Class Overview

This training will provide an overview of the major public health care programs in the United States, Medicare and Medicaid. The content of this training will be as follows:

• Overview of health care in the United States

• Discuss health care expenditures
• Discuss the demographics of the populations that rely upon public programs for health care

• Introduction of the Medicare and Medicaid programs

• General description of programs
• Statutory and regulatory authorities

• Discussion of Medicare

• Part A – Hospital Insurance
• Services provided under Part A
• Beneficiary eligibility requirements
• Provider enrollment
• Reimbursement under Part A
• Part B – Medical Insurance

• Services provided under Part B
• Beneficiary eligibility requirements
• Provider enrollment
• Reimbursement under Part B
• Enrollment in Part A and Part B
• Part C – Medicare Advantage
• General description of Medicare Advantage
• Discussion of Medicare Advantage plans and how they enroll in the Medicare program
• Description of services provided under Part C of Medicare
• Payments to Medicare Advantage plans
• Enrollment in Part A and Part B
• Discussion of beneficiary election periods
• Part D – Prescription Drug Benefit
• General description of Part D
• Beneficiary enrollment
• Provider enrollment
• Prescription Drug Plan application process
• Description of the services provided under Part D
• Medigap
• Discuss options available to Medicare beneficiaries to purchase supplemental insurance
• Describe how Medigap policies fill gaps in Medicare coverage

• Discussion of Medicaid

• General overview of Medicaid
• Discussion of Medicaid grants and the Federal Government’s sharing in State Medicaid costs
• Discussion of how individuals qualify for Medicaid
• Description of other services that states may choose to provide
• Discussion of Medicaid coverage for Medicare beneficiaries (dual eligible)

• Discussion of other significant developments related to the public funding of health care

• Electronic health records
• Overview of EHR and importance to health care
• Meaningful use requirements
• Discussion of the Medicare EHR Incentive Program
• Discussion of the Medicaid EHR Incentive Program

• Health care reform

• General introduction of the Affordable Care Act
• Discussion of Health Care Exchanges
• Discussion of other significant provisions of ACA, including Medicare payment reforms and innovation