3020 Georgia SHIP Guidelines and Standards

Georgia State Seal

Georgia Division of Aging Services
Access to Services Manual

Chapter:

3000 Georgia State Health Insurance Assistance (SHIP) Program

Effective Date:

Section Title:

Georgia SHIP Guidelines and Standards

Reviewed or Updated in:

MT 2013-02

Section Number:

3020

Previous Update:

100 Georgia SHIP Overview

101 General

Georgia SHIP helps beneficiaries and their families understand rights, benefits and choices under the Medicare and Medicaid programs. Georgia’s State Health Insurance Assistance Program (SHIP) and Senior Medicare Patrol (SMP) are components of Georgia SHIP. Through SHIP and SMP, a statewide coalition of staff, volunteers and partners provide free, unbiased and factual health insurance related information and assistance. Georgia SHIP assists recipients in making informed decisions about healthcare options and Medicare plans that best meet their needs.

Georgia SHIP serves to:

  1. Educate beneficiaries, caregivers, professionals and the aging network about Medicare and related insurance benefits, consumer rights and protections;

  2. Assist in the resolution of Medicare billing and related health insurance issues;

  3. Provide advocacy and one-on-one assistance to Medicare beneficiaries in applying for Medicare assistance programs, including, but not limited to: Medicare Savings Programs (MSP), Low-Income Subsidy (LIS) and prescription assistance programs (PAP);

  4. Empower Medicare beneficiaries to prevent health care fraud, error and abuse by educating how to prevent, detect and report suspicious activity;

  5. Empower consumers to make informed decisions concerning health insurance options and to exercise their appeal and grievance rights;

  6. Educate consumers about long-term care insurance including Georgia’s Long-Term Care Partnership;

  7. Recruit, train and retain volunteers to assist in the fulfillment of the program objectives;

  8. Demonstrate program effectiveness through data management; and

  9. Develop partnerships to assist in the dissemination of information to Georgia’s Medicare population.

102 History

The Georgia Department of Human Resources (now Georgia Department of Human Services) Division of Aging Services (DAS) received a Health Information, Counseling and Assistance Grant from the Health Care Financing Administration (now known as the Centers for Medicare and Medicaid Services or CMS) in 1992. The program was named HICARE (Health Insurance Counseling, Assistance and Referral for the Elderly) and operated in six regional planning and service areas (PSAs) in Georgia. In State Fiscal Year (SFY) 1998, HICARE expanded to statewide coverage. In 1999, a grant from the U. S. Administration on Aging (AoA) further expanded HICARE and launched the Senior Medicare Patrol (SMP) project. On July 1, 2002, HICARE became a public-private partnership to include state funded prescription assistance and was renamed GeorgiaCares. In 2005, GeorgiaCares expanded under a state funded LifeLong Planning initiative to educate Georgians in the use of personal planning tools and private funding options to meet future long-term care needs. The LifeLong Planning program and the state funded prescription assistance service were discontinued from the Division of Aging Services due to an economic recession in SFY 2009.

103 Funding and Organization

The Georgia Department of Human Services Division of Aging Services is funded through grants from the Centers for Medicare and Medicaid Services (CMS), the U.S. Administration on Aging (AoA) and state funds appropriated by the Georgia General Assembly and allocates funding to Georgia SHIP. The Division of Aging Services (DAS) administers the statewide Georgia SHIP program and contracts with all twelve of the state’s Area Agencies on Aging (AAAs) for the provision of Georgia SHIP services locally. The AAAs operate Georgia SHIP directly or subcontract with a service provider(s) for program service delivery.

104 Program Activities

The AAA or service provider has considerable flexibility in pursuing various methods of providing Georgia SHIP outreach, counseling and assistance services in their PSA. However, each must provide information and assistance about:

  1. Original Medicare (Medicare Parts A and B);

  2. Medicare Supplement Insurance (Medigap policies);

  3. Medicare Advantage Plans (Medicare Part C);

  4. Medicare Prescription Drug Plans (Medicare Part D);

  5. Medicare appeals and grievances;

  6. Health Care Fraud, Error and Abuse;

  7. Medicare assistance programs;

  8. Long-Term Care Insurance;

  9. Georgia Long-Term Care Partnership;

  10. Consumer Protection; and

  11. Volunteer Opportunities.

200 Georgia SHIP Coordinator

201 General

Area Agencies on Aging assigns the local Georgia SHIP Coordinator to provide public education, outreach, and assistance to Medicare beneficiaries, volunteers, caregivers, professionals and the aging network. The Georgia SHIP Coordinator is employed locally and the position is a full-time equivalent.

