HSF Assistor Training Topic: Kaiser SF Medical Home June 23, :00 am 11:00 am. Trainer: Adrian Nunez, SFHP

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1 1 HSF Assistor Training Topic: Kaiser SF Medical Home June 23, :00 am 11:00 am Trainer: Adrian Nunez, SFHP

2 WELCOME 2 Please put your phones on mute Do not put the call on hold, to avoid music playing in the background We will have a Q & A session at the end During the presentation, send questions to jaguilera@healthysanfrancisco.org and we will address them during Q & A Any unanswered questions can be addressed at a future training and/or Assistor Updates

3 Today s Agenda Items 3 Overview of Kaiser Permanente SF Medical Home Selection Process & Guidelines Summary of walk-aways

4 Documents 4 Copy of Power Point Kaiser Permanente SF Medical Home Summary 6/3/09 Memo to Assistors with FAQ

5 New Medical Home 5 Kaiser Permanente San Francisco Medical Home Effective July 1, 2009 Only open to new HSF participants Can be selected only at SFHP enrollment site Treated like all other HSF Medical Homes Role of the Assistor

6 Open to New HSF Participants 6 To select Kaiser SF Medical Home Must be new to the HSF program Existing or former HSF Participants cannot select Kaiser SF Medical Home during renewal, reenrollment, or modification Persons should not drop, nor be encouraged to drop insurance (including Kaiser insurance) to join HSF. 90 DAY RULE STILL APPLIES

7 Open to New HSF Participants 7 Family Member Exception: Previously or currently enrolled in HSF but family member of participant new to HSF and selecting Kaiser Permanente SF Medical Home Family member = Persons counted in the family size per HSF eligibility rules For example: Married Couple (Person A & Person B). Person A is currently on HSF; Person B has never been in the program and is now applying. If Person B selects Kaiser Permanente SF as a medical home, the married partner (Person A) can change medical home to Kaiser.

8 Selection only at SFHP Site 8 Kaiser Permanente SF Medical Home can only be selected at SFHP Enrollment Site Non-SFHP Assistors must not select Kaiser SF as a medical home for any applicant Kaiser SF Medical Home will always show as closed in One-e-App Therefore the 2-yr question during the medical selection process, does not apply to Kaiser Permanente SF. New HSF Participants wanting to select Kaiser SF as their medical home will not be able to do so

9 What does this mean for Assistors? 9 Continue what you normally do when applicants seeking a different medical home come to see you Refer them to the enrollment site/medical home they are seeking to select If you get asked mid-way in the app process and if the person meets the criteria to select Kaiser, suspend the application and refer them to SFHP Exceptions: Refer to SFHP enrollment site if they indicate they want to select Kaiser SF as their medical home only if they are new to HSF.

10 Things to consider 10 Is there a guarantee that a new participant can select Kaiser SF as a medical home when they apply at SFHP enrollment site? NO. Just like any medical home, there is no guarantee that the home will be open and available the day of the appointment.

11 Things to consider 11 How much should Assistors know about Kaiser SF Medical Home? Similar to other medical homes, Assistors are expected to be familiar with the information provided in the HSF medical home directory Any other questions should be referred to HSF Customer

12 Things to consider 12 Is there a guarantee that a new participant can select Kaiser SF as a medical home when they apply at SFHP enrollment site? NO. Just like any medical home, there is no guarantee that the home will be open and available the day of the appointment.

13 About Kaiser SF Medical Home 13 Access to HSF services only at Kaiser San Francisco Medical Center At 2238 Geary Divisadero Not accessible at other Kaiser locations Services provided are those accessible through the HSF program. Pharmacy accessible at sites noted on directory page Hospital & emergency care provided at Kaiser Foundation Hospital on Geary Blvd

14 About Kaiser SF Medical Home 14 Point-of-Service Fees for Kaiser SF Medical Home Similar to non-dph medical homes, these are not provided to the general public However, applicants can call HSF Customer Service at to learn more about Kaiser SF Medical Home If Assistors are asked about Point-of-Service fees, please refer them to

15 Other FAQs 15 What if an Assistor gets asked by an existing participant to change their medical home to Kaiser SF Medical Home? An Assistor should inform the participant that Kaiser SF Medical Home is only available to new HSF Participants.

16 Other FAQs 16 Can a participant change to Kaiser SF Medical Home during the renewal, modify, or reenrollment? NO. Kaiser SF can only be selected by participants new to the HSF Program.

17 Other FAQs 17 What should an Assistor do when asked by a new participant to select Kaiser SF for their medical home? Please refer them to the SFHP enrollment site by calling to schedule an appointment. Appointments are required. Assistors are welcome to call for the applicant to expedite the appointment process DO NOT send any persons to the Kaiser SF Medical Center Advise that, similar to other medical homes, there is no guarantee that Kaiser SF Medical Home will be open Advise the applicant that there are other Medical Home options to choose from that you can select for them

18 Today s Walk-Away 18 Kaiser SF medical home treated like like other medical homes in the HSF Network Exceptions: Only open to participants new to the HSF Program Selection can only be done at SFHP enrollment site Refer persons to HSF Customer Service when: You do not know an answer to a question, or The applicant wants to schedule an appointment to select Kaiser SF as a medical home

19 Today s Walk-Away 19 Refer to the HSF Medical Home directory when to answer questions about Kaiser SF medical home HSF Assistors are not expected to know more than what is provided in the HSF Medical Home directory for any medical home Do not send applicants to Kaiser SF Medical Home for enrollment related issues 90 day rule for previous insurance still applies

20 Kaiser SF Medical Home 20 Q & A Session During the call, please also feel free to send questions to: jaguilera@healthysanfrancisco.org and we will address them on the call.

101 Grove Street, Room 308 San Francisco, California (415) MANAGED CARE UPDATE FY

101 Grove Street, Room 308 San Francisco, California 94102 (415) 554-2610 www.sfdph.org MANAGED CARE UPDATE FY 2013-14 TABLE OF CONTENTS 1. DPH Enrollment 1 2. Low Income Health Program Transition 3 3.