Local Service Area Plan Appendix D.2

Transcription

1 Local Service Area Plan Appendix D.2 FY 2010 Consumer Benefits Assistance Plan 30 October 2009 Denton County MHMR Center 2519 Scripture Denton Texas fax Page 1 of 6

2 Page 2 of 6

3 Denton County MHMR Center has designated staff to screen all consumers who are not Medicaid or SSI recipients. The process allows for all consumers accessing or receiving services onsite or offsite to be screened every 6 months to one year. The following outlines our benefits assistance process: New Consumers Step 1: At the time of the initial call for services, the Central Access Unit obtains all necessary information to register the consumer into its database system. During this preliminary registration process, Central Access Staff are able to complete a preliminary screening to determine benefits potential and available resources. If third party insured, the Central Access Staff will verify benefits, identify a covered provider and obtain authorization for initial services. Step 2: Once the telephone registration is complete, consumers are scheduled to meet with the Consumer Benefits Coordinator to complete the fee assessment and if potentially eligible, a more in- eligibility process begins. Based on the data received, an application is completed and depth screening the required documentation requested. The Consumer Benefits Coordinator may schedule additional appointments as needed to complete the application process and obtain the required documentation. Step 3: Once the fee, assessment is completed, the information is entered into the database. The date of the fee assessment and eligibility screening and the status of the individual s eligibility, at the time of the screening, is indicated in the appropriate DST or field. The status options include: recipient, approved, denied, pending, in process, and ineligible. Recipient: A person receiving benefits at the time of accessing services Approved: A person for whom we have completed the application process and has been approved for benefits Pending: A person for whom we have completed the application process and have forwarded for review and approval by Medicaid or SSI or CHIP In Process: A person for whom we are attempted to complete the application process but is as yet, incomplete Ineligible: A person that has been determined as ineligible based on the screening process Step 4: All completed fee assessments, eligibility screenings, and applications; are reviewed prior to submission, by reviewers who have received the approved training. Variation to this process: Special Accommodations are available for individuals with a level of capacity that impedes the client from presenting at a service location for financial assessment. In cases where the client is unable due to disability to appear at one of our office locations to complete a financial assessment, the consumer s case manager or initial intake staff will complete the fee assessment and screening and submit to the benefits staff for data entry, review and follow-up. Page 3 of 6

4 C urrent or Existing Consumers Receiving Services Onsite Step 1: All consumers accessing services at any of our locations will be reviewed annually for an updated fee assessment and eligibility screening or if changes in benefits or income are reported. Methods for identifying consumers needing review: a. Front desk report: The front desk lists all consumers scheduled to receive services daily. The report is printed one day prior to the scheduled appointment date and all clients are called to remind them of the scheduled appointment. The report identifies all those requiring an updated fee assessment and eligibility screening and consumers are advised during the appointment reminder call to bring in any required documentation 30 minutes prior to the allotted time to complete the updated fee assessment and eligibility screening. b. Encounter Form: Anyone walking in for services that is not on the current schedule (all providers do not use the automated schedule) will check in at the front desk. Front desk staff will print an encounter form and identify if the consumer requires an updated fee assessment. If so, benefits staff are notified and a fee assessment and eligibility screening is completed. Step 2: All completed applications will be submitted to and reviewed by an approved reviewer. Current or Existing Consumers Receiving Services Offsite Step 1: All consumers receiving services offsite will be reviewed annually for an updated fee assessment and eligibility screening. Methods for identifying consumers needing review: a. Encounter Form: Staff scheduled to provide services off site are required to print an encounter form for each consumer scheduled for services. The encounter form will indicate, among other important information, if the consumer requires an updated fee assessment and eligibility screening. b. CPC Report: All case management staff will be provided a monthly report indicating consumers requiring a fee assessment and eligibility screening. If a non-schedule consumer should seek services this report may be used in lieu of the encounter form to identify if an updated fee assessment and eligibility screening is required. Step 2: If an update is required, the appropriate fee assessment and eligibility screening packet will be completed and submitted to the Benefits and Eligibility staff for data entry, review and follow-up. Step 3: If eligible for benefits and services will only be provided offsite, the benefits staff will work with the service coordinator assigned to insure application is completed. All completed applications will be submitted to and reviewed by an approved reviewer. Designated Representative: All applications completed by the Center staff will indicate a benefits staff as the consumers designated representative. This will ensure that should additional information or an appeal be necessary, the Page 4 of 6

5 appropriate staff is notified. Appeals: Benefits staff will work directly with the consumer or with the case manager, as needed, to appeal st adverse decisions when appropriate. Consumer Benefits will do the 1 Appeal reconsideration letter. If denied, Consumer Benefits will refer consumer to West Texas Legal Association and also provide a listing of disability attorneys in the area. Time Frame to Comple te the Fee Assessment and Application Process: All consumers will have a financial assessment completed within 30 days of registration. Clients will be charged full fee for services until the financial assessment is complete and all required documentation is obtained. Review by Trained Designated Staff: All fee assessment and eligibility screenings, completed forms, completed applications, and any appeals packets are submitted to the Consumer Benefits Office for final review. All Consumer Benefits staff are state trained to review and approve any documentation to be submitted. In most cases, State trained staff provides the financial assessments and screenings. If it is necessary for a non-state trained staff to complete a financial assessment and screening, documentation for this process then all forms etc. will be forwarded to the CBO for final review. Notification of Billing Staff: A designated billing staff will run a report showing all current applications waiting for determination. The designated billing staff will complete a batch medifax to determine if anyone listed has been approved. If an applicant has been approved, billing staff will update the fund source to indicate the change. This report will be forwarded to Benefits Staff for update in the database. The billing process will automatically bill or re-bill services provided during the previous 90 days. If the Benefits staff is notified of approval, staff will update the system and notify billing of a change in fund source by sending a copy of the medifax to billing. Quarterly Reports: A designated staff will run a report by quarter (date range) to identify number of applications completed, number of new screenings completed, number of annual screenings completed, and number approved. This information will be transferred to the electronic report format provided by TDHMHR and submitted by the required submission date. A copy of the completed quarterly report will be forwarded to the CEO. Page 5 of 6

6 UMedicareU: UMedicare D Prescription Drug ProgramU: a. Identify Medicare beneficiaries in our system b. Identify who are dual-eligible c. Determine income levels of all Medicare beneficiaries with a focus on those who are not dual-eligible d. Conduct an individualized assessment on those whose incomes are above 135% of poverty. If appropriate, assist them with low-income subsidy e. Assist those Medicare beneficiaries who are not dual-eligible with low-income subsidy application f. Assist those Medicare beneficiaries who are not dual-eligible with assistance to contacts to help with plan selection and enrollment g. Assist those Medicare beneficiaries who are dual-eligible with contacts to help with plan selection and enrollment Page 6 of 6