South Carolina Health Care Association Christian L. Soura Director September 29, 2015

Agenda Update on Eligibility Determinations Eligibility System Timeline Additional Notes Impact of LTC Business Process Redesign Next Steps Changes to LTC Application Processing Additional Changes to Announce Concept

Update on Eligibility Determinations

Eligibility System Timeline November 2014 New eligibility system deployed for MAGI categories (IBM’s Curam – “ACCESS”) Application backlogs for LTC cases already present Oldest pending application is from 2010 At this point, there were 57% more full-benefit members for each eligibility worker than there had been in April 2011 January 2015 SCDHHS reinitiates annual reviews as required by federal law Eligibility worker turnover rate doubles vs. 2011 levels 1,258 EW/full member in April 2011 vs. 1,976 in November 2014

Eligibility System Timeline March 2015 “Deemed Baby Wizard” is launched; pregnant and newborn backlog is eliminated in weeks Staff are reassigned to work the oldest pending cases SCDHHS begins to issue thousands of Form 1233s April 2015 The first “15-day clocks” on Form 1233s run out Application denials for LTC applications jump from below 50% to over 70% New processing centers are established as agency expands its use to temps to augment eligibility workers (Spring 2015) 1,258 EW/full member in April 2011 vs. 1,976 in November 2014

Eligibility System Timeline July 2015 LTC eligibility workers shift to the BPR model that emphasizes first-touch resolutions, better tracks worker performance SCDHHS changes policy to reduce documentation requirements for LTC applications September 2015 2nd shift launches in Columbia October 2015 2nd shift expands to other regional processing centers 3rd shift launches in Columbia 1,258 EW/full member in April 2011 vs. 1,976 in November 2014

Additional Notes on Eligibility Processing Why is it taking so long to add more LTC workers? Significant increase in eligibility worker turnover means more hiring is needed to show a net increase New hires are primarily being trained on ACCESS; shifting experienced workers to LTC cases saves training time Availability of trainers and training space is limited (training rooms make the best processing centers) Federal funding for the MEDS system was set to expire on June 30, 2015 Obtained a multi-year extension from the federal government last week (retroactive to July 1st) Carrying two eligibility systems has a real cost, though

Impact of LTC Business Process Redesign The BPR model is having an impact: 55% of LTC cases are now completed at the first touch 57 mins: Average transaction time for initial applications 37% reduction in unprocessed documents since mid-July (applications, reviews, changes, verifications)

Next Steps on Eligibility Processing Adding 10 more LTC eligibility workers Expect these will largely come from Non-MAGI group There are 30 workers focused exclusively on the LTC backlog On track to eliminate the backlog early in 2016 65% of the unprocessed documents are now reviews, currently our lowest priority for LTC

Changes to Long-Term Care Application Processing

Changes to LTC Application Processing Made several process changes to reduce lost time: Call applicant and/or authorized representative early in the application process Document efforts to contact separated spouses; do not allow this to delay application processing Calculate home maintenance allowance based upon written or verbal statement Reduce the number of bank statements requested to just the current period and three prior months Combine the LTC Application Addendum and the Statement of Transfer of Assets form Use new tools to improve consistency of asset and income verification

Additional Changes to Announce Updating the Authorized Representative Form (1282) Working with CMS to add a “Release of Information” section New script for LTC employees to use in addressing providers’ requests for information Intended to improve responsiveness and customer service New policies to improve consistency, responsiveness of the outstationed workers to providers Process quick transactions outside of Pathos for up to an hour per day (181s, collecting paperwork for processing/scanning) Give quick status updates and answer questions (30 mins.) Conduct face-to-face visits with applicants/ARs to assist with applications and reviews Complete administrative changes, like address updates

Concept

Concept DHHS would analyze recent nursing home eligibility determinations and propose a reimbursement for unpaid bed days associated with qualifying applications: Applications still pending on April 1, 2015 and denied no later than September 30, 2015 Applications with denial codes such as: You did not complete the required actions You did not send information about your resources You did not send proof of your residency in a timely manner You did not send the needed information This reimbursement amount would be accepted in full satisfaction of any and all rights to payment for services rendered to qualifying Medicaid applicants in this period.