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MassHealth Updates
Massachusetts Health Care Training Forum
July 2013
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
MassHealth Program
Mission Statement 2012-2014 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
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
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
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
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 02780
Fax: 617-887-8777
Medical Benefit Request (MBR’s) and (SMBR’s for community) should continue to be sent to the Central Processing Unit (CPU)
7
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 02171 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
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 02780 Fax: 617-887-8777
9
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 10-1-2013. It will initially have a new insert which will be used to determine eligibility for individuals needing coverage prior to January 1, 2014.
A supply of paper applications can be ordered as they are today 1-800-841-2900 (phone), 617-988-8973 (fax), or
More details related to this publication will be shared through MTF listserv. 10
Introducing One Care: MassHealth plus Medicare
We Will Use… Instead Of… One Care Duals Demonstration
One Care Plans Integrated Care Organizations (or
ICOs)
Long Term Supports Coordinator OR LTS Coordinator IL-LTSS Coordinator
Personal Care Plan Individualized Care Plan
■ Some new terms will replace language used in developing the program so far
11
Expected Date
Action
July Public awareness campaign begins July Three-way contracts signed with One Care plans
August MassHealth and One Care plan implementation readiness activities
Sept. Enrollment guides and self-selection letters sent to individuals in target population; outreach to potential enrollees begins
Sept. One Care plan marketing begins Oct. 1 One Care start date, self-selection enrollments only
By Nov. 1 60-day notice sent to first auto-assignment group
Jan. 1, 2014
Effective date for first wave of auto-assignment (C1s only)
April 1, 2014 (tentative)
Effective date for 2nd wave of auto-assignment
July 1, 2014 (tentative)
Effective date for possible 3rd wave of auto-assignment
Expected Timeline
12
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
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
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), www.mass.gov/masshealth/onecare
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
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
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
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
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
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
One Care Enrollment Packet continued
20
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
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
The MassHealth Operations Member Education Unit
will be available for questions at the lunch roundtable.
Thank-you