supplemental security income (ssi) kev tswj kho mob ... · mob, tsev kho mob me (clinics), thiab...

SSI Managed Care Expansion Division of Medicaid Services

Wisconsin Department of Health Services

Supplemental Security Income (SSI) Kev Tswj Kho Mob (Managed Care) Nthuav Dav

Ntxiv Lub Rooj Sib Tham



Lub Rooj Sib Tham Cov Txheej Lus (Meeting Agenda)

• Xyuas Txog SSI Kev Tswj Kho Mob (Managed Care) Nthuav Dav Ntxiv

• Tswv Cuab Kev Rau Npe Tus Txheej Txheem • Txoj Hauj Lwm Pab Tswv Yim Sab Nraud • Lus Nug thiab Lus Teb • Ntsib thiab Fim nrog cov SSI HMOs

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HMO thiab kev tswj kho mob (managed care) yog dab tsi?

• Health maintenance organization (HMO) yog ib pab kws kho mob, tsev kho mob me (clinics), thiab tsev kho mob uas ua hauj lwm ua ke los pab koj tswj koj kev noj qab haus huv.

• Lub Department of Health Services (DHS) ua hauj lwm koom nrog cov HMOs uas tau xaiv lawv los mus muab Medicaid cov kev pab hauv lub xeev.

• Koj yuav tau txais koj cov kev kho mob feem ntau los ntawm ib lub HMO.

• HMOs khiav txoj hauj lwm kho mob thiab muab cov kev kho mob los ntawm ib cov kws kho mob koom hauj lwm ua ke.

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HMOs Cov Kev Pab Kho Mob

• Mus ntsib kws kho mob • Mus kho hauv tsev kho

mob o Mus pw kho tus mob o Mus kho tus mob tsis pw

• Kuaj mob (x-ray, yees duab hluav taws xob)

• Kho kev nyuaj siab mob hlwb

• Kev tu mob hauv tsev thiab kev tu tus kheej

• Kev kho thaum cev xeeb tub

• Kev npaj kom muaj tub ki raws siab nyiam

• Kev kho mob rau lub cev, kev hais lus, thiab kom rov peem tsheej ua taus hauj lwm pab tus kheej

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Toj mus rau sab 5



HMOs Cov Kev Pab Kho Mob

• Kev pab kom tso tseg tej tshuaj muaj yees (nrog rau dej cawv thiab yeeb tshuaj)

• Lim ntshav • Mus pw kho tus mob

kom rov peem tsheej (pub pw ntev txog 90 hnub)

• Kho qhov muag (nrog rau tsom iav qhov muag)

• Cov cuab yeej siv pab kom hnov lus

• Cuab yeej thiab khoom siv kho mob

• Cov kev pab kho tus mob haus tshuaj muaj yeeb

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Cov Kev Kho Mob Them Raws Tus Nqi Kho (Fee-For-Service Basis), Tsis yog tau los ntawm ib lub

HMO • Tshuaj kws kho mob ua

ntawv mus yuav • Mus pw hauv tsev laus (tom

qab 90 hnub) • Kev kho tus mob puas hlwb

hauv county (county-based mental health services) o Community support programs

(CSPs) o Comprehensive community

services (CCS) o Kev pab thaum muaj xwm

txheej

• Kev kho hniav* • Tsheb thauj mus kho mob

thaum tsis yog mob kub ceev (los ntawm MTM)

• Cov kev kho mob chiropractic

• Kev pab cuam rau hauv tsev thiab zej zos

*Cov kev kho hniav them los ntawm cov HMOs hauv Milwaukee, Waukesha, Racine, thiab Kenosha counties. Ib txhia, tab sis tsis yog tas nrho, cov HMOs hauv Ozaukee thiab Washington counties them rau kev kho hniav.

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SSI Kev Tswj Kho Mob (Managed Care) Yog Dab Tsi?

Medicaid SSI Kev Tswj Kho Mob (Managed Care) txoj hauj lwm: • Muaj ntawv cog lus nrog cov HMOs los mus muab kev kho

mob thiab kev kho tus cwj pwm nyuaj siab mob hlwb rau cov uas tau txais Medicaid SSI los yog SSI-related Medicaid vim muaj ib tus mob xiam oob qhab tsis taus (uas yog lub Disability Determination Bureau txiav txim tias muaj tus mob tiag).

