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

2. 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

3. Update on Eligibility Determinations

4. 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 levels
1,258 EW/full member in April 2011 vs. 1,976 in November 2014

5. 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

6. 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

7. 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

8. 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)

9. 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

10. Changes to Long-Term Care Application Processing

11. 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

12. 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

13. Concept

14. 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.