1 Department of Medical Assistance Services Department of Medical Assistance Services – Eligibility and Enrollment Unit March Department of Medical Assistance Services MMIS WebEx Training

2 Department of Medical Assistance Services Agenda MMIS User’s Guide Managed Care Enrollment Certain Newborn Enrollment Enrolling NB’s of FC Children Social Security Numbers Medicare Buy-In Cancel Reason “001”

3 Department of Medical Assistance Services MMIS User’s Guide Chapter F of the MMIS User’s Guide has been updated to reflect: –Correct entry of member’s address for MCO assignment –Where letters and cards are sent; case address vs. demographic address –When letters are mailed for MCO pre-assignment DMAS Eligibility and Enrollment Unit Webpage:

4 Department of Medical Assistance Services Managed Care Enrollment Eligible foster care/adoption assistance members in the Tidewater and Central regions will be enrolled in a managed care organization (MCO) effective 7/1/13

5 Department of Medical Assistance Services FC/AA Member Pre-assignment Preassignment to an MCO will occur on the May 18, 2013 managed care run Preassignment letters will be mailed by the end of May Individuals have until June 18 to call to make their selection No call by June 18 = enrollment in MCO listed in preassignment letter effective 7/1 Obtain services through fee-for-service (regular Medicaid) until MCO is effective 7/1/13

6 Department of Medical Assistance Services FC/AA Exclusions from Managed Care Children who are hospitalized at time of enrollment; Children placed in a psychiatric residential treatment facility (PRTF); Children who are also covered under parent’s private insurance; and Undocumented minors

7 Department of Medical Assistance Services Enrollment cut-off date  Clients must call by 18 th of the month (or last business day before if 18 th is on a weekend/holiday)  Changes will be effective 1 st of following month  Clients call after 18 th, change is delayed another month  Example: call by June 18, change effective July 1. Call after June 18 and before July 18, change effective August Department of Medical Assistance Services

8 Department of Medical Assistance Services Changing MCOs 90 days from the effective date to contact the Managed Care Helpline to make a change After 90 days, changes are not allowed until annual open enrollment unless member shows good cause Good cause requests may be made by calling the Managed Care Helpline 8 Department of Medical Assistance Services

9 Department of Medical Assistance Services Annual Open Enrollment Notified by mail Members have 60 days to change MCO if they choose If they do not want to change, no action is needed Open enrollment dates vary by region. Visit chs/mc/mc-opn_enrl.pdf for specific dates chs/mc/mc-opn_enrl.pdf 9 Department of Medical Assistance Services

10 Department of Medical Assistance Services Managed Care Helpline The Managed Care Helpline is available for members to call with questions about managed care, providers, and for assistance in choosing/changing their MCO TDD: :30 am – 6:00 pm Monday through Friday 10 Department of Medical Assistance Services

11 Department of Medical Assistance Services MCO Customer Service Amerigroup Anthem HealthKeepers CareNet-Southern Health MajestaCare Optima Family Care Virginia Premier Department of Medical Assistance Services

12 Department of Medical Assistance Services Certain Newborns - Tips When enrolling certain newborns (NB) it is important to remember to: –Enter the mother’s ID number on the demographic screen –Enroll with AC 093 –Citizenship & Identity verification should = “NB” to exempt the NB from the citizenship & identity verification requirement. –Ensure the eligibility begins on the NB DOB – regardless of the application date!

13 Department of Medical Assistance Services NB’s Born to FC Children A child born to a IV-E FC child is enrolled in AC 076 when the mother’s IV-E payment includes an allocation for the child. If the allocation is discontinued and/or child leaves the care of the FC child the newborn child’s AC 076 coverage should be cancelled and reinstated in AC 093 until he turns age one.

14 Department of Medical Assistance Services NB’s Born to FC Children A child who is born to a non-IV-E FC child and who does not receive a IV-E allocation is enrolled as a certain newborn (AC 093) until the child turns age one. Neither an application for Medicaid nor proof of application for a SSN is required for a certain newborn until the child turns age one.

15 Department of Medical Assistance Services SSN Requirements To meet Medicaid eligibility an individual: –Must provide a SSN or provide proof of application for a SSN, unless the individual: Is an alien only eligible only for emergency services Is a child under age one born to a Medicaid mother Broadcast 6977: –Pseudo SSN’s must begin with a “999” prefix –“888” prefix is no longer valid – it is now in use by the SSA

16 Department of Medical Assistance Services Name & SSN Entry in the MMIS The name entered in the MMIS must match the name on the Social Security card or SSA records verifications. MMIS sends this information to SSA for the Medicare Buy-In or the citizenship and identity match

17 Department of Medical Assistance Services SSN Requirement Deadline The verified SSN must be entered into ADAPT and the MMIS by renewal If not provided by renewal and the problem is not an SSA administrative problem, Medicaid coverage should be cancelled

18 Department of Medical Assistance Services SSN Verification MMIS sends identifying data to the SSA for verification on the 21 st of the month The monthly SSN & Citizenship Update Report should be reviewed for rejected member data such as name, SSN, or DOB Any member with a SSN Status of “not verified” must have the discrepancy resolved

19 Department of Medical Assistance Services Medicare Buy-In Medicare Buy-In benefits were created by Congress to help low-income Medicare beneficiaries by paying their Medicare premium. These programs are known as: –QMB (Qualified Medicare Beneficiaries) –SLMB (Specified Low Income Medicare Beneficiary) –QI-1 (Qualified Individuals 1). 19 Department of Medical Assistance Services

20 Department of Medical Assistance Services Medicare The Medicare Program provides Hospital Insurance or Medicare Part A coverage, and Supplementary Medical Insurance, known as Medicare Part B coverage. Coverage for Medicare Part A is free for people age 65 or older who have insured status under Social Security or Railroad Retirement.