202 Minimum Qualifications for a Georgia SHIP Coordinator

The recommended qualifications for a Georgia SHIP Coordinator are:

  1. An undergraduate degree from a four-year college or university, or equivalent work experience;

  2. The equivalent of three (3) years of full-time work experience with at least two (2) years in aging, Medicare, Medicaid, insurance, volunteer coordination or related fields. Comparable experience and/or graduate education may be substituted at the discretion of the Area Agency on Aging;

  3. Good program management skills;

  4. Excellent verbal and written communication skills, including strong presentation skills;

  5. Good interpersonal skills and;

  6. Good organizational skills.

203 Georgia SHIP Coordinator Responsibilities

The Coordinator directly manages all local Georgia SHIP program components, including the State Health Insurance Assistance Program (SHIP) and SMP (Senior Medicare Patrol).

The primary job responsibilities of the Georgia SHIP Coordinator shall be to:

  1. Develop and implement an ongoing volunteer management process in compliance with Volunteer Risk and Program Management (VRPM) policies to ensure coverage in each county of the PSA (see 302 Volunteer Recruitment, 303 Volunteer Retention, 304 Volunteer Recognition);

  2. Provide training to volunteers using DAS Georgia SHIP approved training tools, AoA/CMS publications, the National SHIP Resource Center materials and/or SMP Resource Center materials;

  3. Provide quarterly in-service trainings for volunteers or at least eight (8) hours of update training per year;

  4. Provide technical assistance and distribute program related information to individuals in the PSA with special consideration for time-sensitive information;

  5. Develop and maintain public-private partnerships with various agencies and community-based organizations on the local level and cooperate with state level partners;

  6. Assure the availability and provision for various methods of counseling services, including, but not limited to, in-person, telephone, email, mail, fax, etc.;

  7. Organize, each month, at a minimum, three (3) outreach/education events to an AoA/CMS/DAS targeted population group including, but not limited to:

    1. Faith-based organization;

    2. Dual eligibles with mental disabilities (DMD);

    3. Low income;

    4. Limited English Proficiency/Sensory Impairment (LEP/SI);

    5. Rural;

    6. Homebound;

    7. Minority;

    8. Disabled; and/or

    9. Caregivers;

  8. Provide at least two (2) events per county in the PSA per SFY (July 1 through June 30 of each year);

  9. Establish and maintain a regularly scheduled off-site counseling station in every county in the PSA;

  10. Coordinate special events as appropriate (e.g., CMS initiatives, Older Americans Month activities, DAS initiatives, etc.);

  11. Assist in the development and revision of Georgia SHIP publications, including outreach, training and marketing materials, when requested;

  12. Maintain an adequate supply of up-to-date program related literature and promotional materials;

  13. Attend all regularly scheduled Coordinators meetings and additional required trainings or program meetings. When the Coordinator is unable to attend a required event, notice must be given to DAS Georgia SHIP staff in advance and training scheduled for an alternate time;

  14. Participate in mandatory DAS-sponsored conferences (e.g., Elder Rights Conference, Joint Aging and Disability Resource Connection (ADRC) / Georgia SHIP Conference, etc.);

  15. Participate actively on the Elder Rights Team in the PSA (see 408 Elder Rights Teams) and on the local ADRC Advisory Council;

  16. Assure that all data is entered accurately and timely into the Aging Information Management System (AIMS) and/or other DAS designated data collection systems;

  17. Assure all reports are accurate and received in a timely manner to the appropriate Georgia SHIP DAS staff person;

  18. Assure that the local program satisfactorily accomplishes the goals and objectives reflected in the AAA Area Plan; and

  19. Inform DAS Georgia SHIP staff on all legislative and federal funding contacts and interactions concerning Georgia SHIP.

300 Georgia SHIP Volunteers

301 General

SHIP and SMP are volunteer-based programs mandated by CMS and AoA. DAS Georgia SHIP supports and strongly encourages the recruitment and utilization of volunteers to sustain these programs. Each local program is required to recruit, retain and recognize volunteers based on funding guidelines, e.g., VRPM, P.E.A.C.H. Pals.

302 Volunteer Recruitment

Local programs will maintain an ongoing volunteer management process, including recruitment. Methods for recruitment include newsletter articles, local media, open house events, volunteer fairs, local college groups, senior centers, internet websites or other methods as the Coordinator and AAA deem appropriate.

If an individual contacts the local program for volunteer opportunities, the Coordinator is responsible for follow-up within two (2) working days.

302.1 Number of Recruits

The Coordinator will ensure volunteer coverage in every county of their PSA. Each region is required to have a minimum of six (6) active volunteers (see 303.1 Active Volunteer).