• Muab txoj kev khiav cov hauj lwm kho mob uas yog siv cov HMOs los ntawm koj tus kws kho mob, tus kws kho ib yam mob tshwj xeeb, thiab cov koom txoos khiav hauj lwm hauv zej zos kom paub tseeb tias koj tau txais cov kev kho mob uas koj xav tau.

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Cov Txiaj Ntsim Tau Los Ntawm SSI Kev Tswj Kho Mob (Managed Care)

• Tsis muaj feem yus nrog them (no copays)—Koj tsis tau them feem yus nrog them (copays) rau cov kev kho mob uas cov HMOs muab rau koj.

• Muab txoj hau kev mus ntsib cov kws kho mob ntau dua qub—cov SSI HMOs yuav tsum ua kom tau raws li cov cai nruj uas tau tsim muaj los mus ua kom paub tseeb tias koj tau txais tas nrho cov pab kho tus mob uas yuav tsum tau kho. DHS yeej tsom kwm taug qab xyuas cov cai no tsis so.

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Cov Txiaj Ntsim Tau Los Ntawm SSI Kev Tswj Kho Mob (Managed Care) (txuas ntxiv)

• Kev pab kho tus mob raws li koj tus kheej kev xav tau, muaj kev tswj khiav cov hauj lwm rau koj—Koj tseem yuav tau txais txoj kev pab tswj khiav cov hauj lwm rau koj thiab ib Daim Phiaj Xwm Npaj Kho Tus Mob Raws Li Koj Tus Kheej Kev Xav Tau (Individualized Care Plan). Cov SSI HMOs tseem yuav pab koj daws lwm yam teeb meem, xws li vaj tse, khoom noj khoom haus, thiab tsheb thauj mus los.

• Ua kom txoj kev kho tus mob zoo dua qub—DHS tswj hwm cov SSI HMOs kom ua tau hauj lwm thiab Them raws li Qhov Ua Tau Txoj Hauj Lwm Zoo.

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SSI Kev Tswj Kho Mob (Managed Care) Nthuav Dav Ntxiv (Expansion)

Mus raws li lub teb chaws kev nce qib, Wisconsin Medicaid tau ntxiv cov neeg muaj npe tau txais txoj kev kho mob hauv kev tswj kho mob (managed care) coob ntxiv, tshwj xeeb yog nyob hauv 10 lub xyoos dhau los. Tam sim no ze ntawm 70 feem pua ntawm Wisconsin cov tswv cuab uas tau txais Medicaid tau txais txoj kev kho lawv tus mob los ntawm managed care. • SSI Kev Tswj Kho Mob (Managed Care) tau pib nyob rau hauv

Southeast Wisconsin hauv xyoo 2005. • Txij thaum ntawd los, cov SSI HMOs tau nthuav dav mus ntxiv

thoob plaws cov counties hauv lub xeev.

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SSI Kev Tswj Kho Mob Nthuav Dav Ntxiv (Managed Care Expansion)

• Tam sim no cov SSI HMOs uas muab kev pab kho mob rau cov tswv cuab yog 8 lub.

• Tam sim no cov muaj npe tau txais kev pab hauv SSI HMO thoob plaws lub xeev yog 36,443 leej.

• Tam sim no cov tswv cuab muaj hnub nyoog uas tau txais SSI hauv Medicaid kev kho mob them raws tus nqi kho (fee-for-service) thiab muaj feem tau txais kev tswj kho mob (managed care) thoob plaws lub xeev yog muab khwv yees muaj thaj tsam li 28,000 leej.

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SSI Kev Tswj Kho Mob Kev Rau Npe (Managed

Care Enrollment)

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Tus naj npawb nyob hauv parenthesis yog tus naj npawb ntawm cov HMOs muab kev kho mob rau hauv lub County ntawd

2 lub HMOs los yog ntau dua Nyob ntawm yeem, tribal county



Medicaid SSI HMO Cheeb Tsam Muab Kev Pab Kho Mob

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Anthem BlueCross BlueShield

A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A

Care Wisconsin A A A A A A A A A A A A A A A A A A A A A

Group Health Cooperative – Eau

Claire A A A A A A A A A A A A A A A A A A A A A A A A

Independent Health Care Plan

(iCare) A A A A A A A A A A A A A A A A A

MHS Health Wisconsin

A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A

Molina Healthcare A A A A A A A A A A A A A A

Network Health Plan

A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A

UnitedHealthcare Community Plan

A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A



Medicaid SSI HMO Cheeb Tsam Muab Kev Pab Kho Mob

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A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A

Care Wisconsin A A A A A A A A A A A A A A

Group Health Cooperative –

Eau Claire A A A A A A A A A A A A A A A A A A A

Independent Health Care Plan

(iCare) A A A A A A A A A A A A A A A A A A A

MHS Health Wisconsin

A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A

Molina Healthcare A A A A A A A A A A A A A A A A A A A A A

Network Health Plan


UnitedHealthcare Community Plan




Leej twg thiaj muaj feem tau txais SSI Kev Tswj Kho Mob (Managed Care)?

