OpportunityTitle: SMP Projects
AdditionalInformationOnEligibility: Domestic public or private and non-profit entities including state, local and Indian tribal governments (American Indian/Alaskan Native/Native American), faith-based organizations, community-based organizations, hospitals, and institutions of higher education are eligible to apply.      Through this competition, AoA plans to fund one project in each of the following jurisdictions: Alabama, California, Connecticut, Hawaii, Iowa, Illinois, Indiana, Louisiana, Maryland, Minnesota, Missouri, Mississippi, North Carolina, North Dakota, Nebraska, New Hampshire, Nevada, New York, Pennsylvania, Rhode Island, South Carolina, South Dakota, Utah, Vermont, Wisconsin, Wyoming, Guam and the US Virgin Islands.
Description: The HHS Office of Inspector General estimates that Medicare loses billions of dollars each year due to errors, fraud, and abuse. These losses are due, to a considerable extent, to the many ways in which the funds are disbursed as well as to the sheer magnitude of health care expenditures. Both factors increase the probability of errors while opening wider opportunities for fraud and abuse. While the vast majority of health care providers are honest, those operating unscrupulously, intent on obtaining vital health care dollars illegally, have done so based on the perception that the risks of detection have lessened over the years.Beginning in 1997, the AoA established twelve local demonstration projects designed to recruit and train retired professionals, such as doctors, nurses, teachers, lawyers, accountants, and others to identify and report error, fraud, and abuse. Implemented through the Omnibus Consolidated Appropriation Act of 1997 (Public Law 104-208), Senate Report 104-368 noted that &#147;senior citizens are our best front line defense against these losses, but they often don&#146;t have the information and experience needed&#148; to recognize and accurately report cases of error, fraud, and abuse. The Report further noted that &#147;thousands of retired accountants, health professionals, investigators, teachers, and others &#133; with appropriate training could serve as volunteer expert resources and educators for seniors in their communities.&#148; Accordingly, these projects have worked to test different models designed to train retirees in local communities to serve as both volunteer resources and educators for other Medicare beneficiaries, and to build and strengthen community coalitions of older Americans and service providers.SMP Program TodayIn 2009, the SMP Program will include an estimated 54 project grants in all states, the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands. SMP projects have made great progress in recruiting and training retired professionals and other senior citizens on Medicare and Medicaid error, fraud and abuse. These volunteers work in their communities, senior centers and elsewhere to educate Medicare and Medicaid beneficiaries, family members, and caregivers to actively protect themselves against fraudulent, wasteful and abusive health care practices by reviewing their Medicare benefit statements and reporting suspected errors.SMP projects actively work to disseminate SMP fraud prevention and identificationinformation through the media, outreach campaigns, community events and many other means. Through these efforts, beneficiaries contact the projects with inquiries and complaints regarding Medicare, Medicaid and other health care or related consumer issues. Another key role of the SMP project is to address such inquiries and complaints, either by resolving matters directly or by referrals to appropriate entities. SMP projects refer numerous beneficiary complaints to state and national fraud control /consumer protection entities, including Medicare contractors, state Medicaid fraud control units, state attorneys general, the OIG, and the Centers for Medicare &amp; Medicaid Services (CMS). Capturing SMP program activity data, to include tracking and reporting of beneficiary complaints, referrals, savings and other outcomes in the SMART FACTS system is also a key function of the SMP project. The AoA also receives Health Care Fraud and Abuse Control (HCFAC) funding as authorized by the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The HCFAC funds, which are received from the Medicare Trust Fund, are used to support infrastructure, technical assistance, and other SMP program support and capacity-building activities designed to enhance program effectiveness. The National Consumer Protection Technical Resource Center (the Center), an AoA grantee, provides training and technical support including mentoring of new projects, disseminating best practices and innovations, technical assistance, training and support of SMP project implementation and effective use of AoA&#146;s SMARTFACTS management tracking and reporting system. In 2004, AoA announced a new competitive grant program to support SMP project efforts to advance collaborative and innovative approaches for integration of Medicare and Medicaid fraud awareness and prevention activities within states and communities. A second round of SMP Integration Grants were awarded in 2006, that support the SMP projects&#146; efforts to reach minority, culturally-diverse, and non-English speaking populations with the SMP fraud prevention message. In 2008, seven new SMP Integration Grants were awarded with a focus on developing strategies to reach elders in rural and tribal areas with the SMP message.Semiannually, the HHS Office of Inspector General (OIG) collects data submitted by grantees through SMARTFACTS on the activities and performance results of the program. Since the program&#146;s inception in 1997 through December 2007, SMP project efforts have resulted in: &#149; Education: Almost 2.3 million beneficiaries have been educated during 60,000 group education sessions led by SMP staff or volunteers.