Friday, 19 March 2004 Renewal Simplification Workgroup Present: Alan Takahashi, Stephany Vaioleti, Susan Chung, Jeffrey Young, Pearl Tsuji, Barbara Luksch, Cassandra Stewart, Kookie Moon-Ng, Noe Foster, Liane Hiramoto, and Andreas Cravalho Next meeting: 8 April 2004 at 8:00 AM 1. Update The simplified renewal process with prepopulated forms will go live on 25 March 2004 when the April renewals for Ongoing Unit III are mailed to customers (616 Oahu cases with last names P-Z except those living in Leeward Oahu who are processed by Med- QUEST’s Kapolei Office). Eligibility workers are prepared to handle questions from customers and Jeffrey created a spreadsheet to monitor questions they receive. Results will be reviewed by the workgroup at the next meeting. 2. Sample Size It was determined by the DHS statistical office monitoring quality control that the sample size would be 492 cases per year statewide. Kookie will research if this number of families must be contacted and how many can be qualified dropouts. We want to minimize over pull while assuring the number used for the sample size is statistically sound. 3. Random Sample Follow-Up: Long-Term Plan Note: Please refer to Plan, Do, Study, Act report Cycle #3 (03/05/04) available at Process Improvement Collaborative. Med-QUEST is committed to implementing timely and accurate random sample follow-up through ex parte reviews. The Benefit, Employment, and Support Services Division (BESSD) published a request for proposals (RFP) to modify the HAWI computer system they share with Med-QUEST. The RFP will close in March and a review committee will choose the vendor. Hard copy printouts in ten-inch binders with names in alphabetical order will be replaced by computer access to match social security numbers with household income information filtered to the eligibility worker’s caseload. 4. Random Sample Follow-Up: Short Term Solution Barbara shared renewal information from her conversations with two states. Louisiana successfully carries out passive renewals using ex parte reviews for all cases and eligibility workers contact families through telephone calls if necessary. Idaho implements random sample follow-up. We discussed short-term solutions for Oahu Ongoing Unit III to test in April and May. These options will be discussed at the next meeting: * Telephone Call: possibly call three times at various hours during the day (Cassandra will help draft script). * Email Message: more thorough research needed (Susan will find out if Med-QUEST’s email software is encrypted; prefer eligibility worker email customer rather than use of anonymous email address, etc.). * Mail: If the eligibility worker cannot reach the family via telephone or email, send a friendly letter: “I tried to call you...please call me.” Sticker or stamp on outside of envelope should state: “URGENT! Respond within 10 Days.” 5. Information Sessions with Community Partners * Pearl initially sent a letter to sixty-three community partners explaining the new renewal processes and included samples of Med-QUEST’s passive renewal and active renewal forms. Barbara sent her mailing labels for Renewal Simplification Workgroup members, outstationed eligibility workers, and community training workshop participants as well as updated lists for WIC and DOH public health nursing supervisors. The names will be cross-referenced and those not included in the first mail out will be sent information packets. * Eligibility workers and outstationed eligibility workers will be trained on the new renewal processes. * Kookie suggested the workgroup sponsor a general information session for community, state, and federal partners to clarify the new renewal process and ask questions. We will discuss this idea at the next meeting to determine the need. 6. Covering Kids & Families Process Improvement Collaborative Site Visit We agreed that Thursday, 3 June 2004 is a good date for representatives from the Process Improvement Collaborative Leadership Team to visit. The purpose of the meeting is for Laura Heller and Nicole Ravenell to better understand our Medicaid processes and identify areas where they can help us improve. It is a great opportunity to use experts in the field as Hawaii continues simplifying its Medicaid processes. The day will be spent at Med-QUEST's Dillingham Office from 8:00 AM to 4:00 PM and will include a tour showing the steps application and renewal forms take through the office, data review, and PDSA reports. Thursday, 8 April 2004 Renewal Simplification Workgroup Present: Mary Rydell, Alan Takahashi, Stephany Vaioleti, Crescent Oshita, Jeffrey Young, Barbara Luksch, Liane Hiramoto, Michelle Danley, and Alan Matsunami Next meeting: 3 June 2004 at 8:00 AM at Honolulu Med-QUEST Office 1. Updates a. Oahu Ongoing Unit III Live Test Using Prepopulated Forms * 606 forms mailed by HAWI computer system * 11 returned with no forwarding address * 75 regular and passive renewal forms have been returned * 33 callers