Kom muaj feem tau txais SSI Kev Tswj Kho Mob (Managed Care), koj yuav tsum: • Muaj hnub nyoog 19 xyoos los yog tshaj saud. • Tau txais Medicaid SSI los yog SSI-related Medicaid

vim muaj ib tus mob xiam oob qhab tsis taus. • Tsis nyob hauv ib lub tuam tsev kho mob (institution)

los yog ib lub tsev laus (nursing home).

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Leej twg thiaj muaj feem tau txais SSI Kev Tswj Kho Mob (Managed Care)? (txua ntxiv)

• Tsis koom rau hauv ib qho kev pab cuam tu hauv tsev thiab zej zos (home and community-based waivers program) (Community Integration Program, Community Options Program, IRIS, raug mob rau cov hlwb).

• Tsis muaj npe tau txais kev pab rau hauv ib qho kev pab tu mus sij hawm ntev (long-term care program) (Family Care, PACE, los yog Partnership).

• Rau npe kom tau txais kev pab vim los ntawm cov teeb meem nram qab no: o Tsuas muaj ib lub SSI HMO hauv lub county uas koj nyob nkaus xwb. o Koj tau txais ob qho (uas yog Medicaid thiab Medicare). o Koj muaj npe tau txais kev pab rau hauv Medicaid Purchase Plan

(MAPP).

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Kev Rau Npe Rau Hauv SSI Kev Tswj Kho Mob (Managed Care)

Tsam no koj yuav rau npe rau hauv ib lub HMO tib yam nkaus li BadgerCare Plus cov tswv cuab rau hauv cov HMOs. • Koj yuav xaiv tau lub SSI HMO hauv koj lub county

uas yuav pab tau koj zoo dua raws li koj xav tau. • Yog koj tsis xaiv ib lub, yuav muab ib lub SSI HMO

xaiv rau koj. • Tom qab rau npe rau hauv ib lub SSI HMO lawm, nws

muab 90 hnub rau koj hloov siab mus xaiv ib lub SSI HMO txawv.

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Kev Rau Npe Rau Hauv SSI Kev Tswj Kho Mob (Managed Care)

• Tom qab 90 hnub lawm, koj yuav tau nyob twj ywm hauv lub SSI HMO kom tas lub sij hawm rau npe 12 lub hlis.

• Thaum tas lub sij hawm rau npe 12 lub hlis lawm, koj yuav hloov tau mus rau lwm lub SSI HMOs yog koj xav ua li ntawd.

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SSI Kev Tswj Kho Mob (Managed Care) Cov Sij Hawm Teem Sib Tham Raws Cheeb Tsam

• Cheeb Tsam 1 (Region 1) (Sab Qaum Teb) o Lub 12 Hlis (December) 2017 xa ib tsab ntawv thiab cov

ntaub ntawv rau npe mus rau cov tswv cuab o Cov Rooj Sib Tham (Town Hall Meetings)

• Lub 1 Hlis (January) tim 10, 2018 (1:30 PM txog 3:30 PM, 5:00 PM txog 7:00 PM)

• Northcentral Technical College (NTC), Wausau o Lub 2 Hlis (February) 2018 muab cov tswv cuab tso rau

hauv ib lub HMO (yog hais tias tus tswv cuab tsis xaiv kom tau ib lub)

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SSI Kev Tswj Kho Mob (Managed Care) Cov Sij Hawm Teem Sib Tham Raws Cheeb Tsam (txuas

ntxiv)

• Cheeb Tsam 3 (Region 3) (Sab Hnub Poob Nruab Nrab) o Lub 1 Hlis (January) 2018 xa ib tsab ntawv thiab cov ntaub

ntawv rau npe mus rau cov tswv cuab o Cov Rooj Sib Tham (Town Hall Meetings) Lub 2 Hlis (February) tim 6, 2018 (1:30 p.m. txog 3:30 p.m., 5:00 p.m.

