transitional minnesotacare
DESCRIPTION
Transitional MinnesotaCare. 2007 MFWCAA Conference Health Care Training Jen Gerber. Agenda. Renewal vs. HCAPP Retro MinnesotaCare Coverage and Premium Payments Financial Control Basics Health Plan Enrollment Who answers MinnesotaCare questions? Resources. Renewal vs. HCAPP. - PowerPoint PPT PresentationTRANSCRIPT
Transitional MinnesotaCare
2007 MFWCAA Conference
Health Care Training
Jen Gerber
2
Agenda
Renewal vs. HCAPP Retro MinnesotaCare Coverage and
Premium Payments Financial Control Basics Health Plan Enrollment Who answers MinnesotaCare questions? Resources
3
Renewal
vs.
HCAPP
4
Timely T-MCRE Renewal
Was an MA basis of eligibility gained – if so, determine for MA.
If not, determine eligibility for MCRE.
5
Timely T-MCRE Renewal
Apply all MCRE eligibility criteria and program rules.
If eligible, approve pending awaiting payment.– Subject to all MCRE rules and policies.– Must pay monthly premium.– Note: There is no penalty or barrier to future
GAMC or T-MCRE eligibility for these applicants.
6
Timely T-MCRE Renewal
If the enrollee is not eligible for MCRE, do not require a new application.
Example: Enrollee now has access to ESI.
7
Late Renewals
Consider renewal forms submitted in the renewal month as applications for MCRE if there is no MA basis of eligibility.
Juan’s renewal month is February, his coverage ended the end of January. We receive his renewal on February 15. What do we do with the renewal?
8
Late Renewals
Applicant sends in a renewal after the renewal month.
Find out what program the applicant wants to apply for.
9
Late Renewal
If MCRE:1. Use the renewal as a new application.
2. They will have a gap in coverage.
3. Not eligible for retro.
4. Can be forwarded to MCRE Ops is county is not a MCRE enrollment site.
If all programs:1. Need a new HCAAP. Send one out.
10
Require a new application
Any time a former T-MCRE enrollee wants to reapply for MA, GAMC, or T-MCRE.
John’s T-MCRE ended the end of last month and he did not reapply. Now wants T-MCRE again. Do we need a new app? Can we use a renewal for T-MCRE?
11
Examples – When to require a new application
After the effective date of T-MCRE closure.
While MCRE is pending. After failing to transition to MCRE after
having been determined eligible at renewal.
After transitioning to MCRE and then having coverage closed for any reason.
Etc.
12
Retro
MinnesotaCare
And Premium
Payments
13
Retro MCRE
Eliminate gaps in coverage.
All T-MCRE/GAMC/MA clients are eligible if they apply for MCRE within 30 days of their coverage closing.
Don’t assume there is enough time left in the month.
14
Retro MCRE
On August 1st , you close T-MCRE for September 1st, and approve MCRE for September 1st.
Household has until August 31st to make initial premium payment.
Set up retro for September, ongoing for October.
Send Retro Notice – DHS-3446.
15
Making first premium payment
Must be paid before noon on the last business day.
Always paying the ongoing premium only.
Can be made online, mailed or in person in St. Paul.
16
Obligation ID/Invoice Number
17
Obligation ID/Invoice Number
18
Retro Premium Payments
To be eligible for retro coverage, clients must pay the initial and optional (retroactive) MCRE premiums by the end of the month following the month of premium billing.
Must be paid for the entire retro period.
19
Retro Premium Payments
The Retro Premium is mailed to the enrollee after the ongoing premium is paid.
Contact the MMIS Help Desk to get funds moved if applied to the incorrect month.
20
Retro Coverage Example
Eligibility determined and initial premium mailed on January 14.
Initial premium must be rec’d by last working day in Feb. to be considered for retro coverage.
Premium rec’d Feb 20, retro months will be Jan. and Feb.
Premium rec’d March 1, denied retro.
21
Initial and Retro Premium Payments
If the initial premium for ongoing eligibility:
Is received by the end of the month following the billing month:– MMIS will send the option premium notice if
they were set up for retro eligibility.– The enrollee must pay the optional premium
by the end of the month following the optional billing month.
22
Initial and Retro Premium Payments
If the initial premium for ongoing eligibility:
Is not received by the end of the month following the billing month:– MMIS will deny retroactive MCRE.– Ongoing MCRE will remain pending for up to
three additional months on MMIS.
23
Initial and Retro Premium Payments
If the optional premium:
Is received before the due date:– MMIS will approve retroactive MCRE from the
date that MA or GAMC closed to the date ongoing MCRE began.
– Enrollees must accept retroactive coverage for all available months.
24
Initial and Retro Premium Payments
If the optional premium:
Is not received by the due date:– MMIS will deny retroactive MCRE.– Ongoing MCRE remains active.
25
OSEL with Retro Obligation
26
Financial
Control
27
OBLG
28
OSLT
29
OACT
30
Health
Plan
Enrollment
31
Health Plan Enrollment
Case is processed and made P41. MMIS creates and enrollment form and
assigns a default health plan. Enrollment packet mailed to household. Household fills out info and mails back. DHS receives form and the info is entered
onto RCHP.
32
Health Plan Enrollment
After the 15th of the month:
– Worker fills out the form with enrollee.
– Map of health plans on Countylink under Managed Health Care Programs.
– Fax it to DHS. Fax # 651-431-7464.
33
Fee-for-Service
There are two exceptions when an enrollee will not be enrolled in a health plan.
1. Retro MCRE months.
2. Any Reinstatement month.
34
Who Answers MCRE Questions?
County MCRE case, the County servicing the case, answers the questions.
MCRE Operations case, MCRE Operations answers the questions.
35
Resources
Helpful Resources:– Health Care Programs Manual– MMIS User Manual– MMIS User Services
• 651-431-3930• 1-800-366-7894
– HealthQuest