wanted to know what to do with the form (16 received the passive renewal form and 17 the regular form) * 68 surveys were returned (17 passive and 51 regular) b. Envelopes Returned with Address Changes * Med-QUEST cannot send mail to the new address due to HIPAA regulations. * Eligibility workers should exhaust all possible ways to contact the customer before closing the case. * Procedures will be: ...If the forwarding address is outside Hawaii: close the case. ...If the forwarding address is in Hawaii or there is no forwarding address: call the customer. Call at least three times at different hours throughout a one-week period and leave a minimum of two voicemail messages. ...If the telephone number in the case file is no longer in service, call telephone assistance to ask for a new number. * We must continue working on possible email alternatives (e.g., if the customer has an email address, Med-QUEST could send a message: “We are trying to contact you. Please call us at xxx-xxxx.” Michelle explained that managing volumes of email messages for record keeping could be difficult. Barbara will check with James Lum, Chief Information Officer at the Department of Human Services (DHS)’s Office of Information Technology (OIT), regarding the department’s policy on contacting customers via email. c. Documenting Changes * Currently, if a change is reported to the eligibility worker via telephone, a notation is made in the case record and the eligibility worker mails the customer a notice confirming the details. * Barbara will check if Centers for Medicare and Medicaid Services (CMS) requires changes in writing from customers. d. Food Stamp Customers (Cases with Children) * They will not receive a prepopulated passive renewal form but get all the privileges of the passive renewal process because Med-QUEST will receive a copy of Form 1240 (Application for Financial and Food Stamps Assistance) and use it for medical assistance renewal. If the customer does not return Form 1240 or verify information, the case will be closed for the Food Stamp Program but not Med-QUEST benefits. * We discussed that Benefits, Employment, and Social Services Division (BESSD) workers are very inconsistent in keeping Med-QUEST cases open when food stamp benefits are closed: ...Some food stamp cases are closed because the customer is no longer a Hawaii resident, however the medical benefits are kept open. ...If Form 1240 is not returned to BESSD, sometimes the whole case is shut down including medical benefits. ...Med-QUEST gets monthly reports of combination case closures (those receiving both food stamp and medical benefits), however it is too time consuming for ...Med-QUEST staff to double check BESSD’s work to find out if medical cases were closed inappropriately. We will ask the DHS director to meet with BESSD and Med-QUEST to resolve this problem. e. Lost Forms * If a customer loses a regular renewal form, she/he is asked to complete the current reapplication form (1100B). * If a customer loses a passive renewal form, information can be discussed over the telephone followed by a confirmation letter outlining details about the call. 2. Ideas for Strengthening Renewal Connections a. Med-QUEST and QUEST Plans * Stephany and Jeffrey discussed Derrick Dale’s presentation at last week’s Covering Kids & Families Process Improvement Collaborative learning session in Chattanooga, Tennessee. He is from CareOregon and explained it helps their company financially to keep eligible customers enrolled due to churning costs. * If AlohaCare, Kaiser, and HMSA knew renewal dates, would they send advanced notices to their customers telling them to watch for a renewal form from Med-QUEST? b. Outstationed Eligibility Workers * The Hawaii Covering Kids Kahuku Local Project will test sending advanced postcards to notify families their renewal form will be coming from Med-QUEST. We reviewed Idaho’s sample. 3. Second Notices A second notice could limit unnecessary closures and save Med-QUEST staff time. Barbara shared Pennsylvania’s preprinted form that explains “This is the second request for renewal that we are sending. If you already replied to the first renewal notice, you can ignore this letter.” A similar notice could be mailed by HAWI to Med-QUEST’s customers with a reminder of what to do (passive versus regular cases) and a telephone number to call with questions. For regular renewals, it could include this sentence at the top: “Your medical assistance will stop on XX/XX/XXXX if we do not hear from you by XX/XX/XXXX.” 4. Information Sessions for Community Partners * Barbara will organize a Hawaii Covering Kids State Coalition meeting in Honolulu the week of 17 May 2004. * Med-QUEST can sponsor a videoconference roundtable for the Neighbor Islands using the state’s free equipment. 