NOMNC

Medicare Advantage Plans

 

Medicare health plans are another way to get your Part A (Hospital Insurance) and Part B (Medical Insurance) benefits instead of original Medicare. There are several types of plans to choose from, including Medicare Advantage Plans (Part C).

Medicare Advantage Plans

If you have Part A and Part B, you can join a Medicare Advantage Plan, sometimes called "Part C" or an "MA plan". This type of Medicare health plan is offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D).

Before joining a Medicare Advantage plan

Talk to your employer, union, or other benefits administrator about their rules before you join a Medicare Advantage Plan. In some cases, joining a Medicare Advantage Plan might cause you to lose your employer or union coverage. If you drop or lose employer or union coverage for yourself, you may also lose coverage for your spouse and dependents. You may not be able to get this coverage back.

Insurance companies can decide if a plan will be available to everyone with Medicare in a state, or only in certain counties. Insurance companies may also offer more than one plan in an area, with different benefits and costs. Each year, insurance companies can decide to join or leave Medicare.

If a plan decides to stop participating in Medicare, you'll have to join another Medicare health plan or return to Original Medicare.

Example: Mr. Johnson joined a Medicare Advantage Plan that only serves members with both Medicare and Medicaid. Mr Johnson loses his Medicaid eligibility. Medicare requires Mr. Johnson's plan to disenroll him unless he becomes eligible for Medicaid again within the plan's grace period.

Types of Medicare Advantage Plans:

Health Maintenance Organizations (HMOs)

Preferred Provider Organizations (PPOs)

Special Needs Plans (SNPs)

Medicare Medical Savings Accounts (MSAs)

Private Fee-for-Service Plans (PFFS)

Fentanyl

Several fentanyl doses sold by the defendants tested positive for xylazine, an animal tranquilizer that is of similar potency to fentanyl but not susceptible to treatment with Narcan, a medication that can reverse overdoses. Known by its street names “tranq” and the “zombie drug,” xylazine can cause users to blackout in a stupor and kill skin tissue by burning the flesh, which leads to deep sores.



According to the DEA, fentanyl is approximately 100 times more potent than morphine and 50 times more potent than heroin as an analgesic. From 2011 through 2021, fatal overdoses associated with misuse of clandestinely produced fentanyl and fentanyl analogs increased markedly. According to the Centers for Disease Control and Prevention (CDC), overdose deaths involving synthetic opioids, excluding methadone were involved in roughly 2,600 drug overdose deaths each year in 2011 and 2012, but from 2013 through 2021, the number of drug overdose deaths involving synthetic opioids, excluding methadone increased dramatically each year, to more than 68,000 in 2021. The total number of overdose deaths for this category was greater than 258,000 for 2013 through 2021. Overdose deaths involving synthetic opioids are primarily driven by illicitly manufactured fentanyl, including fentanyl analogs.

Nursing Home Employee Charged with Fentanyl Distribution

On February 7, 2024, in federal court in Central Islip, a complaint was unsealed charging a man (Defendant 1) and a woman (Defendant 2) with conspiring to distribute fentanyl. According to the allegations, between May 2023 and January 2024, the couple sold approximately 270 grams of fentanyl, often conducting these transactions in broad daylight and at public locations across Long Island. Notably, one of these locations was outside a nursing home where Defendant 2 was employed.

In several transactions, Defendant 2 sold significant quantities of fentanyl to an undercover officer in the parking lot of the nursing home where she worked. When the undercover officer arrived, Defendant 2 exited the nursing home, completed the sale, and then returned to work inside.

Compliance: Diversion-Prevention program

 

Compliance Perspective

Issue Nursing home employees may be involved in drug-related activities, which can lead to legal and ethical issues. The use, possession, sale, transfer, or distribution of non-medically prescribed controlled substances or of alcohol on the facility’s premises or at any of the facility’s work sites should be prohibited. Any employee found in violation should be subject to disciplinary action up to and including dismissal on the first offense. Employees should be prohibited from possessing paraphernalia on facility premises used in connection with non-medically prescribed controlled substances and from reporting to and being at work while under the influence of alcohol, illegal drugs, or any controlled substance. Failure to prevent diversion of residents’ prescribed controlled medications by staff who sell or take the drugs for their personal use may be considered abuse, neglect, misappropriation, and fraud, in violation of state and federal regulations. Facilities should implement a proactive diversion-prevention program which identifies the types of medications most likely to be taken, signs that diversion has taken place, and signs of impairment. Discussion Points Facilities should have policies and procedures prohibiting drug and alcohol use at work, and all employees should read and sign an agreement stating they understand and will comply with these policies. Policies should also include guidelines for handling medications, reporting suspicious activities, and conducting background checks on employees. Staff should receive regular training on drug-related issues. This training should cover topics such as recognizing drug-related activities, reporting suspicious activities, and handling medications. A program titled Drug and Alcohol Policy and Practices is available to all clients on Med-Net Academy in the Substance Use category.  Periodically audit to ensure that nursing home employees are following policies and procedures addressing drug-related activities. These audits should include reviews of medication logs, employee background checks, and reports of suspicious activities.