MassHealth Updates. Massachusetts Health Care Training Forum July 2013

Transcription

1 MassHealth Updates Massachusetts Health Care Training Forum July 2013

2 MassHealth Updates 1. MassHealth Mission 2. Centralization of Receipt of Senior Medical Benefit Request (SMBR s) for Long Term Care Reminder 3. Changes in Processing Location for Certain Special Programs 4. Virtual Gateway Application Filing Change 5. Publications Update 6. Dual Demonstration Update 7. Health Safety Net Updates 2

3 MassHealth Program Mission Statement To improve the health outcomes of our diverse members, their families and their communities, by providing access to integrated health care services that sustainably promote health, well-being, independence, and quality of life. In conjunction with the MassHealth mission the Member Education Unit s goal is to effectively educate our applicant/member s regarding their potential for, and receipt of MassHealth benefits. 3

4 Centralization of Senior Medical Benefit Request (SMBR s) for Long Term Care All SMBR forms for individuals residing in or entering a long-term-care facility must be mailed to a centralized location at the Central Processing Unit (CPU) in Charlestown, MA The centralization allows MassHealth to continue to provide consistent processing in a timely manner. Incoming SMBRs are assigned to an intake worker in one of the four MassHealth Enrollment Centers (MECs) (Chelsea, Springfield, Taunton, or Tewksbury). MassHealth no longer maintains geographic boundaries for SMBR processing. 4

5 Centralization of Senior Medical Benefit Request (SMBR s) for Long Term Care The SMBR is assigned to a specific intake worker who is responsible for that SMBR until a disposition on the case is determined The assigned worker will send out a verification checklist that includes the worker's name, telephone number, and the MEC address to use to return the verifications When returning the verifications or assisting a family member in returning the verifications, please make sure that the intake worker's name appears on the envelope Do not send verifications to the CPU address. 5

6 Centralization of Senior Medical Benefit Request (SMBR s) for Long Term Care Any SMBR submitted directly to a MEC will be sent to the CPU to be assigned according to the protocols that were established in February 2013 If an SMBR is received at a MEC, it will be date-stamped by the MEC to ensure that the application date reflects the actual date the application was received The SMBR will not remain in the receiving MEC for processing but instead will be forwarded to the CPU to be assigned 6

7 Centralization of Senior Medical Benefit Request (SMBR s) for Long Term Care MassHealth eligibility review forms and verifications for ongoing MassHealth members should continue to be sent to: MassHealth Enrollment Center P.O. Box 1231 Taunton, MA Fax: Medical Benefit Request (MBR s) and (SMBR s for community) should continue to be sent to the Central Processing Unit (CPU) 7

8 Location Changes for Processing of Special Programs Effective June 3, 2013 The processing of the following special programs will be transferred from the Chelsea Enrollment Center (MEC) to: MassHealth Central Office 100 Hancock St. Quincy, MA Title IV-E DCF Interstate Adoptions Refugee Medical Assistance (RMA) program intake Intake for the EAEDC population over 65 Chafee Referrals Autism Waiver Processing of Short Term SC-1 forms for members currently active for community MassHealth will be transferred from the Chelsea MEC to the Taunton MEC. 8

9 Virtual Gateway Application Filing Change If a member lost eligibility for failure to return a review it is ok for the provider to submit a new VG application regardless of how long the case has been closed The member can also has the option to submit the review form to: MassHealth Enrollment Center (EDM) P.O. Box 1231 Taunton, MA Fax:

10 Publications Update MassHealth is creating a new paper application for benefits for the under age 65 population to comply with the implementation of the Affordable Care Act (ACA) The new application will be available for use on It will initially have a new insert which will be used to determine eligibility for individuals needing coverage prior to January 1, A supply of paper applications can be ordered as they are today (phone), (fax), or publications@mahealth.net More details related to this publication will be shared through MTF listserv. 10

11 Introducing One Care: MassHealth plus Medicare Some new terms will replace language used in developing the program so far We Will Use One Care One Care Plans Long Term Supports Coordinator OR LTS Coordinator Personal Care Plan Instead Of Duals Demonstration Integrated Care Organizations (or ICOs) IL-LTSS Coordinator Individualized Care Plan 11

12 Expected Timeline Expected Date July July August Sept. Sept. Oct. 1 By Nov. 1 Jan. 1, 2014 April 1, 2014 (tentative) Action Public awareness campaign begins Three-way contracts signed with One Care plans MassHealth and One Care plan implementation readiness activities Enrollment guides and self-selection letters sent to individuals in target population; outreach to potential enrollees begins One Care plan marketing begins One Care start date, self-selection enrollments only 60-day notice sent to first auto-assignment group Effective date for first wave of auto-assignment (C1s only) Effective date for 2 nd wave of auto-assignment July 1, 2014 (tentative) Effective date for possible 3 rd wave of auto-assignment 12