5. Random Sample Follow-Up for Passive Renewals Note: Customers who return the form as well as those who did not return it will be called to test the validity of this method. For those who returned the form, Med-QUEST will check that there are no additional changes to report. For those who did not return the form, Med-QUEST will ask about all changes. a. Telephone * Call at least three times at different hours throughout a one-week period and leave a minimum of two voicemail messages. * If the telephone number in the case file is no longer operating, call telephone assistance to request a new number. * We will research email possibilities. b. Telephone Interview Script Draft #2 was distributed and comments will be submitted to Barbara by 15 April 2004. 6. Renewal Forms: Tweaks We will compile feedback from the surveys, outreach workers, and workgroup members to tweak the passive and regular renewal forms. Workgroup members were requested to send their comments to Barbara by 15 April 2004. It was noted that future changes to these forms must get in the OIT systems modification queue. Tuesday, 13 April 2004 Application Simplification Workgroup Present: Jeffrey Young, Liane Hiramoto, Barbara Luksch, Melba Bantay, and Waynette Cabral. Next meeting: TBA 1. Cover Letters We voted against a cover letter because all information is self-contained in the applications. 2. Ideas from Other States Question 1: We discussed adding the sentence “This person will get all information from our office” but decided it isn’t necessary. 3. Form 1108 Tweaks a. Update immigration web site URL on page 7. b. Add child abuse and domestic violence hotline numbers under “Important Resources” on page 7. 4. Form 1100 Tweaks a. Add pages: “Bilingual and Sign Interpreter Services” and “Mikah the Mynah Bird.” b. Add questions and answers pertinent to the general population as well as nonpregnant adults: * What is the difference between QUEST and Medicaid Fee-for-Service? Medicaid Fee-for-Service is for customers who are blind, disabled, and 65 years old or older. All other customers are enrolled in QUEST which is a managed care program. * If I get Medicaid Fee-for-Service, will it pay my medical bills? Yes. Your medical bills may be paid if you go to a health care provider who accepts Medicaid. * If I have Medicare, can I still get Medicaid Fee-for-Service? Yes. If you qualify for Medicaid Fee-for Service, the state may pay your Medicare premiums. * Must I live in Hawaii to apply? Yes. You must be a Hawaii resident. People who need medical assistance must also plan to live in Hawaii indefinitely. * Can only United States citizens get medical assistance? No. You can be a United States citizen, United States National, lawful resident alien, qualified alien, or citizen from the Federated States of Micronesia, Republic of the Marshall Islands, or Republic of Palau. c. Important Resources We will add Medicare, SagePlus, and Executive Office on Aging. 5. Video Script for 1108 Lovelee Productions will produce a new video on how to complete the children and pregnant women application. A final edit of the script will be sent to all workgroup members for comments prior to production. Friday, 16 April 2004 Oahu Outstationed Eligibility Workers Present: Shari-Lyn Castillo, Regina Quimpo, Momi Sonognini, Angie Tam Sing, Cougar Lind, Joette Manning, Barbara Luksch, Hi‘i Campbell, Michelle Malufau, Jeffrey Young and Hue Nettrour. 1. Who Should Attend It was explained this meeting is for those trained to complete form 1100A, as well as other Med-QUEST forms, that are attached to the application before it is sent to the Honolulu Med-QUEST office. 2. Announcements a. New DHS Funded Outreach Program The Hawaii Primary Care Association will contract with community health centers, Native Hawaiian Health Care Systems, and other nonprofit safety-net health care agencies to conduct outreach and enrollment for TANF, housing, food stamps, Med-QUEST (MQD) programs, child care, and the Hawaii Immigrant Health Initiative. There are currently six locations hiring outstationed eligibility workers: Community Clinic of Maui, Kalihi-Palama Health Center, Kokua Kalihi Valley, Waianae Coast Comprehensive Health Center, Waikiki Health Center, and Waimanalo Health Center. Eventually the program will expand to thirty-three sites. b. Outstationed Eligibility Workers (OEWs) at New Federally Qualified Health Centers (FQHCs) In compliance with Centers for Medicare and Medicaid Services (CMS) guidelines, MQD reimburses FQHCs for at least one OEW position. New FQHCs include Kauai Community Health Center, Molokai Community Health Center, and Hana Community Health Center. 3. Rewriting Hawaii Administrative Rules (HAR) Angie relayed information from Paul Higa at MQD’s Policy and Program Development Office. They are currently amending the application and renewal sections to reflect current simplified procedures (e.g., self-declaration of income, assets, social security numbers, birth dates, etc.). This is great news because MQD eligibility workers are trained using current HAR, therefore some request pay stubs, social security cards, and other unnecessary documentation. In December 2003, Lillian Koller requested that MQD share a draft version of the amended HAR with their eligibility staff, CMS, state agencies, and community organizations during the draft process. It will save the division time and money by reducing the need for immediate changes after the rules are officially adopted. There should be a minimum of two meetings with these groups to review drafts of the amended rules before the public hearing. 