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

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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.

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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.

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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.

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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

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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)

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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.

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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

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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

publications@mahealth.net

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

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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

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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

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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

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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!

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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

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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

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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

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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

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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

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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

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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

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The MassHealth Operations Member Education Unit

will be available for questions at the lunch roundtable.

Thank-you