veterans benefit enhancement slides march 11 2013 … · • William Allman, Veterans Benefit...

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States Help Veterans Access Health Benefits and Save Money, Too

March 11, 2013

OverviewVeterans Benefit

Enhancement Project History and Overview for

Washington

Veterans Benefit Enhancement Project

History and Overview for California

How PARIS can be used to identify referrals for

military related benefits

Medicaid SavingsRole of Legislature in

Implementation

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Archive of This Webinar

• This webinar will be archived and posted to the NCSL website in approximately 5 business days. 

• It will be available at:• It will be available at: http://www.ncsl.org/default.aspx?tabid=25872

PresentersPresenters• William Allman, Veterans Benefit Enhancement 

Project, Office of Program Integrity, Washington 

and President, PARIS Board of Directors

• Manuel Urbina, Program Integrity Manager, 

California and PARIS Board of Directors

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Veterans Benefit Enhancement (VBE) Project History and Overview for WA and CAHistory and Overview for WA and CA

How PARIS (PARIS quarterly data utilized) identifies referrals for military related benefits

How the project leads to State Medicaid Savings hil f ili i h d d hwhile facilitating much needed veteran outreach

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The veteran population between the ages of 65 and 85 will grow by 10% and 23% respectively w g w by % % p v yover the next 15 yearsVeteran Outreach Lagging http://www.mcclatchydc.com/2012/11/19/v-print/175067/va-outreach-lags-as-many-

h lveterans.htmlGAO VA Benefit Awareness Report -http://www.gao.gov/products/GAO-12-153

In 2002 Met with elderly spouse of a Medicaid Long Term Care (LTC) Recipient

LTC Medicaid subject to Estate Recovery

Marked increase in Medicaid LTC expenditures, expected to increase by 200% over the next five years

50% of all males > 60 are veterans

42 CFR 433.138 Medicaid Payer of last resort

42 CFR 435.608 Mandatory pursuit of any TPR

Partnership with State DVA established

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AGENCY GOALS

• Improve client services to veterans and their families. p• Reduce estate recovery for WA veterans and their

families. • Reduce Medicaid LTC related expenditures.• Share data to identify clients potentially eligible for

veterans benefits.• Define ownership roles between the two agencies.p g

Public Assistance Reporting Information SystemFederal-State partnership which provides the 52 participating State Public-Assistance Agencies detailed information and data to assist them in maintaining program integrity and detecting/deterring improper payments. Data comes fromData comes from◦ Department of Defense

Active Duty MilitaryReserves MilitaryRetired MilitaryOffice of Personnel ManagementCivil Service Employees & Retired

◦ Veterans AdministrationV d i f i h VA l iVeterans and survivors of veterans with current VA monetary claimsor a history of VA monetary benefits

◦ Interstate MatchesSSN matches with other states

CMS now requires state participation SMD10009

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WA State’s match sends SSNs for allrecipients; andrecipients; and financially responsible assistance unit members

Benefits of Utilization of PARIS DataHealth insurance identification

TRICARECHAMPVACHAMPVAVeterans Health Care

Maximize monetary VA payments

Data Utilized for TPL responsibility:

Department of Defense:

◦ Third Party Liability

Military Health Insurance (TRICARE)

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TRICARE Beneficiary Categories Reservists on active duty > 30 days – under

d dFederal ordersRetired reservists and family membersActive duty and retired service membersSpouses and unmarried children (including stepchildren) of active duty or retired service membersWid r id r d m rri d hildr fWidows or widowers and unmarried children of deceased active duty or retired service members

Match case numbers of TRICARE sponsors with:Medicaid recipients case numbers without known

TRICARE Refer to Coordination of Benefits for update of

TRICARE TPLSome may need DEERS (Defense Enrollment Eligibility

Reporting System) confirmationp g y )TPL coded in MMISNotify recipients12 month retroactive Medicaid recoupment

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Veterans Benefits for active clientsInformation originates from the VA’s (Benefit Administration) VETSNET Treasury screen

Veterans Benefits for active clientsInformation originates from the VA’s (Benefit Administration) VETSNET Treasury screenMatches with the veteran ’s and payee’s (most often the spouse if other than veteran) Social Security Number

Matches with the veteran ’s and payee’s (most often the spouse if other than veteran) Social Security Number

Enrollment into the VA Healthcare SystemSome veterans can receive Rx without the needSome veterans can receive Rx without the need of a VA doctor. Their own physician may prescribe* Receiving A & A or Housebound* Receiving 50%+ service connected

compensation

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Civilian Health and Medical Program of theCivilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)Eligibility Groups for CHAMPVA (not eligible for TRICARE):

Spouse or child of veteran permanently and totally disabled, service-connectedSurviving spouse or child of veteran who diedSurviving spouse or child of veteran who died from service-connected disability, or was rated totally and permanently disabled

Medicaid veterans receiving the $90 nursing home benefit amount and are no longer residing in a nursing home and entitled to their full

thl b fit tmonthly benefit amount

Medicaid veterans receiving “0” amount – Need to review change reason; if due to lack of completed yearly review; facilitate completion/submissionSome veterans are eligible for full VA nursing care coverage*Receiving 70%+service connected

compensation S t b titl d t p i l r i nn t dSome veterans may be entitled to a special service connected compensation claim

* Vietnam veterans with diagnosis ofa condition meeting Agent Orange criteria

**Aid and Attendance Benefit facilitation

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Bill Allman /Tim DahlinWA State Health Care AuthorityWA State Health Care AuthorityPayment Review ProgramVeterans Benefit Enhancement ProjectPhone: (360) 725-1020/725-2077E-mail: william.allman@hca.wa.gov

tim dahlin@hca wa govtim.dahlin@hca.wa.gov

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VETERAN BENEFIT ENHANCEMENTVETERAN BENEFIT ENHANCEMENTVETERAN BENEFIT ENHANCEMENTVETERAN BENEFIT ENHANCEMENT

PARIS Board of DirectorsPARIS Board of Directors--CaliforniaCalifornia--

M l U biManuel UrbinaProgram Integrity Manager, California

and PARIS Board of Directors

CabinetCabinet

About CaliforniaAbout California

Cabinet Cabinet AgencyAgency

Health ServicesHealth ServicesDepartmentDepartment

Human Services Human Services DepartmentDepartmentpp pp

MedicaidMedicaid TANFTANF SNAPSNAP

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Discussion PointsDiscussion Points

∗ ROLE OF LEGISLATURE IN IMPLEMENTATION

∗ PILOT PROGRAM

∗ FUTURE OPERATIONS

∗ Legislative Analysis/Recommendations

∗ Statutory Mandates

∗ Reporting Requirementsepo t g equ e e ts

∗ Hearings/Oversight

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∗ Objectives/Goals

∗ Scope of Pilot

∗ Partner for Outreach Services

∗ Outcomes

∗ Cost\Benefit Analysis

∗ Expansion Considerations

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PARIS Board of DirectorsPARIS Board of DirectorsMarch 11, 2013March 11, 2013

Questions?The webinar archive and power points will be

available online next week.www.ncsl.org

Staff Contact:Laura ToblerLaura.tobler@ncsl.org