302.2 Bilingual Volunteer

The Coordinator should recruit at least one bilingual volunteer in the language most commonly spoken in the PSA other than English. Also, the local program will utilize translation services made available by the AAA (see 403 Area Agency on Aging Responsibilities).

303 Volunteer Retention

Due to the extensive training provided to each Georgia SHIP volunteer, a commitment of six (6) months of active service is preferred.

303.1 Active Volunteer

To maintain an active status with the program, a volunteer must conduct Georgia SHIP activities during a 6-month period of time. Active status is determined by the local Coordinator for volunteers who are “seasonal” or unable to fulfill this obligation due to travel, illness, family crisis, etc. Active volunteers should be documented in AIMS and other program databases (i.e., SMART FACTS and SHIP NPR).

303.2 Inactive Volunteer

An inactive volunteer has resigned or not conducted Georgia SHIP activities within a 6-month period. Inactive volunteers should be removed from AIMS and other program databases (i.e., SMART FACTS and SHIP NPR) on a monthly basis. DAS Georgia SHIP staff should be notified of all volunteer changes.

304 Volunteer Recognition

Each local program should recognize volunteers, at least annually, through an event or function to provide volunteers with a token of appreciation (i.e., certificate, award plaque, etc.) when funding is available. DAS Georgia SHIP will also provide an annual volunteer recognition event when funding is available. Coordinators are required to attend DAS-sponsored volunteer recognition events and when requested participate in the planning of the statewide recognition event. When the Coordinator is unable to attend a required event, notice must be given to DAS Georgia SHIP staff in advance. Coordinators should encourage volunteers to attend.

305 Volunteer Application, Documentation and Files

Volunteer applications are provided by DAS Georgia SHIP. AAAs or provider agencies will maintain a volunteer application for each volunteer. An original of the completed application is maintained at the local Georgia SHIP office, with one copy retained by the volunteer and one copy sent to DAS Georgia SHIP. The following documentation will also be maintained for each Georgia SHIP volunteer and reviewed during monitoring:

  1. Documentation of training received;

  2. Signed time sheets reflecting actual hours worked;

  3. Acknowledgement of receipt of Health Insurance Portability and Accountability Act (HIPAA) training;

  4. If applicable, a copy of volunteer’s valid driver’s license, driver’s record check and proof of insurance or a signed waiver form verifying proof of insurance (see 405 Vehicle Insurance Liability);

  5. Verification of a federal level criminal records check for volunteers in a position of trust. A position of trust involves access to beneficiaries or other vulnerable people’s personal and/or confidential information;

  6. Verification of a background check to include, but may not be limited to, verification of:

    • Identity

    • Volunteer history and experience

    • Employment history and experience

    • Education

    • Social security number; and

  7. If applicable, a certificate of ability to attest to their ability to perform their assigned duties.

306 Volunteer Opportunities and Training

The local program will ensure volunteers are recruited in accordance with established volunteer opportunities (e.g., PEACH Pals). The Coordinator and the volunteer will agree upon the scope of each individual volunteer’s activities to meet the needs of the local program. Volunteer opportunities may include one-on-one counseling, enrollment assistance, data entry, administrative support, outreach and education.

Volunteer training will be conducted by the local Coordinator and/or DAS Georgia SHIP as outlined in the duties and responsibilities of the volunteer application.

307 Volunteer Certification

Volunteer certification is required for positions of trust. Certification may include, but is not limited to, orientation training, role specific training, and/or a volunteer skills assessment. Certification must be obtained before any position of trust can begin.

When a volunteer skills assessment is required, volunteers will be given two attempts to receive a pass rating (80% or greater); DAS Georgia SHIP and/or the local Coordinator will provide technical assistance as needed for preparation of retesting. If the volunteer fails to receive a pass rating after two (2) attempts, it will be up to the PSA to decide alternate volunteer opportunities.