&#149; Counseling: More than 980,000 one-on-one counseling sessions were held with or on behalf of a beneficiary. &#149; Events: Close to 21 million people are estimated to have been reached by SMP community education events.&#149; Media Outreach: Over 170,000 media outreach events have been conducted.&#149; Resolution of Complaints: Over 104,000 complaints received from beneficiaries, their families or caregivers as a result of educational efforts were resolved or referred for further investigation. &#149; Savings: Over $105.65 million in savings, including Medicare and Medicaid funds recovered, beneficiary savings and other savings have been attributed to the project as a result of documented complaints. Project Objectives and ActivitiesThe goal of SMP Projects is to empower beneficiaries/consumers to prevent health care fraud through outreach and education. Program coverage must target vulnerable, hard-to-reach population beneficiaries, their families and other consumers. The purpose of this competition is to provide the opportunity to fund one (1) SMP Project in each eligible state or US territory for a project period of up to three (3) years based on the availability of federal funds. Applicants under this announcement are required to design and implement strategies to address each of the following SMP Strategic Program Objectives:&#149; Foster National and Statewide Program Coverage. Applicants must provide a comprehensive plan with appropriate strategies to achieve statewide coverage. This plan is required of all applicants, whether they be statewide entities, regional, area or local organizations. Statewide program coverage is defined for this purpose as service to each county within the state or in each region within the territory. Types and levels of service shall be specified as well as strategies or approaches by which statewide coverage will be achieved and enhanced. Examples of appropriate strategies that may be used to ensure statewide program coverage include collaboration with organizations representative or knowledgeable about of the target population, formal partnering, sub-granting or contracting with other area, regional or statewide organizations, toll-free lines, web sites and web-based strategies, and statewide media and outreach plans. &#149; Improve beneficiary education and inquiry resolution for other areas of health care fraud. Applicants must provide a plan, with specific performance goals and measures, for increasing SMP program coverage to at least one of these other areas of health care fraud: Medicaid, Durable Medical Equipment (DME), or home health care. Plans must also include specific strategies to partner with one or more health care organizations at the state level to leverage other resources in support of expanded program coverage to the other area(s) of health care fraud (Ex., Medicaid Fraud Control Unit, Home Health Care Association, Discharge Planners, etc.).&#149; Foster national program visibility and consistency. To enhance the capability of AoA&#146;s Aging and Disability Resource Centers (ADRC) to identify and refer instances of potential health care fraud to the SMP project, applicants are required to provide an approach for collaboration with the ADRC(s) in their state, as well as other community-based service providers in their states and communities. In addition, to ensure the seamless, consistent reporting of SMP performance outcomes to the OIG semiannually, applicants must demonstrate capacity to fully implement a web-based data collection and reporting system, ensuring program activities, including simple inquiries, outreach and education, volunteer management and complex issues are accurately recorded and tracked in a timely manner. &#149; Improve the efficiency of the SMP program while increasing results for both operational and quality measures. AoA utilizes the SMARTFACTS system to collect data, track, assess, and measure program performance. In addition, AoA will use data to assess SMP project progress in reaching SMP Strategic Program Objectives, including activities, populations served, and quality of grantee program efforts. Hence, applicant plans must reflect priorities, activities and staff/system capacity to capture project performance data. The plan must also address how project performance relative to the following SMP program measures (at a minimum) will be tracked, assessed and increased: 1. The numbers of elderly beneficiaries educated,2. Inquiries and the rate of inquiry