Friday, 7 December 2007 Application Simplification and Renewal Simplification Workgroups Present: Andreas Cravalho (HMSA), Edy Green (Med-QUEST Eligibility Branch), Barbara Luksch (Hawaii Covering Kids), Rochelle Sparko (Legal Aid Society of Hawaii), John Swindle (Kaiser), Julie Thomas (AlohaCare), Pearl Tsuji (Med-QUEST Policy and Program Development Office), Christine Wong (Med-QUEST Policy and Program Development Office), Sunny Yee (Med-QUEST Eligibility Branch), and Jeffrey Young (Med-QUEST Eligibility Branch). Next Meeting: Workgroup members familiar with Centers for Medicaid and Medicare Services Code of Federal Regulations (CFR) and Hawaii Administrative Rules (HAR) will meet on 27 December 2007 at 2:00 PM. 1. Welcome and Introductions We welcomed new members to the meeting. Several issues affect Med-QUEST’s application and renewal processes, therefore a joint meeting for both workgroups was scheduled. 2. History Revisited Barbara reviewed process simplification activities from June 1999 to the present (see attached). 3. Updates It was noted during 2007 the state installed new computers in all Med-QUEST Eligibility Branch offices and allocated ten new eligibility worker positions as follows: Honolulu (3), Kapolei (4), Kauai (1), Maui (1), West Hawaii (1). Furthermore, Aloha United Way 211, statewide community-based document sites, QUEST plans, Med-QUEST Customer Service Branch, and Med-QUEST Policy and Program Development Office staff handled a large volume of calls and paperwork to alleviate eligibility branch’s workload. 4. PERM Information The Centers for Medicare & Medicaid Services (CMS) began a new Payment Error Rate Measurement (PERM) program. Contractors perform statistical calculations, medical records collection, and medical/data processing review of selected State Medicaid and CHIP claims. Hawaii will be audited in 2008. The goal of our two workgroups is to develop internal Med-QUEST procedures for consistent ex parte reviews to eliminate application and renewal error rates without forcing customers to go on scavenger hunts. 5. Ex Parte Reviews Ex parte means without customer contact. Reports currently available to Med-QUEST and the frequency: a. Benefit, Employment, and Support Services Division (BESSD): Financial Assistance and Food Stamp Program—1 month old. b. Social Security Administration Benefits: SSA (Beneficiary Data Exchange System/BENDEX) and SSI (State Data Exchange System/SDX)—1 month old. c. Beneficiary Earnings Exchange Record (BEER): self-employment earnings. d. Internal Revenue Service (IRS): unearned income—1 to 2 years old. e. State Wage Information and Collection Agency (SWICA): identifies employer and wages paid to Department of Labor (DOL)—online information up-to-date and hard copies issued every 3 months. f. Child Support (Keiki System): Med-QUEST has limited access— <1 month old. g. Unemployment Insurance Benefit (UIB)—1 month old. When applications are registered, the social security number triggers SDX and BENDEX. It was also explained one clerk per Med-QUEST office can logon to SWICA, DOL, and UIB information because there are a limited number of keys allowed by DOL. We discussed Income and Eligibility Verification System (IEVS) used by eligibility workers to determine each applicant’s eligibility. Eligibility workers are required to check and match IEVS with application information for accurate eligibility determination. 6. Preserving Application Self-Declaration and Children’s Passive Renewals More time is required to review CMS CFR and PERM program guidelines. Barbara will meet with Rochelle and Med-QUEST representatives in a few weeks to outline a draft of details for the workgroups. 7. Application Simplification a. Outstationed eligibility workers and Med-QUEST supervisors gave feedback on improving form 1149 (Request for Application Emergency Processing) and a draft revision was distributed. We discussed edits and Barbara will email a second draft to workgroup members for additional changes. b. The following Hawai‘i Administrative Rules still must be fixed: 17-1711-12 (9) Birth date is self-declared 17-1711-13 (a) Interview not required 17-1714-5 Birth date is self-declared Chris will check if these rule revisions will be included with other Med-QUEST rule changes. c. Med-QUEST’s eligibility and enrollment web page should have citizenship, alien status, and photo identification documents. Submitting these documents is a one-time requirement, therefore the web page must show those who completed the task so they are not required to do it again. Chris will follow-up with Randy Chau. d. A major barrier to enrolling in the QUEST-ACE program is retirement funds, especially people who lose jobs and are often ineligible due to this asset. Retirement funds are different from other assets because of the accumulation methods and financial penalties for cashing out, so it should be exempt. Thursday, 13 December 2007 Conference Planning Committee Present: Ruth Ota, Mary Rydell, Alan Takahashi, and Barbara Luksch 1. Malama i na Keiki 9 Goal: By working together, we will find, enroll, and retain all eligible children and youth in health insurance. We reviewed the Malama i na Keiki 8 evaluation report, including suggestions for the next conference. It was agreed presenters will focus on cross-cultural understanding. We chose Friday, 4 April 2008 at the Best Western Plaza near the Honolulu airport and the theme will be “Everyday People.” 2. Ideas for Guest Speakers We brainstormed these ideas: * Welcome: Legislators * Guest Speaker: Pacific Islands Expert * Med-QUEST Supervisors: Training Workshops * Kim Gennaula and Guy Hagi: Teamwork in a Cross-Cultural Environment Barbara will contact the speakers to organize our agenda. Sanuk activities will be interspersed throughout the day and Barbara has fun music ready. 3. Participants The limit is 100 and will include conference planning committee members and four Oahu Med-QUEST supervisors to conduct training workshops. All other participants must be agency staff whose full-time responsibility is directly interacting with families, such as outreach workers, outstationed eligibility workers, public health nurses, DOE counselors and school health aides. We will also invite two Med-QUEST eligibility workers per unit. 4. Travel Barbara will book travel for Med-QUEST’s Neighbor Island eligibility workers through a DHS grant. Travel scholarships will be offered to others who stay the entire day. Participants from Kau and Hana can be reimbursed for hotel accommodation on 3 April 2008. Participants will be reminded to book early. Thursday, 27 December 2007 Process Simplification (PERM Team) Present: Barbara Luksch (Hawaii Covering Kids), Rochelle Sparko (Legal Aid Society of Hawaii), Alan Takahashi (Med-QUEST Eligibility Branch), Pearl Tsuji (Med-QUEST Policy and Program Development Office), and Christine Wong (Med-QUEST Policy and Program Development Office). Next Meeting: 11 January 2007 at 1:30 PM The Centers for Medicare & Medicaid Services (CMS) began a new Payment Error Rate Measurement (PERM) program. Contractors perform statistical calculations, medical records collection, and medical/data processing review of selected State Medicaid and CHIP claims. Hawaii will be audited in 2008. The goal of our two workgroups is to develop internal Med-QUEST procedures for consistent ex parte reviews to eliminate application and renewal error rates without forcing customers to go on scavenger hunts. 1. Renewals We discussed how to continue passive renewals for children. This procedure was never intended for adults, however during implementation the Renewal Simplification Workgroup was told adults receiving health insurance benefits could not be separated from their recipient children. We will continue researching Hawaii’s options. 2. Applications Med-QUEST Policy and Program Development Office suggested applicants submit copies of electric bills or other proof of residency documents. However, the task force doesn’t want people to go on scavenger hunts, therefore it was decided mailing a letter to applicants without it being returned would prove the person lived in Hawaii. It was noted we are an island state, therefore residency is not a problem like other states that share borders. We drafted a filter diagram for applicants that are not subject to PERM regulations because they are eligible for other government programs.