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News from the Eligibility and Enrollment Workgroup Meeting December 3, 2018

By Heather Kennedy posted Dec 10,2018 09:18 AM

  

Dear Members,

Last week, I attended an HHSC eligibility and enrollment workgroup meeting to discuss issues that were raised when TAHC&H, MCOs, providers, and other stakeholders met with Rep. Richard Raymond in mid-November. Rep. Raymond serves as the Chair of the Human Services Committee, and serves on the Health & Human Services Transition and Oversight Committee.

Ongoing Improvement Initiatives

To begin, state staff gave an update on various initiatives they have implemented to improve their data and processes for eligibility determination and client enrollment since 2016. These include:

  • A real-time Social Security Number (SSN) verification process; merging multiple client IDs associated with the same SSN when needed to reduce/prevent duplicate numbers in the system;
  • Implementation of a policy requiring that staff verify and clear SSN issues before approving Medicaid benefits; and
  • Enhanced SSN validation to check accuracy of an individual’s name, reducing the creation of multiple Medicaid ID numbers.

Through these efforts, the state reports that the number of duplicate Medicaid ID numbers has been reduced by over 50% (currently around 220 per month).

Long-Term Care (LTC) Portal and STAR Kids Operational Process Improvements

HHSC also presented information on updates and changes they have made to the LTC portal at TMHP, and process improvements they have made for the STAR Kids program, in particular. The LTC portal has been updated to allow HHSC to adjust ISP dates for member enrollment data collection, and the state plans to put medical necessity member notification letters on the portal in January 2019. These letters will be sent to the MCOs via the TexMed system. Additional details about this change will be communicated to the public by HHSC and TMHP in the coming weeks.

HHSC has also begun notifying families via their STAR Kids MDCP call campaign of medical necessity denials and informing them of the fair hearings process, as well.

Prioritizing Issues from the Rep. Raymond Meeting

Attendees were then asked to prioritize a list of issues identified during the Rep Raymond meeting, determining what actions can be taken now to improve eligibility and enrollment without legislation, as well as what changes are needed that would require legislation to implement. The workgroup’s recommendations on these items will be presented to Rep Raymond at a follow-up meeting on December 12, 2018. Attendees added a few new issues to the list, as well. The list under consideration includes (in no particular order):

  1. Extending post-partum Medicaid coverage for mothers from 2 to 12 months following delivery (legislation required).
  2. Directing HHSC to explore federal options to lift the annual re/determination/reassessment for MDCP when there is no substantial change in condition, researching an expedited way to make this redetermination. Potential solutions could also apply to other waiver services, as well.
  3. Funding an overhaul of the state’s eligibility system to ensure the most accurate information is available, and update interfaces with MCO systems to ensure plans have good data from HHSC (legislation required). System changes could also include:
    1. Nursing facility eligibility system updates, giving nursing homes a way to identify that a client has Medicaid and managed care, and communicate that information to the MCOs when a member enters or leaves a facility—they cannot see this information currently.
    2. Standardizing HIPAA transactions for Capitation and Capitation Adjustment files to modernize them and eliminate manual processes at HHSC.
    3. Provide system capabilities for the extension of Medicaid eligibility for clients during a Fair Hearings process (up to 120 days).
    4. Prevent the Social Security Administration’s address file from overwriting corrected/current address information for members on SSI who don’t report changes of address to the SSA.
  4. Allow families to select the delivery method most appropriate for their child’s needs (FFS vs Managed Care). MDCP families would have the ability to opt out of managed care (legislation required).
  5. Ask HHSC to delay the implementation of the Intellectual and Developmental Disability (IDD) LTSS project (legislation required).
  6. Provide gap coverage when a client loses waiver/Intermediate Care Facility (ICF) eligibility (legislation required)
  7. Request 12 months of continuous eligibility for children in Medicaid programs similar to that of kids in CHIP (legislation needed) to prevent loss of coverage due to income verification/documentation.
  8. Enrollment of clients into managed care at the time of their eligibility determination.
  9. Perform prospective eligibility, similar to what is done in Medicaid in other states. Assess reasons for retroactive changes and identify solutions.
  10. Develop a reconciliation process for member eligibility.

TAHC&H will continue to monitor these issues and provide feedback to inform the process, updating you as more information becomes available. Please send any questions you may have to heather@tahch.org.

Thank you!

 

 

 

 

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