txog 7:00 p.m.) Onalaska Omni Center, Onalaska

o Lub 3 Hlis (March) 2018 muab cov tswv cuab tso rau hauv ib lub HMO (yog hais tias tus tswv cuab tsis xaiv kom tau ib lub)

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SSI Kev Tswj Kho Mob (Managed Care) Cov Sij Hawm Teem Sib Tham Raws Cheeb Tsam (txuas

ntxiv)

• Cheeb Tsam 5 (Region 5) (Sa Qab Teb Hnub Tuaj) o Lub 2 Hlis (February) 2018 xa ib tsab ntawv thiab cov ntaub

ntawv rau npe mus rau cov tswv cuab member o Cov Rooj Sib Tham (Town Hall Meetings) Lub 3 Hlis (March) tim 8, 2018 (1:30 p.m. txog 3:30 p.m., 5:00 p.m.

txog 7:00 p.m.) Village of Mount Pleasant Municipal Building, Mount Pleasant

o Lub 4 Hlis (April) 2018 muab cov tswv cuab tso rau hauv ib lub HMO (yog hais tias tus tswv cuab tsis xaiv kom tau ib lub)

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(txuas ntxiv) • Cheeb Tsam 6 (Region 6) (Milwaukee) o Lub 3 Hlis (March) 2018 xa ib tsab ntawv thiab cov ntaub

ntawv rau npe mus rau cov tswv cuab member o Cov Rooj Sib Tham (Town Hall Meetings) Lub 4 Hlis (April) tim 11, 2018 (1:30 p.m. txog 3:30 p.m., 5:00 p.m.

txog 7:00 p.m.) • St. Ann Center for Intergenerational Care – Bucyrus Campus

Lub 4 Hlis (April) tim 12, 2018 (1:30 p.m. txog 3:30 p.m., 5:00 p.m. txog 7:00 p.m.) • Tommy G. Thompson Youth Center – Wisconsin State Fair Park

o Lub 5 Hlis (May) 2018 muab cov tswv cuab tso rau hauv ib lub HMO (yog hais tias tus tswv cuab tsis xaiv kom tau ib lub)

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(txuas ntxiv) • Cheeb Tsam 2 (Region 2) (Sab Qaum Teb Hnub Tuaj) o Lub 4 Hlis (April) 2018 xa ib tsab ntawv thiab cov ntaub

ntawv rau npe mus rau cov tswv cuab o Cov Rooj Sib Tham (Town Hall Meetings) Lub 5 Hlis (May) tim 8, 2018 (1:30 p.m. txog 3:30 p.m., 5:00 p.m.

txog 7:00 p.m.) Brown County Public Library, Green Bay

o Lub 6 Hlis (June) 2018 muab cov tswv cuab tso rau hauv ib lub HMO (yog hais tias tus tswv cuab tsis xaiv kom tau ib lub)

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(txuas ntxiv) • Cheeb Tsam 4 (Region 4) (Sab Qab Teb Nruab Nrab) o Lub 4 Hlis (April) 2018 xa ib tsab ntawv thiab cov ntaub

ntawv rau npe mus rau cov tswv cuab o Cov Rooj Sib Tham (Town Hall Meetings) Lub 5 Hlis (May) tim 15, 2018 (1:30 p.m. txog 3:30 p.m., 5:00 p.m.

txog 7:00 p.m.) Sheraton Hotel, Madison

o Lub 6 Hlis (June) 2018 muab cov tswv cuab tso rau hauv ib lub HMO (yog hais tias tus tswv cuab tsis xaiv kom tau ib lub)

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SSI Kev Tswj Kho Mob (Managed Care) Cov Kev Zam Rau (Exemptions)

DHS yuav xyuas cov ntawv ua tuaj mus thov kom muab kev zam (exemption requests) raws li nyias qhov teeb meem thiab muab kev zam rau thaum pom tias tsim nyog. Cov kev zam (exemptions) uas tej zaum koj thov tuaj kuj muaj xws li: • Rau npe rau hauv ib lub HMO lag luam (commercial HMO). • Yog American Indian los yog Alaskan Native. • Muab kev kho tus mob mus ntxiv—koj yuav tsum tau kho tus

mob kom tas raws li nws txoj kev kho ua ntej rau npe rau hauv lub SSI HMO. Cov kev zam no tsuas muab mus ib lub sij hawm luv luv xwb.