13 Prospective One Care Plans Three plans are moving forward with readiness activities, leading toward contracting Commonwealth Care Alliance Fallon Total Care Network Health Plans that sign three-way contracts and complete Readiness Review will be able to accept enrollments in October MassHealth and CMS look forward to One Care implementation with a strong group of plans 13

14 Public Awareness and Outreach Overview Kick-off in mid July, with activities continuing through the fall Designed to ensure that Consumers, families, providers, CBOs are informed about One Care and prepared for enrollment Key information sources are prepared before MassHealth mails enrollment package Consumers/families have places to go for more information and enrollment assistance after they receive enrollment package Components include Materials and website Webinars and other trainings for plans, providers, and others supporting individuals in their enrollment decisions Community outreach sessions and other public forums 14

15 Materials and Website Print materials will include One Care at a Glance flyer Introduction to One Care booklet (see next slide) Posters Large print and Braille formats will be available Print materials will mailed to approximately 20,000 MassHealth providers, state agencies and CBOs New website (to launch mid July), With text, captioned webinars, video logs Links to other awareness materials and supplemental FAQs Radio PSA (English and Spanish) Stakeholder input was critical to development of materials thank you! 15

16 Introduction to One Care Booklet Details Content One Care overview Understanding One Care plans Signing up for One Care/Selecting a One Care plan Additional Information (covered services, etc.) Print and electronic distribution Expected to be posted on new One Care website in: English (mid July) Spanish (late July) Large print (August) ASL Video logs (late August) Print versions will be mailed to providers, state agencies, and CBOs in August, and available for order in English, Spanish, large print, and Braille 16

17 Webinars and Other Training SHINE counselors, state agency staff, and CBOs receiving training to ensure they can support people seeking information and assistance starting in July and August Webinars: Introduction to One Care (May 23) Contemporary Models of Disability (June 13) Enrollee Rights (planned for August 1) ADA Compliance (planned for Sept/Oct) Cultural Competency Compliance (planned for Sept/Oct) Webinars will serve as trainings for plan staff and providers, but also for individuals or organizations providing assistance (e.g. SHINE, state agency staff, CBOs, etc.) Online courses and shared learning conferences for plans and providers are also being planned for this fall 17

18 Community Outreach MassHealth also planning to host or participate in other public forums Community outreach sessions Planned for fall/winter 2013 For potential enrollees, families, guardians to learn more about One Care and ask questions At public libraries and other accessible locations One Care plan fairs Planned for fall 2013 With representation from plans Opportunity for interaction and Q&A Presentations and/or exhibit tables at key conferences and events, such as: MassHealth Training Forums, ADDP Conference, BIA-MA Conference, EOHHS Consumer Conference 18

19 One Care Enrollment Packet Enrollment information will be sent to everyone who can enroll in a One Care plan Welcome letter Enrollment Guide Tips for choosing a One Care plan Ways to find out about a One Care plan s network of providers Information about the medications a One Care plan will cover One Care plan important phone numbers and information Options for signing up for a One Care plan, including ways to tell MassHealth if a person does not want to join Contact information for MassHealth Customer Service and SHINE 19

20 One Care Enrollment Packet continued Enrollment Decision Form Lists the available plans Includes the option for an individual to not sign up for One Care (opt-out) List of Covered Services One Care at a Glance flyer with FAQs Return mailing envelope Materials developed with CMS and stakeholder participation 20

21 Health Safety Net Payments Interim Payments Providers received interim payments based on historical claim value during the transition to MMIS claims submission The first claims-based 837I & 837P payments were processed in December for January payment Recovery of interim payments made from July though December began in January 2013 Monthly recovery amount is calculated based on each provider s monthly claim value If monthly claims demand is less than twice the interim payment amount, then the recovery is half of the monthly demand If monthly claims demand is greater than or equal to twice the interim payment amount, then the recovery will be any amount exceeding the interim payment amount 21

22 Health Safety Net Payments Interim Payments This is a reminder that all remaining interim payment amounts will be recovered in the September 2013 payment at the close of the HSN fiscal year Providers should be aware of this deadline as they continue to submit claims from the transition period Providers can find their current remaining balance on the insert received with their HSN monthly payment 22

23 The MassHealth Operations Member Education Unit will be available for questions at the lunch roundtable. Thank-you