Friday, 23 July 2004 Process Improvement Collaborative Present: Jeffrey Young, Stephany Vaioleti, Barbara Luksch, and Alan Takahashi Next meeting: 30 August 2004 at 11:30 AM 1. Presentation by Sue Uyehara, DOH WIC Program Support Section Chief WIC is a people-intensive service that requires relationship building with customers. It is important their families feel that someone cares about them. Furthermore, high quality customer service prevents employee burn out and creates a more positive work environment. Some of the key training areas with their staff are civil rights (which complements customer service), voicemail messages, and telephone etiquette. Training was provided at each site and at subsequent staff meetings situations were role-played to improve skills. Customer service brochures are distributed to employees, bulletin boards have updated news, and a committee developed “Our Best Practices Guide to Customer Service.” Customer surveys are used to monitor success and determine problem areas. 2. Reminder Postcards: Kahuku Local Project Stephany provided feedback on postcards to remind Med-QUEST customers about upcoming annual renewals. Twenty-one reminder postcards (10 cases with children and 11 adult-only cases) on 06/28/04 and follow-up surveys were mailed on 07/12/04. a. Five postcards were returned without forwarding addresses. b. Two surveys were returned with positive feedback on the reminder postcards. c. Fourteen surveys were not returned: * The outreach worker contacted eight customers: three cases had been closed (1 excess income, 1 previously pregnant woman, 1 employer-sponsored health insurance), four expressed positive comments about the reminder postcards, and one had not received the renewal form from Med-QUEST. * The outreach worker was unable to contact six customers (four cellular telephones were disconnected and two were work telephone numbers that were no longer valid). They will continue sending postcards monthly and keep us abreast of their progress. 3. Verification Checklists We reviewed data on applications denied because the customer did not provide required information. The statewide average is 517 per month (27.3% of all applications) which is high considering Med-QUEST has simple applications and accepts self-declaration for income, assets, birth dates, citizenship, and social security numbers. We developed our August 2004 PDSA (Plan, Do, Study, Act) on verification checklists that Alan will write. Monday, 30 August 2004 Process Improvement Collaborative Present: Stephany Vaioleti, Barbara Luksch, and Alan Takahashi Next meeting: 27 September 2004 at 11:45 AM 1. Verification Checklists Alan brought samples of three checklists that Med-QUEST eligibility workers will field test: * Only Children and/or Pregnant Women Are Applying * Non-Pregnant Adults and Children Are Applying * Only Non-Pregnant Adults Are Applying Copies can be downloaded by clicking on the PDSA for 5 August 2004 at: Process Improvement Collaborative. One eligibility worker in each application unit at the Honolulu office will use them. 2. Voicemail Messages We reviewed sample voicemail messages that Sue Uyehara shared with us at the last meeting and wrote two scripts--in the office but unable to answer and out of the office--for Med-QUEST Eligibility Branch employees. We also wrote our activity in the required PDSA (Plan, Do, Study, Act) method. Alan will discuss implementing this customer service technique with his staff. 3. Eligibility Calculator The Hawaii State Department of Human Services (DHS) is interested in developing a computer software program to determine preliminary eligibility for QUEST and Medicaid. It will be web-based and basic household information will be entered to decide if the applicants are eligible for any of Med-QUEST’s thirty-six programs. Users could include eligibility workers, outstationed eligibility workers, and outreach workers. Meetings were held with DHS Office of Information Technology, Med-QUEST Training Office, Med-QUEST Eligibility Branch, and DevTurtle LLC. 4. Forwarded Mail Med-QUEST is coordinating their policy to use new addresses supplied by the United States Post Office with Benefits, Employment, and Support Services Division (BESSD). However, if BESSD’s policy is more restrictive than we want, Med-QUEST will develop its own policy. 