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SSI HMO Cov Luag Hauj Lwm Kho Tus Mob Mus Ntxiv

Cov SSI HMOs yuav tsum muab kev kho tus mob mus ntxiv rau cov tswv cuab uas tuaj rau npe tshiab raws li nram qab no: • Them rau cov kev pab kho mob thawj 90 hnub rau

cov kws kho mob tam sim no uas tsis nyob hauv HMO pawg koom hauj lwm ua ke (HMO network).

• Them rau cov ntawv tso cai them raws tus nqi kho (fee-for-serivce) uas twb muab ua ntej lawm tsawg kawg 90 hnub tom qab rau npe nyob rau tib theem ntawm txoj kev kho tus mob.

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SSI HMO Cov Luag Hauj Lwm Kev Khiav Kho Mob

Cov neeg khiav hauj lwm kho mob (health care coordinators) pab koj kom koj tau txais txoj kev kho mob uas koj xav tau, uas muaj xws li: • Ua cov kev txheeb xyuas (assessments) koj tus mob tsis pub

dhau 60 hnub tom qab koj rau npe kom pab koj nkaj siab koj cov kev xav tau kho tus mob zoo dua qub.

• Tsim kom tau ib daim hom phiaj npaj kho koj tus mob (care plan) tsis pub dhau 90 hnub tom qab rau npe.

• Pab kom koj nrhiav tau ib tus kws kho mob thiab kom tau cov ntaub ntawv xa koj mus rau cov kws kho mob tshwj xeeb uas paub ib tus mob zoo (specialists).

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SSI HMO Cov Luag Hauj Lwm Kev Khiav Kho Mob

• Pab koj teem kom tau cov sij hawm mus ntsib kws kho mob yog koj xav tau kev pab rau qhov no.

• Txuas koj mus rau lwm cov kev pab uas koj xav tau, xws li tej kev pab uas muaj nyob hauv lub county, vaj tse, khoom noj khoom haus, thiab tsheb thauj mus los.

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SSI Kev Tswj Kho Mob Pov Hwm Tswv Cuab thiab Kev Tiv Thaiv

Kev tsis txaus siab thiab kev rov txiav txim dua • Koj muaj qhov xaiv los ua ntawv tsis txaus siab los

yog thov kom rov txiav txim dua ntawm HMO. • Koj tuaj yeem ua tau: o Ntawv tsis txaus siab los yog rov txiav txiv rau koj lub HMO. o Ntawv tsis txaus siab mus rau DHS. o Ntawv thov kom rov txiav txim dua mus rau Division of

Hearings and Appeals kom muaj ib lub rooj plaub txiav txim ncaj ncees

• DHS thiab HMOs puav leej saib xyuas tswv cuab cov kev tsis txaus siab thiab kev rov txiav txim dua kom thiaj taug qab saib tau cov kev txhawj xeeb.

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Pov Hwm Tswv Cuab thiab Tiv Thaiv: Cov Kev Pab

Cov kev pab los pab koj nrhiav tau kev mus cuag tau, kev txhawj xeeb txog cov kev pab kho mob, los yog kev kho mob zoo tshaj:

• HMO Cov Sawv Cev Rau Tswv Cuab o HMO cov kev pab mus cuag tau o Cov tswv cuab hu tau rau HMO

Member Services los mus cuag • Tus Sawv Cev Sab Nraud

o DHS ua ntawv cog lus nrog Disability Rights of Wisconsin (DRW) kom pab rau SSI HMO cov tswv cuab

o 1-800-708-3034

• Tus Sawv Cev Pej Xeem muab Kev Tswj Kho Mob (Managed Care Ombuds) o DHS tus pab sawv cev rau cov

tswv cuab o 1- 800-760-0001

• Tus Kws Paub Txog Kev Rau Npe (Enrollment Specialists) o Wisconsin Medicaid kev pab los

mus pab cov tswv cuab kev txhawj xeeb txog kev rau npe

o 1-800-291-2002

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Yog Xav Paub Ntxiv

Mus saib www.dhs.wisconsin.gov/medicaid/hmo-2018chng.htm.

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https://www.dhs.wisconsin.gov/medicaid/hmo-2018chng.htm

https://www.dhs.wisconsin.gov/medicaid/hmo-2018chng.htm



Tswv Cuab Kev Rau Npe

HMO Enrollment Specialist Automated Health Systems, Inc.

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Automated Health Systems, Inc.