308 Volunteer Dismissal or Refusal to Certify/Recertify

DAS and/or the local Georgia SHIP program(s) maintain the right to dismiss any volunteer who does not follow established policies and procedures. Justifiable causes for dismissal include, but are not limited to:

  1. Providing counseling on a topic for which the volunteer did not successfully complete Georgia SHIP training;

  2. Expressing opinions, either positive or negative, to beneficiaries, clients or others that damage the reputation of Georgia SHIP as an unbiased source of information;

  3. Creating a discriminatory environment based on gender, race, nationality, age, disability, religion or sexual orientation;

  4. Representing Georgia SHIP in an unfavorable or unprofessional manner;

  5. Profiting, in any way, from providing Georgia SHIP services;

  6. Engaging in activities that could be considered a conflict of interest (see 407 Conflict of Interest);

  7. Acting inappropriately based on substantiated reports of misconduct by beneficiaries, clients or others involved in Georgia SHIP activities;

  8. Failing to attend quarterly in-service meetings and other mandatory training sessions without reasonable cause (e.g., travel, illness, family crisis, etc.);

  9. Refusing to help a Coordinator with counseling or outreach more than five (5) times in a year without reasonable cause;

  10. Knowingly providing inaccurate or outdated information to beneficiaries, clients or others;

  11. Failing to document activities and/or file necessary reports by the established deadline;

  12. Providing medical, legal or financial advice to Georgia SHIP beneficiaries, clients or others;

  13. Being under the influence of alcohol or illegal drugs while on volunteer duty or representing Georgia SHIP;

  14. Unauthorized use or misuse of program equipment and/or materials;

  15. Failing to adhere to policies and standards in place by administering agencies (i.e., the AAA, DAS, and DHS).

DAS and/or the local Georgia SHIP program(s) will maintain policies on notifying volunteers of the possible grounds for corrective action or termination from the program. If the decision is to terminate the volunteer, a copy of this action must be on file with DAS Georgia SHIP and the local program.

400 Inter/Intra-Agency Coordination

401 General

DHS/DAS contracts with all twelve of the state’s Area Agencies on Aging (AAAs) for the provision of the Georgia SHIP program locally within their assigned PSA. The AAAs operate the Georgia SHIP program directly or subcontract with a service provider(s) for program delivery.

402 Division of Aging Services Responsibilities

DAS Georgia SHIP provides overall statewide leadership for Georgia SHIP and is responsible for the management, planning and direction of the program. DAS shall:

  1. Evaluate statewide program outcomes and effectiveness at least annually and implement improvements based on analysis of programmatic data and feedback from CMS/AoA, AAAs, Coordinators, volunteers and clients;

  2. Evaluate local Georgia SHIP program performance and compliance of these standards through reports, monitoring, mystery shopping, site visits and other quality improvement/assurance methods;

  3. Develop, implement and maintain policies, procedures, standards and goals for the administration of the Georgia SHIP program;

  4. Conduct a risk assessment on the roles, work and activities of volunteers;

  5. Develop, implement and maintain materials for training and distribution purposes;

  6. Provide information and referral on current issues and trends under the SHIP and SMP programs;

  7. Participate on the state Elder Rights Team (see 408 Elder Rights Teams) and the state ADRC Advisory Council;

  8. Identify a liaison or contact person for referral and assistance in key agencies and organizations, such as CMS, AoA, Quality Improvement Organization (QIO), Office of State Insurance Commissioner (OIC) and Social Security Administration (SSA);

  9. Develop and maintain relationships with statewide partner organizations;

  10. Maintain the Aging Information Management System (AIMS), in collaboration with the Division of Aging Services (DAS) and the Office of Information Technology (OIT);

  11. Review, comment and approve Georgia SHIP components of the annual Area Plan submitted by the AAAs;

  12. Prepare Georgia SHIP components of the annual Just the Facts report and other requested reports;

  13. Conduct certifications, re-certifications and ongoing training for Georgia SHIP Coordinators;

  14. Assist the AAAs with arrangement for temporary provision of Georgia SHIP services during transition to a new Coordinator or provider agency;

  15. Participate in interviews for applicants as a member of an interviewing team and/or assist in job performance review at the provider agency’s request;

  16. Develop and maintain a Georgia SHIP website including basic program information and updates (see 607 Electronic Access);

  17. Participate in relevant trainings, conferences and meetings and share information appropriately (see 410 Coordination of Information); and

  18. File grant applications and ensure all grant requirements and reports are completed in a timely manner.

403 Area Agency on Aging Responsibilities

The AAA is responsible for assuring the provision of Georgia SHIP services in its PSA as per the DHS/DAS contract, either through subcontracts(s) with a provider agency or by serving as the provider agency. The AAA shall:

  1. Maintain a full-time equivalent Georgia SHIP Coordinator that is not assigned any duties outside of the scope of the Georgia SHIP Program;

  2. Inform DAS Georgia SHIP of all local staff changes and interruptions in staffing within five (5) business days of notice and/or change;

  3. Provide a transition plan to minimize disruption in Georgia SHIP services when the Coordinator position is vacant or when the contract for the program is terminated or not renewed;

  4. Evaluate the effectiveness of the local Georgia SHIP program at least annually and make adjustments in activities and/or budget items to meet the needs of the program;