5. Change Report Form for Outstationed Eligibility Workers (OEWs) We reviewed form 1179 that health plans use to report household changes to Med-QUEST and tweaked it for field-testing by OEWSs. Our goal is to keep eligible people enrolled in QUEST and Medicaid and decrease the number of cases closed because addresses and telephone numbers in Med-QUEST’s records are invalid. Wednesday, 15 September 2004 Oahu Outstationed Eligibility Workers Next meeting: TBA Present: Regina Quimpo, Shawnna Lani, Victoria Napuelua, Pat Kaheaku, Linda Paragoso, Alex Yim, Lani Figueroa, Ululani Aiana, Susan Clemente, Sheryl Atanes, Princess Gomez, Ronnie Taamu, Brian Higgins, Airleen Lucero, Barbara Luksch, Hii Campbell, Cassandra Stewart, Michelle Malufau, Christine Wong, and Alan Takahsahi. 1. Who Should Attend It was explained this meeting is for those trained to complete form 1100A and other Med-QUEST (MQD) forms attached to the application before it is sent to the Honolulu Med-QUEST office. 2. Announcements a. Hawaii Administrative Rules We continued to request the rules be revised to reflect MQD’s streamlining procedures that have been in effect since June 2000. The Policy and Program Development Office (PPDO) agrees, however there are currently other priorities. b. Form 1123 A revised version to designate an organization as well as an individual is at the attorney general’s office for approval. c. Large Volume of Applications They can be ordered through MQD's Kapolei office. Please call or email Alan Matsunami at 692-8074 or amatsunami@medicaid.dhs.state.hi.us. d. Updated MQD Eligibility Branch Contact Information for Oahu Barbara distributed an updated list with supervisor’s names and areas of responsibility. Angie Tam Sing retired in June and Alan Takahashi is temporarily assigned as the Eligibility Branch administrator. Victoria Napuelua is temporarily assigned as the Oahu Section administrator. e. CMS and DHS Forwarded Mail Policies The Centers for Medicare and Medicaid Services (CMS) allows states to use forwarding addresses provided by the United States Postal Service, therefore the Hawaii State Department of Human Services (DHS) will amend its policy for MQD. MQD will try to coordinate with BESSD to help customers participating in both programs, however if BESSD’s policy is more restrictive then MQD will create its own. f. Problems with BESSD Cases If an outstationed eligibility worker has problems with a BESSD case, she/he should contact Pat Murakami, BESSD administrator at 586-5230 or pmurakami@dhs.hawaii.gov. Provide as much detail as possible about the case and assigned BESSD unit. 3. Pregnant Women Applications The outstationed eligibility workers (OEWs) praised MQD for processing pregnant women applications within three to five business days. Furthermore, they explained that MQD’s current system, Expedited Processing for Pregnant Women Applications, is better than presumptive eligibility and could serve as a model for other states. The OEWs track all their organizations’ applications and are surprised by inaccurate information that is sometimes provided by other health center personnel. We discussed the Hawaii Primary Care Association survey. It was noted that three items delayed applications: household income, pregnant woman offered employer-sponsored health insurance, and citizenship status. These were appropriately questioned and in each case OEWs worked with MQD to clarify them. MQD has assigned two eligibility workers--one per application unit--to process pregnant women applications. OEWs should call the designee regarding questions about pregnant women applications. If the eligibility worker’s voicemail states she/he is out for the day, the supervisor should be contacted. 4. New Renewal Processes Michelle explained their field test of postcard reminders. Others who are interested should let Barbara know and she will email Word document versions. We discussed following-up the postcards with a notice to Med-QUEST--similar to the Health Plan Change Form (1179). It was agreed changes will be typed on the form and it will be field tested by Waikiki Health Center, Hawaii Covering Kids Kahuku Local Project, Kalihi-Palama Health Center, Waimanalo Health Center, and Waianae Coast Comprehensive Health Center. 5. Application Denial Reasons and Verification Checklists Barbara distributed a data chart the Process Improvement Collaborative used to track reasons for application denials. Until recently, approximately 500 applications were denied monthly because the customer did not provide information. Alan explained three verification checklists the eligibility workers at Honolulu’s MQD office will field test beginning 20 September 2004: “Non-Pregnant Adults and Children Are Applying,” Only Non-Pregnant Are Applying,” and “Only Children and/or Pregnant Women Are Applying.” It was noted that OEWs could also use the checklists. Alan is tracking the number of pending notices sent before, during, and after the field test. Results will be discussed at the next meeting. 