Automated Health Systems, Inc. (AHS), muaj ntawv cog lus nrog DHS los muab kev pab rau npe hauv SSI kev tswj kho mob. • AHS tau pab cuv cov kws muaj npe hauv BadgerCare

Plus/SSI mus rau cov kev pab tswj kho mob txij xyoo 2005.

• AHS yog thawj qhov kev tiv tauj rau cov tswv cuab thaum lawv rau npe xaiv lawv qhov HMO.

• AHS muab kev kawm, kev mus cuag tau, thiab ntaub ntawv txog kev sawv cev ntsig txog kev rau npe.

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Lub Luag Hauj Lwm ntawm Tus Kws Paub Txog Kev Rau Npe

• Piav cov txiaj ntsig ntawm qhov kev rau npe rau kev tswj kho mob

• Tsis xaiv ib qho zoo tshaj ib qho tiam sis tsuas pab koj xaiv kom tau ib qho HMO uas pab tau koj cov kev xav tau xwb

• Txiav txim seb koj cov kws kho mob tseem ceeb tshaj plaws yog cov twg thiab seb cov HMO twg lawv ua hauj lwm nrog

• Pab koj xaus koj cov teeb meem

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HMO Kev Rau Npe

• Thawj phau ntawv txog HMO kev rau npe • Cov ntawv tau ua • Tsab ntawv pom zoo

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HMO Kev Rau Npe

• Koj txais tau ib phau ntawv txog kev rau npe uas caw koj los rau npe.

• Thawj phau ntawv txog kev rau npe muaj xws li ram qab no: o Tsab ntawv txais tos o Wisconsin Medicaid SSI HMO Program Guide o Wisconsin Medicaid SSI HMO Choice Booklet o Daim foos rau npe xaiv/lub hnab ntawv muaj chaw

nyob xa dawb o Daim ntawv txog kev pab ntawm tus sawv cev sab nraud

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Kuv yuav Xaiv ib qho HMO Li Cas?

• Nug koj cov kws kho mob thiab lwm tus kws muab kev pab kho mob seb lub Medicaid HMO twg lawv nyob rau. o Tsev neeg tus kws kho mob o Tus kws pab kho mob hlwb o Kws kho mob (piv txwv, kws kho plawv, kws kho yam uas tsis haum rau

lub cev, kws kho mob xyuas poj niam lub cev [OBGYN]) o Tsev kho mob o Kws kho ib ce o Kws kho koj tib leeg xwb

• Hu rau tus kws paub txog kev rau npe kom paub seb lub HMO twg ua hauj lwm nrog koj cov kws kho mob.

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Kuv yuav rau npe rau hauv ib qho HMO li cas?

• Koj yuav xaiv tau qhov los mus rau npe ntawm qhov xa koj daim foos rau npe xaiv tuaj. o Txais cov foos thiab muab ua kom tiav txhua hnub. o Tsis tas muab daim postage rau.

• Koj tiv tauj tau AHS thiab rau npe xaiv saum xov tooj ntawm 1-800-291-2002. o Cov kws paub txog kev rau npe muaj nyob rau thaum 7:00

a.m. txog 6:00 p.m (Monday txog Friday) o Peb muaj cov kws paub txog kev rau npe uas hais lwm hom

lus.

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Qheb Kev Rau Npe

Koj yuav hloov tau koj lub HMO rau ib qho laj thawj twg hauv thawj 90 hnub ntawm kev rau npe.

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Yuav ua li cas yog kuv tsis xaiv ib qho HMO?

Yuav xaiv ib qho rau koj yog koj tsis tau xaiv ib qho. DHS yuav xav ib daim ntawv tuaj rau koj qhia koj paub tias tau xaiv ib qho HMO rau koj lawm.

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Yuav muaj dab tsi tom qab kuv rau npe hauv ib qho HMO?

• Koj yuav txais tau ib tsab ntawv ceeb toom pom zoo txog koj kev rau npe.

• HMOs yuav xa phau ntawv ua tswv cuab tshiab rau npe tuaj rau koj rau lub hlis cov tswv cuab pib lawv qhov kev rau npe hauv HMO. Phau ntawv txog tswv cuab kev rau npe yuav muaj xws li: o Piav txog cov kev pab los ntawm koj lub HMO. o Ntaub ntawv txog koj cov kws kho mob, tsev kho mob me, tsev kho

mob loj, thiab lwm tus kws pab kho mob uas koj muaj feem mus cuag raws li koj lub HMO.

• Koj tuaj yeem cia siab tias yuav txais tau ib tsab xov tooj ntawm koj lub HMO thaum koj rau npe lawm los mus sib tham txog koj kev noj qab nyob zoo.