resolution, and3. Medicare, Medicaid or other savings. &#149; Target training and education to isolated and hard -to -reach populations. The Older Americans Act requires that program services target low-income, vulnerable populations that are traditionally underserved due to isolation, ethnic, cultural, language barriers, or other factors. Applicants are required to identify specific target populations within the state, and provide a plan to reach these target populations through innovative and collaborative methods. Signed letters of collaboration from organizations representing the target population must accompany your application and include the kind and level of support offered, e.g., facilities, volunteers or funds. Interventions to reach the state&#146;s target population should reflect one or more innovative outreach strategies, such as those developed by the SMP Integration grantees. (See www.smpresource.org for applicable information.) Applicants must provide plans for evaluation of the success of targeting plans in achieving program goals through analysis of program data provided through use of a web-based management, tracking and reporting system. To advance the above objectives, applications are sought from consortia of state, area or local, public or nonprofit agencies and organizations, including Indian tribal governments, faith-based organizations and community organizations, with a demonstrated capacity to utilize effective models for the recruitment, training, support, and retention of retired persons who, with appropriate training, could provide volunteer service as expert resources and educators for older persons in their communities. Applicants must demonstrate the level of collaboration (s) with signed letters from organizations representing the target population(s) and assign key tasks in the project&#146;s state wide work plan to these organizations. All applicants should demonstrate their capacity and experience in using quantitative performance outcome information to support their activity and management decisions.Projects should utilize best practice models and test innovative approaches for recruiting retirees fully capable of teaching and educating Medicare and Medicaid beneficiaries to better monitor payments on their behalf and recommend actions to address identified discrepancies. In every case, applicants should propose activities that will effectively employ the unique skills, varied experiences, good will, and availability of retired professionals in assisting older persons to become more educated about their health care expenditures under Medicare and Medicaid. As beneficiaries, citizens, and taxpayers, older persons can and should have the knowledge necessary to assess their health care bills, statements, and other documents accurately and to identify and report suspected instances of error, fraud, and abuse. Examples of practices deserving their careful scrutiny include: billing for services not rendered; overcharging for services performed; waiving patient coinsurance; accepting or paying kickbacks for patient referrals; offers of motorized and durable medical equipment; and providing inappropriate or unnecessary services.The applicant must provide a detailed plan for the management and operation of the SMP Project. This includes: &#149; developing a systematic plan for project start-up;&#149; providing a comprehensive plan for statewide program coverage that identifies national, state-wide and community-based collaborations and innovations designed to address and reach the targeted populations; &#149; involving a variety of community-based, local, state and federally-financed aging network services organizations including ADRCs;&#149; developing formal partnerships, collaborations and other arrangements as needed to address state-wide SMP Program Objectives; &#149; researching the demographics of the population to be served, and identifying barriers to program access; &#149; developing outreach strategies specifically designed to overcome these barriers and reach the target population, utilizing SMP Integration strategies, as appropriate;&#149; identifying a specific strategy for recruiting, training, and maintaining a pool of SMP volunteers, including seniors with language and other skills and abilities to help reach minority communities; &#149; developing a training plan for staff and volunteers sufficient to conduct effective group and one-on-one educational efforts, respond to inquiries, and make necessary referrals for action, tailored for the target populations and achieving program objectives;&#149; developing outreach strategies and priority areas for current coverage and Medicaid, DME or home health care fraud education based on assessment of trends, issues and cases identified within the statewide service area; and&#149; developing a plan to evaluate project performance, including full and accurate web-based collection and reporting of program activities as required by AoA or the OIG. (The successful applicant will be trained and required to use the AoA SMARTFACTS system.)
GrantorContactEmailDescription: barbara.lewis@aoa.hhs.gov
GrantorContactText: Barbara Lewis &lt;br/&gt;SMP Project Officer &lt;br/&gt;Phone 202-357-3532