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How Prevalent Is Mental Illness in the U.S.?

• Mental illness causes more disability than heart
  disease and cancer.
• There are more than 200 mental disorders, with
  anxiety being the most common.
• More than a quarter of the population will
  experience an anxiety disorder during their
  lifetime.
• About 20 of Americans suffer from a mental
  illness.

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Conversation Stigma of Mental Illness

• In your experience, how does the stigma,
  embarrassment, and denial associated with mental
  illness get in the way of helping beneficiaries?
• Are you aware of any mental illness myths that
  you need to set aside yourself?

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Why Underserved?

• Stigma, embarrassment, denial
• Emotions that may be experienced by
  beneficiaries, caregivers, or SHIP counselors
• Lack of a clear line between health and illness
• Less than a third of people with diagnosable
  mental illness receive help.

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Your Role

• Build on existing Medicare benefit counseling
  skills by becoming more sensitive toward and
  aware of persons with mental illness.
• Act within the parameters defined by your SHIP
  Director and training.

SHIP Counselors are not expected to
diagnosis or treat mental illness.
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Mental Illnesses You May Encounter
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Fact Sheets

• Depression
• Anxiety
• Dementia

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Conversation Depression, Anxiety, Dementia

• What do you do when a person
• Cannot remember what they have selected, today or
  previously?
• Starts becoming violent?
• Does not seem connected to reality?
• Wants to address all tasks associated with
  benefit selection at once?
• Does not believe they can make benefit decisions?

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Fact Sheets

• Counseling People with Mental Illness

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Medicare Benefits Counseling for People With
Mental Illness
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Conversation Developing Strategies for Success

• What do you do when a person
• Becomes agitated?
• Refuses or cannot provide information?
• Requests an increasing amount of your time?
• Will not stop talking about other problems in
  their lives?
• Speaks angrily to you?
• Cannot focus on the task at hand?

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Counseling an Anxious Beneficiary

• Tip Sheets
• Counseling People with Mental Illness
• What Should you Do in a Difficult Conversation?
• Anxiety
• What are some of the difficulties that behaviors
  associated with anxiety may create during a
  counseling session?

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Strategies for Successful Conversations

• Redirect the conversation if a person becomes
  agitated or resistant.
• Ask for information in multiple ways.
• Maintain boundaries.
• Be empathetic and patient.
• Be respectful of the person.
• Put your feelings (but not your safety) aside.

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Prescription Drug Coverage Counseling

• Key Conversations
• Prescribed dose vs. covered dose
• Contingency plans
• Step therapy
• Annual costs and alternative funding sources

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Connecting With Mental Health Resources
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Conversation Current Practice for Connecting to
Mental Health Resources

• What do you do when a person
• Self-identifies with a mental illness and asks
  for assistance?
• Displays what you perceive to be symptoms of a
  mental illness?
• Exhibits crisis behaviors such as talk of suicide
  or harm to others?
• Requests or seems to need a resource not provided
  by your SHIP?

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Strategies for Connecting

• Recognize that the best way to help is to make a
  connection with the appropriate expert.
• Always act within the boundaries of your role as
  a SHIP Counselor as defined by your SHIP Director
  and training
• You can connect by
• Having an awareness of your local mental health
  landscape.
• Being familiar with national mental health
  resources.

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Local Mental Health Landscape

• Community Service Boards provide services to
  individuals in VA with mental illnesses, mental
  retardation or substance abuse disorders.
• Department of Mental Health, Mental Retardation
  and Substance Abuse ServicesP.O. Box
  1797Richmond, VA 23218-1797Phone
  804-786-3921Toll-free 800-451-5544 Fax
  804-371-6638TDD 804-371-8977
• Virginia Office for Protection Advocacy1910
  Byrd Avenue, Suite 5Richmond, VA 23230Phone
  804-225-2042 (TDD)Toll-free 800-552-3962
  (Statewide) Fax [phone]E-mail
  general.vopa_at_vopa.virginia.gov Internet
  www.vopa.state.va.us

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National Resources

• Crisis Hotlines
• Suicide
• 1-800-273-TALK (8255) or 1-800-799-4889 (TTY)
• 1-800-SUICIDE
• Substance Abuse
• 1-800-662-HELP (4357)
• Substance Abuse and Mental Health Services
  Administration (SAMSHA)
• http//mentalhealth.samhsa.gov/databases/
• 1-800-789-2647

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National Resources, Continued

• Other Resources
• The American Psychiatric Association
• www.psych.org
• American Psychological Association
• www.apa.org
• Mental Health America
• http//www.nmha.org/
• National Alliance on Mental Illness
• http//www.nami.org/
• National Council on Community and Behavioral
  Health Care (NCCBH)
• http//www.nccbh.org/

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Summary

• CMS goals related to SHIP TAP
• Facilitate the provision of information to people
  with Medicare.
• Reach out to vulnerable populations.
• Work with partners to improve service to people
  with Medicare.
• Mental illness
• Impacts people of all ages and social structures.
• Responsible for more disability than any other
  illness.
• Strategies for success
• Appropriate tools for diverse situations.

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Sensitivity Awareness Training.

• Lynne Tierney
• CMS RO
• Health Insurance Specialist
• Trudy Maske
• Virginia VICAP Director