6. Properly Completing Form 1100A Cassandra reviewed a properly completed 1100A. She explained that information should match what is on 1100/1108 for faster processing. If there are questions, OEWs should call her. 7. Questions and Answers from Community Training Workshops Barbara distributed a draft handout with questions posed by workshop participants during the past eleven months. Answers were written by MQD. She requested feedback on additional common questions before it is in final print. 8. Clarifications * If an application is not processed within 45 days, the household members requesting health insurance will be covered if Med-QUEST caused the delay. Coverage continues until the application is approved or denied. * Health plan information should be sent to the Customer Service Branch. * A customer should contact her/his eligibility worker if a renewal form is lost. If the closure date has passed, the customer must complete a new application. * Newborns (Medical-Only Cases): A newborn whose mother is a QUEST or Medicaid recipient at the time of birth does not need an application. OEWs can call the mother's eligibility worker to add the baby or fax a copy of the souvenir or official birth certificate with the mother's social security number and birth date or Medicaid identification number. The child will be eligible from date of birth. * If an eligibility worker is on vacation, her/his voicemail will give a number to call. If it is the Kapolei Unit, telephone calls are automatically forwarded to another person who can help. * If an application is in receiving status, call the reception line to check on it. * If a customer changes his/her name, a document such as marriage certificate or divorce decree is required. They are also encouraged to notify the Social Security Administration to avoid conflicting database information. 9. Request from MQD MQD no longer requires interviews therefore their eligibility workers don’t have an opportunity to educate applicants prior to enrollment. Chris asked the OEWs to please explain to customers about health cards, how to use the cards, and how to communicate with health care providers. This will help prevent medical bills from piling up unnecessarily. Monday, 27 September 2004 Process Improvement Collaborative Present: Stephany Vaioleti, Barbara Luksch, and Alan Takahashi Next meeting: 28 October 2004 at 11:45 AM 1. Verification Checklists Alan explained field test results. The two Med-QUEST eligibility workers only sent ten pending notices during the three-week test. This was a 50% decrease from the previous month. The applications were processed faster and customers who were approved could access necessary health care. We were surprised at the dramatic results and plan to implement the checklists throughout the Oahu units and then statewide. 2. Learning Session 3 The next national collaborative meeting will be in San Diego from 10-12 November 2004. We plan to attend workshops on self-declaration of income, effects of language barriers on renewals, using prepopulated forms, pros and cons of passive renewals, and ways to correct and/or prevent incorrect addresses. 3. Continuation of Hawaii’s Process Improvement Collaborative Our team agreed to continue meeting when the one-year national initiative ends in November. We will also collect and analyze monthly data and use small scale testing to improve Med-QUEST’s processes. 4. Adding a Newborn Alan clarified the updated policy for adding a newborn: A newborn whose mother is a QUEST or Medicaid recipient at the time of birth does not need an application. The facility or customer can call the mother's eligibility worker to add the baby or fax a copy of the souvenir birth certificate with the mother's social security number and birth date or Medicaid ID number. The newborn will be covered either by Medicaid until enrolled in a health plan or enrolled in the mother's health plan effective the date of birth regardless of when it is reported. An application is required for the baby if the newborn's mother is not a QUEST or Medicaid recipient at the time of birth. The eligibility date will be the date Med-QUEST receives the application minus five calendar days if necessary (“five days retroactive”). Note: If the mother is receiving financial assistance or food stamps, BESSD requires verification of birth and an application for the baby.