4. Form 1123 We have requested for over one year MQD change form 1123 to allow an organization be designated as the authorized representative. HIPAA [45 Section 164.508 (c)] allows a category to be named person(s) or class of persons (e.g., organization). Furthermore, allowing a person rather than an organization to be designated is a potential problem for MQD because if that person leaves employment, she/he can still call Med-QUEST about a case. At an Application Simplification Workgroup meeting, Paul explained that if a state law is more stringent than HIPAA, MQD must follow the state law. In this situation, only allowing an individual to be an authorized representative is a Hawaii Administrative Rule. Therefore, Barbara will send a letter to Kookie Moon-Ng requesting MQD revise form 1123. 5. New Renewal Processes Jeffrey reviewed the two new renewal forms and processes. Cases with children will receive a lilac-colored passive renewal form and adult-only cases will receive a regular gray-colored one. The current field test is through his unit (Oahu Ongoing III) and it will be implemented statewide beginning 1 June 2004. It was requested that OEWs share information on the new renewal processes with their customers, let them know the forms will be coming, and help with information and completion. More details are at Passive Renewal Information. It was noted that if the case is closed and information is received before end of the calendar month, the case can be reinstated. 7. Notifying Med-QUEST of Changes Please make sure all customers submit changes to MQD as soon as they occur, especially a new mailing address. 8. New 1100A Angie and Jeffrey reviewed the latest edition (February 2004) with the group. It can be downloaded in typable PDF format at: Library of Forms. 9. Form 1108: Feedback and MQD Processing The participants highly praised the new children and pregnant women application and said it is a great success. It is very simple and much easier to complete because it does not ask about absent parents or assets and has fewer questions. Single parents and guardians, who were previously fearful about applying for their children, are now willing to sign them up. It was explained when a completed application comes to a MQD office with a pregnant woman identified in Question 2, the entire application is processed within five days. There was a recent instance wherein the pregnant woman was approved right away and her disabled child was pending. It was explained that the delay was caused by the requirement to have the child’s case evaluated by the Aid to the Disabled Review Committee (ADRC). 10. F1 and F2 Visas This information is from MQD PPDO: For parents who entered the United States temporarily to attend school as students with no intention of abandoning residence in a foreign country, they are excluded from receiving medical assistance except for emergency medical services if they meet all other eligibility requirements (e.g., generally those with children or who are age 65 years or over, blind, or disabled would qualify if their emergency condition places their health in jeopardy and could result in serious impairment to their body functions or serious dysfunction of any body organ or part). Generally, MQD would cover the delivery for the mother’s baby because it meets the emergency services requirement. Residency for the newborn is correctly questioned. We assume she/he is a United States citizen because the birth occurred in the United States. As an individual who is incapable of indicating intent, the residency of his/her parents would be considered that of the child. Therefore, if the parents have no intent of abandoning their residence in a foreign country, the child would not meet the residency requirement, although she/he may meet the citizenship requirement. 11. Hawaii Primary Care Association (HPCA) Request HPCA is requesting data from FQHCs, Hawaii Covering Kids Local Projects, and Oahu hospitals regarding MQD’s processing time for pregnant women applications. A letter and charts will be mailed on 20 April 2004 and need to be returned by 14 May 2004. Results will be shared with HPCA Board of Directors and Lillian Koller. 12. Eligibility/Enrollment Web Site We reviewed a sample screen and discussed how to interpret the information. 13. Updated OEW Guidebook Angie distributed amendments to the guidebook. We thanked her for this excellent manual that assists the OEWs by keeping them up-to-date with MQD’s policies and procedures.