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Yog kuv tus kws kho mob tsis txais kuv qhov HMO ne?

• Yog koj muaj ib tus kws kho mob los yog ib tug kws pab kho mob uas tsis yog ib feem ntawm koj lub HMO, ces koj lub HMO yuav cia koj mus ntsib tus kws kho mob 90 hnub ntxiv los mus muab kev kho koj.

• Yog koj tau kev pom zoo rau qee hom kev pab kho uas zwm rau hauv Medicaid qhov yuav tsum them nyiaj thiaj tau kev kho (fee-for-service), koj lub HMO yuav cia koj txais tau qhov kev kho ntawd ntawm tib tug kws kho mob 90 hnub ntxiv.

• Nco ntsoov qhia rau koj lub HMO paub txog koj cov sij hawm teem mus kho mob tom ntej.

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Sij Hawm Kaw-Hauv (Lock-In Period)

• Lub sij hawm kaw-hauv (lock-in period) pib 90 hnub tom qab xaiv ib qho HMO thiab kav cuaj lub hlis.

• Koj yuav hloov tsis tau koj lub HMO rau lub sij hawm kaw-hauv (lock-in period)

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Ceeb Toom Thaum Tsis Kaw-Hauv

• Yuav xa ntawv tuaj qhia koj thaum koj lub sij hawm kaw-hauv (lock-in period) xaus lawm.

• Koj yuav hloov tau koj qhov HMO raws siab nyiam.

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Rau Npe rau SSI Tswj Kev Kho Mob cov Qauv (Managed Care Enrollment Example)

• Kauj Ruam 1—koj tau txais phau ntawv rau npe ntawm lub xeev thaum Lub 12 Hlis Tim 18, 2017.

• Kauj Ruam 2—koj ua tiav thiab xa daim foos xaiv los yog hu rau tus kws paub txog kev rau npe los mus xaiv koj lub HMO thaum Lub 1 Hlis Tim 31, 2018. o Yog tias koj tsis xaiv ib lub HMO ua ntej Lub 1 Hlis Tim 31, 2018, yuav

xaiv ib lub HMO rau koj. o Muab 90 hnub suav txij hnub koj xaiv ib lub HMO los yog tau xaiv ib lub

HMO rau koj los mus hloov tau rau ib lub HMO txawv.

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Rau Npe rau SSI Tswj Kev Kho Mob cov Qauv (Toj Ntxiv)

• Kauj Ruam 3—koj yuav txais tau ib tsab ntawv ntawm lub xeev pom zoo rau koj lub HMO rau Lub 2 Hlis Tim 5, 2018.

• Kauj Ruam 4—koj yuav txais tau ib tsab ntawv txais tos thiab ib phau ntawv txog kev rau npe ntawm koj lub HMO Lub 2 Hlis Tim 12, 2018.

• Kauj Ruam 5—lub sij hawm kaw-hauv (lock-in period) pib Lub 5 Hlis Tim 1, 2018. Koj yuav hloov tsis tau lub HMO kom txog rau thaum lwm lub sij hawm kaw-hauv tas.

• Kauj Ruam 6—lub sij hawm tas rau thaum Lub 2 Hlis Tim 1, 2019. Tsam no koj yuav hloov tau lub HMOs yog koj xav hloov.

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HMO Tus Kws Paub Txog kev Rau Npe (HMO Enrollment Specialist)

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1-800-291-2002 Monday–Friday 7 a.m.–6 p.m.

Bilingual Spanish, Hmong TTY



SSI Tswj Kev Kho Mob Tus Sawv Cev Sab Nraud

(SSI Managed Care External Advocacy Project)

Disability Rights Wisconsin (DRW)

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Disability Rights Wisconsin

• DRW muab kev tiv thaiv thiab kev sawv cev rau cov neeg muaj mob xiam oob qhab.

• DRW yog ib qho kev pab thoob teb chaws Amelikas rau cov neeg, cov tsev neeg, muab kev pab cov kws tshaj lij, thiab lwm tus kev txhawj xeeb txog kev xiam oob qhab.

• DRW yog tsa los ntawm Tus Tswv Xeev kom muab vaj huam sib luag raws txoj cai rau txhua tus neeg hauv lub xeev uas muaj kev xiam oob qhab los ntawm ib tug sawv cev thiab thaum cov kev pab hloov.