  5. Ensure that the local Georgia SHIP program maintains a sufficient supply of office supplies and equipment (e.g., electronic equipment, toner, paper, postage, etc.) to meet the needs of the clients served;

  6. Provide opportunities for the local Georgia SHIP program and other aging and social service organizations to collaborate to promote the health, safety and well being of people with Medicare;

  7. Ensure translation services are available via a translations line contract;

  8. Assure that each Georgia SHIP office has, at a minimum, a high-speed internet connection and a sufficient voicemail system for incoming messages;

  9. Promote awareness of Georgia SHIP services to consumers and the general public within the service area;

  10. Ensure data and reports are provided to DAS in a timely manner and in the format required;

  11. Work with DAS Georgia SHIP to remedy any program deficiencies within the PSA within 30-120 days, or sooner depending on the severity of the deficiency;

  12. Submit an annual Area Plan reflecting the overall goals and/or focus of Georgia SHIP and SMP;

  13. Generate and maintain all required records, reports and documentation of Georgia SHIP activities and volunteers;

  14. If applicable, maintain a copy of volunteer’s valid driver’s license, driver’s record check and proof of insurance or a signed waiver form verifying proof of insurance (see 405 Vehicle Insurance Liability); and

  15. Conduct federal level criminal records checks for volunteers in a position of trust (see 305 Volunteer Application, Documentation and Files).

404 Advocacy

Identifying advocacy issues is an important program activity for Georgia SHIP Coordinators, staff and volunteers. Issues identified should be communicated to the DAS Georgia SHIP staff immediately through oral or written communication.

Coordinators, staff and volunteers are free to express their individual opinions to their elected officials, but are prohibited from speaking for, or on behalf of, the Georgia SHIP Program without prior approval from the AAA Director or DAS Georgia SHIP Program staff. Coordinators, staff and volunteers should not use the name or logo of Georgia SHIP, SMP, DHS and/or DAS when expressing their personal opinions to their elected officials.

405 Vehicle Insurance Liability

Georgia SHIP Coordinators, staff and volunteers shall not transport client(s) in any vehicle regardless of its ownership. Administering agencies are required to obtain, (if necessary), proof of a valid driver’s license, driver’s record check and/or proof of insurance for all drivers using their own or a company vehicle for Georgia SHIP activities.

Georgia SHIP Coordinators, staff and volunteers are covered by the state law, including O.C.G.A. § 49-6-63(g) and the DOAS Employee Liability Agreement, for actions within the scope of Georgia SHIP activities.

406 Privacy and Confidentiality

Georgia SHIP Coordinators, staff and volunteers shall maintain the privacy and confidentiality of information disclosed to them in the course of carrying out Georgia SHIP activities pursuant to state and federal laws, regulations and DHS and DAS policies, including the Health Insurance Portability and Accountability Act (HIPAA) of 1996. All Georgia SHIP volunteers are subject to the Georgia Department of Human Services policies on HIPAA. Volunteers may share information on counseling activities with only DAS Georgia SHIP staff and designated staff at the local AAA, as appropriate. Volunteers shall inform clients regarding confidentiality and privacy practices. Oral and/or signed consent is required to disclose information to outside sources and clients must authorize Georgia SHIP to discuss their information with others, unless otherwise required by law.

407 Conflict of Interest

All DAS Georgia SHIP and local staff, including volunteers, in accordance with state and federal laws, regulations and DHS/DAS policies, will refrain from engaging in any activities that could cause a conflict of interest or the appearance of a conflict of interest. Volunteers and staff may not sell or endorse, directly or indirectly, any related products or services, including those related to insurance. Any situation appearing to have a conflict of interest should be evaluated by DAS and/or AAA legal staff to ensure compliance with state and federal law.

408 Elder Rights Teams

The DAS Georgia SHIP staff and local Georgia SHIP Coordinators shall participate in the state and local Elder Rights Team and coordinate with the AAA, Long-Term Care Ombudsman (LTCO) Program, the Elderly Legal Assistance Program (ELAP), the Elder Abuse Prevention Program, Adult Protective Services and other pertinent entities (see also 203 Georgia SHIP Coordinator Responsibilities and 402 Division of Aging Services Responsibilities).

409 Partnership and Resource Development

DAS Georgia SHIP will develop statewide resources for the program through grant funds and public-private partnerships. The DAS Georgia SHIP will develop collaborations with organizations that will enhance the statewide Georgia SHIP. Participant updates and activities will be disseminated to local Coordinators and AAAs. Each local program will support DAS partnership efforts and develop cooperative relationships within their regions with participating agencies. The local Coordinator will report any issues and concerns of all significant local partnership activities or local development activities directly to DAS Georgia SHIP.

