Third Party Liability

MFWCCA Conference 2008

Duluth

10/08,09/2008

Benefit Recovery COB/TPL

Jan Taylor, Manager Benefit Recovery Section

DHS Health Care OperationsJan.taylor@state.mn.us

651-431-3139

Benefit Recovery Section

Responsible to ensure that MHCP is payer of last resort; all other resources must be used to fullest extent

Partner with financial worker staff in many ways to gain information and fulfill responsibilities

Important that clients understand their responsibilities about TPL

Units within BRS

Health Insurance Unit

Tort Liability Unit

MA Lien and Estate Recovery Unit

Medicare Revenue Enhancement (LTC)See Handout Pg. 1—BRS Contact List

Health Insurance Unit

Maintain the TPL Resource File in MMIS– Reviewing county added TPL records

(including those interfaced from PRISM)– Incoming faxes from medical providers—

updates– Reviewing Possible Insurance Cases for

unknown TPL

See Handout—Attachment A

Health Insurance Unit

Bill health insurers for retro coverage

--Processing TPL payments/denials Review & Approve Cost Effective Health

Insurance policies File updates with data match results

– Child support (daily)– Tricare (annually)– Other insurance carriers (current RFP)

Medicare & LTC Insurance are TPL

Regardless of where the payment of benefits is directed

– LTC insurance must be coded as a policy in MMIS/TPL Resource

– Providers of LTC services must bill and report receipt of payment on the claims submitted to MHCP

Do Not Treat LTC Insurance Proceeds as Income/Assets

If the policy is not specifically “income replacement” it is TPL

If benefits are payable as a result of home care services or NF services = TPL

Client or personal rep must pay the benefits to the nursing home

Coverage Types Expanded

MMIS has new Coverage Types for the expanded benefits of LTC insurance

– 13—Nursing Home Only – 27—Nursing Home + Home Care*– 28—Nursing Home Only (Partnership Qualified)*– 29—Nursing Home + Home Care (Partnership

Qualified)*

*New Coverage Types were Implemented February 2008; See LTCP Bulletin #08-21-08.

Services Covered by Managed Care Organization (MCO)

If SNF or Home Care services are covered by an MCO, LTC insurance benefits are payable to the MCO

The LTC insurance payments must be reported on the claims submitted to the MCO

The MCO is secondary to LTC insurance benefits

New Initiatives for Improved Efficiency

Quality improvement process (Lean/Kaizen) used for three major BRS processes

County staff members participated in a short-term “Focus Group” to review draft products and provide input

Cost Effective Health Insurance

Decision Tree (In Development)

Decision Tree (State Agency Staff)

“Standard Work” Document in Use for BRS Staff

Process Changes Identified

CEHI Form is being revised (Draft)

MMIS Request for “Combo Screen” of data relevant to CE review

Use of Fax for Future Requests and

Workflow Changes

State Plan Amendment to CMSSee Handout—Attachment B

Tort Liability Unit Pursues TPL Related to Accidents/Injuries

--Grant money may be part of BRS Claim

“Leads” to Cases– Client has a duty to report– Attorney for client is looking for medical

expenses paid as related to the injury– Medical Service Questionnaires are

generated– Refer calls/correspondence to BRS

Tort Liability

Types of Tort TPL– Workers’ Compensation (DOLI data match)– Auto no-fault/auto litigated– Homeowners’ Insurance – Medical Malpractice – Product liability (rx drugs, devices, etc.)– Personal Liability– Class Action or Multiple Plaintiff Cases

MSQ Process

“Standard Work” (final)

FAQs Document (See Handout—Att. D)

MMIS Changes

Improve compliance with form completion/return

Reduce turn-around time

Form Revision

Simplify form & use “flash print” or “script” process rather than hard copy forms (pin-feed)

DHS 2237/2237ASee Handout—Att. C

Proposed New MSQProcess

Daily process and direct mail of First/Sec. Notice MSQs

Move parameters on notices up (from 90 days to 60 days to 45 days)

Rely on county staff to apply closing guidelines at Worker Message

MA Lien & Estate Recovery

County agency staff send MA Lien Referral Worksheets and SNT Referrals to BRS

BRS staff file MA property liens when appropriate and monitor SNT clients

County Agency staff file estate claims upon the death of the last surviving spouse

BRS provides technical assistance to county collections staff

Medicare Revenue Enhancement (MREP)

Program to ensure that Medicare benefits are used first for LTC Services

LTC facilities required to submit documentation for review of potential cases

Technical assistance provided to LTC facilities re: Medicare, and other requirements

Deficit Reduction Act (DRA) & LTC Partnerships

MN passed implementing language effective 07/01/06 based on DRA authority given to states – More people will be buying LTC insurance

which may or may not be Partnership qualified

– All LTC insurance has the effect of protecting assets (by virtue of providing the benefit)

Goals

Effective communication with external customers (develop and maintain presence on public and county websites, etc.)

More efficient processes with better results

Continue to review & implement changes

Questions?

Your Thoughts?