• DRW yog ib feem ntawm lub teb chaws cov kev pab ntawm tsoom fwv kev saib xyuas cov chaw khiav dej num rau cov xiam oob qhab.

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Keeb Kwm ntawm SSI Kev Tswj Kho Mob Tus Kws Sawv Cev Sab Nraud

• Disability Rights Wisconsin tau txias DHS daim ntawv cog lus thaum Lub 4 Hlis Xyoo 2005 los mus ua tus kws sawv cev sab nraud rau cov tswv cuab uas rau npe hauv SSI-cov kev tswj kho mob.

• Qhov External Advocacy Project tseem tab tom muab kev pab rau SSI Medicaid HMO cov tswv cuab ntawm txhua lub county huav xeev Wisconsin.

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Tswv Cuab Kev Paub Zoo txog Kev Sawv Cev Sab Nraud

(External Advocacy Project)

• Ib daim ntawv txog Kev Sawv Ceb Sab Nraud (External Advocacy Project) yuav muaj nyog hauv koj phau ntawv txog kev rau npe.

• Kev tiv tauj qhov kev pab no kuj muaj nyog nrog daim ntawv ceeb toom tsis xav tau HMO cov kev pab.

• Koj yuav txais tau ib daim postcard muab kev pab tiv tauj txhua xyoo ntawm qhov Kev Sawv Cev Sab Nraud (External Advocacy Project).

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Cov Kev Pab Muab los ntawm Kev Sawv Cev Sab Nraud

• Kev Kawm • Kev Pab • Kev Sawv Cev

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Tswv Cuab Kev Kawm

• Piav qhia tias kev tswj kho mob (managed care) yog dabtsi • Pab koj nkag siab SSI HMO Kev rau npe mus li cas • Piav qhia koj cov cai thiab luag hauj lwm raws li ib tug tswv

cuab hauv ib lub SSI HMO • Piav qhia koj kev kho toj ntxiv, koj yuav txais tau kev kho mob

ntawm koj tus kws kho mob tam sim no uas tsis nyob hauv lub network ntawm koj lub SSI HMO, rau thawj 90 hnub ntawm kev rau npe

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Kev Pab

• Pab koj mus cuag HMO tus kws paub txog kev rau npe (enrollment specialist) nrog ib daim ntawv teev koj cov kws kho mob kom lawv thiaj pab tau koj rau npe xaiv

• Pab koj mus cuag tau koj lub SSI HMO kom tau kev pab: o Kev kho mob tshwj xeeb o Khoom siv los yog khoom siv kho mob o Kev kho mob hlwb los yog kev kho mob quav yeeb tshuaj

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Kev Pab

• Piav qhia tias cov kev pab twg yuav tsum tau ua ntej tau kev tso cai thiab yuav pib li cas

• Piav qhia seb yuav mus cuag tau kev pab nrhiav tsheb thauj mus los li cas uas tsis yog vim kev mob kub ceev (non-emergency medical)

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Kev Sawv Cev

• Pab cov tswv cuab uas txais tau daim nqi tsis thwj lawm

• Pab koj nkag siab cov kev txiav txim ntawm qhov SSI HMO kom tsis pub los yog txiav cov kev pab

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Kev Sawv Cev (Toj Ntxiv)

• Pab txog kev kom rov txiav txim dua raws cov kev xaiv no o Txhim kho qhov teeb meem nrog rau kev pab los

ntawm SSI HMO tus kws sawv cev o Ua ntawv tsis txaus siab nrog SSI HMO o Thov kom muaj ib qho kev ntsuam xyuas

(ombuds) hauv xeev o Thov kom muaj ib rooj hais kev ncaj ncees hauv xeev

• Kev sawv cev rau kev pab: ua hauj lwm nrog SSI HMO thiab DHS los txhim kho kev kho mob kom zoo dua qub rau txhua tus tswv cuab

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Hu rau Qhov Twg

Yog koj muaj lus nug txog SSI Kev Tswj Kho Mob Kev Pab Cuam los yog teeb meem nrog koj kev kho mob thiab lub SSI HMO, koj yuav:If • Hu rau: o 1-800-708-3034 (toll free). o 414-773-4646.

• Nug txog SSI Kev Tswj Kho Mob Tus Kws Sawv Cev Sab Nraud

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Ua Tsaug!

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Lus Nug?

[email protected]

mailto:[email protected]

supplemental security income (ssi) kev tswj kho mob ... · mob, tsev kho mob me (clinics), thiab...

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