410 Coordination of Information

The DAS Georgia SHIP shall provide for the coordination of information between federal, state, local and other agencies and local programs on Medicare, health care fraud and other related topics.

DAS shall act as the conduit for programmatic, contract, complaint and other program related information between the local Coordinators and DAS funders (i.e., CMS and AoA) in accordance with applicable DAS Program Instructions or Memorandums.

411 Records Retention

Local Georgia SHIP programs shall maintain all original client and volunteer records at their site or designated location. Records will be maintained for the length of time required by the fund sources, generally for six (6) years. Coordinators will also maintain copies of training agendas, curriculum and sign-in sheets. Files should be maintained in accordance with HIPAA (i.e., out of plain sight when in use or under lock and key).

412 Credit and Logo Policy

To ensure statewide consistency and program recognition, all materials developed for Georgia SHIP must display the Georgia SHIP logo and, if possible, the logo of DHS and/or DAS. Printed Georgia SHIP materials should also include the DAS statewide phone number, 1-866-55AGING or 1-866-552-446. Additional logos or tag lines may be needed as required by funding sources including, but not limited to, CMS and AoA. Georgia SHIP must follow the logo policy of the Georgia Department of Human Services, Office of Legislative Affairs and Communications.

To ensure adherence to grant requirements and quality standards, DAS Georgia SHIP retains the right to review and approve or deny public education and training materials produced by AAAs and provider agencies. Locally developed materials must be submitted to DAS Georgia SHIP for approval or denial prior to printing and distribution. Allow a minimum of two (2) business days for review and response.

Local programs may add the logo of the AAA or Regional Commission (RC) to give printed materials a local identity. It is not appropriate to add the logo of a for-profit partner to any materials bearing the DHS or DAS logo without written approval from DAS.

Coordinators should display the Georgia SHIP logo on presentation tables, exhibits and booths at events.

500 Training and Technical Assistance

501 General

The DAS Georgia SHIP will provide training to Coordinators. Included in the training will be materials that Coordinators will use to ensure that up-to-date, accurate information concerning health insurance issues is provided to volunteers, Medicare beneficiaries, their caregivers, partners and the general public. Additionally, DAS Georgia SHIP will assure that local Coordinators receive information and training to assist them in the program management process. Local Coordinators may have volunteers or other staff to participate in DAS Georgia SHIP trainings with prior approval.

DAS Georgia SHIP will also provide appropriate training to volunteers, Medicare beneficiaries, their caregivers, partners and the general public.

502 New Coordinator Training

The DAS Georgia SHIP will begin training all new Coordinators within the first fifteen (15) working days of employment. Methods may include classroom, self-study, web-based conferencing, teleconferencing and/or other appropriate methods. Mandatory training will be provided on the following topics:

  1. Georgia SHIP Program Overview, including DAS, SHIP and SMP;

  2. Original Medicare (Medicare Parts A and B);

  3. Medicare Supplement Insurance (Medigap policies);

  4. Medicare Advantage Plans (Medicare Part C);

  5. Medicare Prescription Drug Plans (Medicare Part D);

  6. Medicare Assistance Programs;

  7. Medicare Appeals and Grievances;

  8. Health Care Fraud, Error and Abuse;

  9. Consumer Protection;

  10. Long-Term Care Insurance;

  11. Georgia Long-Term Care Partnership;

  12. Counseling and presentation skills;

  13. Data Management, including Performance Measures and AIMS;

  14. Volunteer Management; and

  15. Program Management.

503 Georgia SHIP Certification Process

Three (3) months after employment, DAS Georgia SHIP staff will provide to the Coordinator a written or online examination developed to assess their ability to apply SHIP and SMP information appropriately.

The Coordinator must complete and return the written or online examination within one (1) month of its receipt. The written or online examination will be evaluated on a pass/fail basis by DAS Georgia SHIP staff within thirty (30) calendar days. If the Coordinator does not receive a pass rating (80% or greater), DAS Georgia SHIP will provide technical assistance as needed for preparation of retesting.

Coordinators may not submit the written or online examination more than two (2) times within ninety (90) days of the receipt of the initial testing. If the Coordinator fails to receive a pass rating after two (2) attempts, the AAA must appoint a new Coordinator.

When the written or online exam is given a pass rating, DAS Georgia SHIP will administer an oral examination. If the oral exam is not passed upon the initial attempt, one (1) additional attempt will be given. If a pass rating is not obtained after the second (2nd) attempt, the AAA must appoint a new Coordinator.

