1. AUTHORIZED REPRESENTATIVES MISSOURI HOSPITAL ASSOCIATION Missouri Family Support Division

2. Welcome! Presenting from Missouri FSD:  Julie Gibson, Designated Principal Assistant  Glenda Deason, Manager, MHABD Medical Review Team Processing Center, Springfield, MO  Linda Simmoneau, Program Development Specialist, Medical Review Team

3. FSD Modernization and Reorganization Upgrading to new/modern technology – MEDES – replacing existing legacy system (FAMIS)  Web-based, automated system  Stronger case management tools  Cheaper to operate and maintain Phase I -- MEDES – MAGI Medicaid (January, 2015) Phase II will focus on Non-MAGI Medicaid (elderly, disabled) – (2016)

4. FSD Reorganization Key Elements of FSD Reorganization:  Centralizing application processing/ specialized customer services  Creating Customer Resource Centers throughout the state  Employing call center technology and processes  Converting paper case files to electronic format

5. WHAT CHANGES WILL YOU SEE? How does this impact Authorized Representatives?

6. MHABD MRT Specialization  “MRT Central” MRT Central will enable faster and more efficient processing and will provide a centralized point of contact for Authorized Representatives Consolidates processing of MHABD MRT to one primary location – Greene County, Springfield, MO Eligibility staff and Medical Review Team work hand in hand to expedite processing of MHABD MRT applications from start to finish MRT Central staff become a “specialized team” in processing MHABD MRT applications

7. Partnership with Authorized Representatives MRT Central values the important partnership with ARs and is committed to providing excellent customer service STL AR is transitioning operations to MRT Central – all information sent to the STL AR Group will be forwarded to MRT Central via e-mail Please begin using this new email address that has been established solely for applications from hospitals and facilities: FSD.HospitalApplications@dss.mo.gov

8. MAKE SURE THAT THE APPLICATION AND OTHER REQUIRED FORMS ARE COMPLETED THOROUGHLY How can Authorized Representatives help expedite processes?

9. MHABD Forms IM-1MA Application for Benefits IM6-AR – Appointment of Authorized Representative MO-650-2616 – Authorization for Disclosure of Consumer Medical/Health Information IM-61B – Disability Questionnaire IM-61C Work History in the past 10 years IM-61D Hospitals, Medical Facilities and Physicians seen within the Past Year

10. MHABD Verification Forms IM-9 Insurance and Prepaid Burial Verification Request IM-12 Employment Information Verification Request IM-7 Financial Information Verification Request

11. IM-1MA Application for Benefits

12. Tips for Completing the IM-1MA Application If applicant is homeless – be sure and note this on the application and include a mailing address – which can be the hospital/authorized representative’s mailing address Ensure that the type of application is marked, i.e. disabled, over 65, blind/visually impaired. If client is wishing to pursue Gateway to Better Health, please write that in If married and living together, both spouses must be listed on the application All types of income, earned or unearned, should be listed on the application

13. IM-1MA (Cont’d) Make sure all resources are indicated on the application Ensure that the application is signed and dated Please make sure we receive the completed application as soon as possible, especially if it is late in the month For example, if the client fills out the application and it is dated for March 30, but we don’t receive it until April 1, then April will be the month of application If the client does not have unpaid medical bills prior to the month of application, it may not be necessary for you to go through the need of obtaining information for the months prior (see next slide)

14. Prior Quarter Coverage Indicate on the application whether or not prior quarter coverage is needed. MOHealthNet may cover outstanding medical costs incurred by the applicant (or spouse) in the 3 months prior to the month application is received All types of income, earned or unearned, should be listed on the application, including prior quarter Make sure all resources are indicated on the application, including any owned in the prior quarter

15. Options for Authorized Representatives Consider the level of involvement you want/need to have on behalf of a client FSD allows for several options that will enable a provider to assist the client: 1)Become a legal Authorized Representative by completing IM-6-AR 2)Client can give FSD permission to discuss his/her specific case with you (without making you an official AR) by notating on the MO-650-2616 (HIPAA form) 3)Client can give FSD the same permissions as # 2 by completing the newly created IM-6-NF

16. IM6-AR Appointment of Authorized Representative

17. IM6-AR – Appointment of Authorized Representative As an Authorized Representative, you become FSD’s primary contact for the client:  Represent the client in Hearings  Receive all correspondence on behalf of client  Access to client case information  Speak to FSD on behalf of the client In completing the IM-6-AR:  Ensure that this form is completed in its entirety  Must be signed by the Authorized Rep, or it cannot be accepted  Make sure that the form is legible  Please print your name behind your signature

18. MO-650-2616 – Authorization for Disclosure of Consumer Medical/Health Information

19. This is often the most confusing form for the client to complete Please have the client sign this form in black ink.  MRT Processing must have signatures that are visible in order to obtain the appropriate medical records needed /schedule necessary evaluations Ensure that both signature lines are signed on the back of the form Make sure that the individual has NOT signed the revocation area

20. IM-6-NF AUTHORIZATION FOR RELEASE OF MEDICAL/HEALTH INORMATION TO THE NURSING FACILITY

21. A user-friendly form that gives FSD permission to discuss a person's case with the provider Alternative to the IM-6-AR Does not make the provider the Authorized Representative

22. IMPORTANT TO ENSURE THAT THEY ARE COMPLETED AND SUBMITTED Other MRT Forms

23. IM-61B – Disability Questionnaire

24. This form is the voice of the individual when MRT is making a determination. Must be completed thoroughly MRT Processing must know ALL medical conditions of the individual This form also helps to determine if any other evaluations need to be scheduled for the client

25. IM-61C Work History in the past 10 years

26. FSD must obtain employment information for the past 10 years The individual must make every attempt to provide accurate and complete information

27. IM-61D Hospitals, Medical Facilities and Physicians seen within the Past Year

28. Provide information for all medical services the individual has received in the most current year FSD will not be requesting records older than one year The dates of service are critical to obtaining the relevant medical records – be sure to include them

29. IM-9 Insurance and Prepaid Burial Letter

30. This form is required if the individual has any life insurance or burial policies, and must be completed and signed by the client The name of the company is required The company address is requested, if available

31. IM-12 Employment Information Request

32. This form can be supplied if paystubs are unobtainable by the individual Ensure that the form is signed Ensure that the employer name and address is provided:  It is very important that we know the location of the employer where the client works/worked, especially since many are franchised or have multiple locations

33. IM-7 Financial Information Request

34. This form is completed by a bank/financial institution, and is necessary if the client does not have access to, or does not provide their financial institution/bank account verification If the individual has access to their information, please have them attempt to obtain the information themselves, as some banks charge a fee for filling out the IM-7

35. MHABD Authorized Representative Case Status Report Starting April 1, 2015: AR will receive “Vendor” Case Status Report Semi- Monthly  Two “Vendor” Case Status Reports E-mailed to AR On 1 st each month status for prior month from 16 th to last day On 16 th each month status for current month 1 st to 15 th Will develop a customized report for ARs in the near future

36. MHABD AR Case Status Report (Cont’d)  Current “Vendor” Case Status Report contains the following fields:  Participant Name (AR)  Case Number (for AR zeroes)  Application Date  Referral Received Date  Application Status Pending Approved Not Eligible  Effective Date of Status

37. Vendor Case Status Report

38. Final Notes FSD.HOSPITALAPPLICATIONS@DSS.MO.GOV This email address is monitored 100% of every business day MRT Central will follow-up on any pending AR applications If you do have an urgent matter, you may call Glenda Deason at 417-895-6062 Also, check out our updated website at dss.mo.gov/fsd/