21 Department of Medical Assistance Services Medicare Buy-In Overview The Statutory Authority for the Buy-In program is section 1843 of the Social Security Act. The procedure by which a Medicaid eligible individual, who is also eligible for Medicare Part B, has their premium paid for by the State. Transfers some medical costs for this population from the Title XIX Medicaid program to the Title XVIII Medicare program. 21 Department of Medical Assistance Services

22 Department of Medical Assistance Services Medicare Part A An individual must be eligible for Medicare Part A in order to be included in a Part A Buy-In agreement or group payer arrangement. Part A eligibility can be obtained by those: –Age 65 or over who are U.S. residents and citizens or aliens lawfully admitted for permanent residence who have resided in the U.S. five years prior to application for enrollment 22 Department of Medical Assistance Services

23 Department of Medical Assistance Services Medicare Part A In some instances the state will pay for the cost of enrollee’s Medicare Part A if one is being charged. Beneficiaries who may have a reduced Part A premium cost: –Individuals who have 30 to 39 qualified work quarters 23 Department of Medical Assistance Services

24 Department of Medical Assistance Services Medicare Part B An individual must be eligible for Medicare Part B in order to receive Buy-In benefits. Part B eligibility can be obtained by those: –Age 65 or over who have Medicare Part A –Age 65 or over who are U.S. residents and citizens or aliens lawfully admitted who have resided in the U.S. five years prior to application for enrollment –Under age 65 and eligible for Medicare Part A due to receipt of Title II or Railroad disability benefits for more than 24 months –Medicare Part A recipients with chronic renal disease (dialysis patients) 24 Department of Medical Assistance Services

25 Department of Medical Assistance Services Medicare ID Numbers An individual’s Medicare number always begins with a nine digit number and ends with either one alpha character or a alpha number characters such as; – A or; – B1 Railroad Retirement Board (RRB) Medicare numbers contains an alpha prefix and a six or nine digit number such as; –A or; –WCA Department of Medical Assistance Services

26 Department of Medical Assistance Services Medicare The Social Security Administration (SSA) determines Medicare eligibility and maintains the Master Beneficiary Record (MBR). The Centers for Medicare and Medicaid Services (CMS) manages the Medicare program. SSA sends information to CMS regarding Medicare eligibility and CMS maintains a master file of all individuals eligible for Medicare. 26 Department of Medical Assistance Services

27 Department of Medical Assistance Services Buy-In Eligibility An individual can refuse Medicare Part B coverage due to the cost of the premiums. If found Medicaid eligible, they do not have to wait for the open enrollment period for Part B. Buy-In will begin immediately or within 2 months. MN non-QMB AC’s have a 2-month waiting period from the Medicaid begin date until buy-in begins. Non-QMB members are not eligible for Part A Buy-In. 27 Department of Medical Assistance Services

28 Department of Medical Assistance Services Buy-In Eligibility The following Medicaid AC’s are not eligible for Medicare Buy-In: –AC 005, 006, 007, 008, and 009 (FAMIS) –AC 066 (Breast and Cervical Cancer Treatment and Prevention) –AC 080 (Plan First) –AC 055 (Qualified Disabled Working Individual) AC 055 (Qualified Disabled Working Individual) is only eligible for Medicare Part A Buy-In 28 Department of Medical Assistance Services

29 Department of Medical Assistance Services Buy-In Eligibility Cut-off falls on the 23 rd of each month On the 24 th of each month Buy-In files are forwarded to CMS to: –Establish Buy-In for new Medicaid members –End Buy-In for cancelled Medicaid members –Correct existing information in the CMS files CMS processes the file by the end of the month and sends a response file to DMAS. 29 Department of Medical Assistance Services

30 Department of Medical Assistance Services Buy-In Eligibility The Buy-In Unit analyzes reports to make any needed corrections to the Buy-In process. Buy-In analysts assists LDSS offices, SSA staff, CMS, providers and members with premium issues or claims resolution. Medicaid cancellations are submitted to CMS on the month following cancellation to prevent erroneous premium deductions when eligibility is reinstated.

31 Department of Medical Assistance Services Buy-In Unit Contact Information Buy-In Inbox: Staff Contact Information: –Rhonda Bowers(804) –Sherrill Taylor (804) –Phoebe Adams (804)

32 Department of Medical Assistance Services Cancel Reason “001” MMIS Cancel Reason Code “001” is only used to close eligibility for deceased members; not to be confused with ADAPT change reason “001”. If Cancel Reason “001” is mistakenly used send an to the Enrollment Inbox for correction by DMAS staff. Screen help in the MMIS provides a complete list of cancel reason codes used in the MMIS.

33 Department of Medical Assistance Services Thank you… Thank you for viewing this presentation. Continue to send questions and comments about this training or ideas for future trainings to: Eligibility and Enrollment issues should be sent to the Enrollment Inbox at Patient pay enrollment questions or issues should be to the Patient Pay Inbox at