Coordinators are required to obtain a pass rating from both the written and oral examinations.

504 Georgia SHIP Recertification Process

Eighteen (18) hours of training is required each year to receive Georgia SHIP Recertification. To fulfill the requirement, each Coordinator must complete a minimum combination of 6 hours of SHIP-related training, 6 hours of SMP-related training and 6 hours of other program related training (e.g., volunteer management, additional SHIP and SMP and other program-related topics). The training must be provided from sources approved by DAS Georgia SHIP. Recertification is not required during the initial SFY of certification.

505 Refusal to Certify/Recertify an Individual as a Georgia SHIP Coordinator

DAS Georgia SHIP may refuse to certify/recertify any Georgia SHIP Coordinator for reasons including, but not limited to, the following:

  1. Failure of the Coordinator to meet and/or maintain minimum qualifications for certification or recertification;

  2. Existence of any conflict of interest or appearance of a conflict of interest (see 407 Conflict of Interest);

  3. Deliberate failure of the individual to disclose any conflict or interest or appearance of a conflict of interest (see 407 Conflict of Interest);

  4. Giving or having the appearance of giving an endorsement or preference for any product or specific service provided to Georgia SHIP clients;

  5. Violation of confidentiality or HIPAA requirements;

  6. Failure to provide adequate and appropriate services to Georgia SHIP clients;

  7. Falsifying records or consistently misrepresenting or having errors in reporting and data;

  8. Failure to follow the standards, policies and procedures of the DAS Georgia SHIP Program;

  9. A change in employment duties which is inconsistent with Georgia SHIP duties;

  10. Separation from the Georgia SHIP Program due to, but not limited to, termination of employment with the provider agency, an extended absence from the program preventing fulfillment of job responsibilities, termination or non-renewal of a provider agency’s contract;

  11. Providing counseling on a topic which the Coordinator did not successfully complete Georgia SHIP training;

  12. Expressing opinions, either positive or negative, to beneficiaries, clients or others that damage the reputation of Georgia SHIP as an unbiased source of information;

  13. Creating a discriminatory environment based on gender, race, nationality, age, disability, religion or sexual orientation;

  14. Representing Georgia SHIP in an unfavorable or unprofessional manner;

  15. Profiting, in any way, from providing Georgia SHIP services;

  16. Acting inappropriately based on substantiated reports of misconduct by beneficiaries, clients or others involved in Georgia SHIP activities;

  17. Failing to attend required in-service meetings and other mandatory training sessions without reasonable cause (e.g., illness, family crisis);

  18. Knowingly providing inaccurate or outdated information consistently to beneficiaries, clients or others;

  19. Failing to document activities and/or file necessary reports by the established deadline;

  20. Providing medical, legal or financial advice to Georgia SHIP beneficiaries, clients or others; and

  21. Failing to adhere to policies and standards in place by administering agencies (i.e., the AAA, DAS, and DHS).

506 Process for Refusal to Certify/Recertify an Individual as a Georgia SHIP Coordinator

Prior to refusing to certify or recertify, DAS Georgia SHIP shall conduct one or more of the following actions:

  1. Consult with the contracting AAA to consider remedial actions to avoid the refusal to certify or to recertify;

  2. Provide written notice of such refusal to the contracting AAA agency and/or provider agency. Such notice shall:

    1. Specify the reasons for the refusal to certify or recertify, and

    2. Set forth the effective date of such refusal;

If the refusal to certify or recertify an individual as a Georgia SHIP Coordinator results in the absence of Georgia SHIP services in the relevant service area, the AAA and/or provider agency and DAS Georgia SHIP shall arrange for the provision of Georgia SHIP services until a Georgia SHIP Coordinator is designated.

600 Access to Georgia SHIP Services

601 General

The Georgia SHIP provides information statewide, and occasionally nationally, on Medicare and other related issues. Community and beneficiary education is provided through, but not limited to, in-person, telephone, email, mail, fax, website and public forums.

602 Standard of Promptness

Each method of contact will maintain a maximum standard of promptness of two (2) working days.

If a caller cannot be reached on the first callback of a telephone inquiry, a second attempt is required.

603 Telephone Access

Each local program will provide a local telephone number where client calls will be received. The greeting message must clearly identify the Georgia SHIP Program.

To assure that the statewide system remains fully functional, all changes affecting the toll-free hotline should be relayed to DAS Georgia SHIP prior to the change. This includes changing the local telephone routing number or location of the telephone (e.g., new site or new office). Financial charges may be incurred on these change requests and are not the responsibility of DAS Georgia SHIP.

604 Business-Hours Coverage

The Georgia SHIP hotline at local levels will be answered live, six hours a day on days of regular business operations with a minimum of thirty (30) hours a week. A voicemail answering system must be provided on each line that has a capacity of collecting at least 30 messages or up to 60 minutes to ensure calls are intercepted while assisting other clients.

605 After-Hours Coverage

Each local program must provide a voicemail system that will collect at least 30 messages or up to 60 minutes for messages received after normal business hours.

606 In-person Counseling Sessions

Clients may request in-person counseling sessions. Staff and volunteers, with the guidance and approval from the local Coordinator, shall make reasonable efforts to accommodate these requests and meet with clients in public locations. The agreed upon location should be in a safe, accessible site that affords some protection of privacy [i.e. office, off-site counseling station (see 608 Off-site Counseling Stations), library, health clinic, etc.].

607 Electronic Access

The DAS Georgia SHIP will maintain basic Medicare information on the DAS website (www.aging.dhr.georgia.gov/portal/site) and the Georgia SHIP website (www.mygeorgiacares.org). When possible, reciprocal links will be added to DAS, Georgia SHIP, local offices and partner websites.

608 Off-site Counseling Stations

An off-site counseling station is a location, other than the local Georgia SHIP office, where clients receive one-on-one counseling and/or enrollment assistance. Off-site counseling stations are locally accessible to all beneficiaries in the PSA, including low-income, rural and hard-to-reach populations.

Georgia SHIP will establish and maintain off-site counseling stations in every county throughout Georgia.

700 Community Education and Outreach

701 General

Group sessions and presentations are an opportunity to provide free, unbiased and factual health insurance information to people with Medicare and others in a group setting. Community education and outreach events (i.e., health fairs or booths) are efforts to inform individuals about the available services offered through Georgia SHIP. These events may be arranged by the local Georgia SHIP program or conducted in response to a request from an organization.

Each local Georgia SHIP program will assess, plan and provide community outreach and education to ensure that people with Medicare, their caregivers and others are able to make informed health coverage decisions and understand related rights and protections. Local Georgia SHIP programs will conduct community education and outreach events throughout the year (see 203 Georgia SHIP Coordinator Responsibilities).

702 Materials for Distribution

Each local Georgia SHIP program will have up-to-date literature and promotional materials available at outreach and education events and be able to fill requests for materials. The local Georgia SHIP program will distribute materials from national, state and local partners.

Information and outreach materials disseminated at outreach and community education events are at the discretion of the Coordinator; however, materials should be relevant to the subject matter of the event. Ideally, materials should include information about SHIP, SMP and a variety of Medicare and consumer protection information.

Due to the limited availability of materials, it is recommended that no more than two (2) promotional items be distributed at each event. However, this restriction does not include brochures or informational handouts.

703 Locations

Events may be conducted in a variety of settings including, but not limited to, outdoor parks, senior centers, service organizations, religious organizations, businesses and libraries. All events locations should be handicap accessible and provide reasonable accommodations to those with disabilities.

800 Program Management

801 General

Data collection is mandatory and required at all levels (i.e., Coordinators, staff, volunteers, partners). The Aging Information Management System (AIMS) is the official reporting system for the Georgia SHIP. Entering data into AIMS or any DAS-designated system is required. Reporting and tracking this information accurately and timely is required by state and federal fund sources. Data management must be inputted and validated on a monthly basis.

802 Reports

Reporting requirements are stipulated in the contracts between DAS and the AAA (i.e., Annex R, S, Y and Y1). Additional reports may be requested. Each local program will submit reports to DAS Georgia SHIP in accordance with the contract or request and in the required format.

803 Due Dates

All due dates for data required by DAS are stipulated in the contract with the AAA. Due dates are the 15th working day of the month and are submitted monthly, quarterly or semi-annually as required unless otherwise indicated in writing.

804 Data Collection

Data collection is required for counseling services and community outreach and education (e.g., public and media forms or client registration forms). The data collected must be entered into AIMS or any DAS-designated system and submitted in a timely and accurate manner.

805 Grant Funding Expenditures

CMS SHIP funds are to be obligated by March 31 of each calendar year and are to be liquidated by May 15 of each calendar year.

AoA SMP funds are to be obligated by May 31 of each calendar year and are to be liquidated by July 15 of the same calendar year.

Grants outside of basic SHIP and SMP awards will be specified accordingly.

Effective Date: January 2013

Approved:

__________________________________________________________________
Dr. James J. Bulot, Director
Georgia Department of Human Services Division of Aging Services