Friday, 11 January 2008 Process Simplification (PERM Team) Present: Aileen Befitel (Med-QUEST Administration), Paul Higa (Med-QUEST Policy and Program Development Office), Barbara Luksch (Hawaii Covering Kids), Kookie Moon-Ng (PERM Project Leader), 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: 31 January 2008 at 1:30 PM 1. DHS Policy Decisions Hawaii is distressed about the PERM initiative because it creates barriers for eligible people to receive health insurance benefits. However, Med-QUEST is driven by Code of Federal Regulations (CFR) and CMS guidance, therefore it must implement the procedures. Except for CHIP and state-only funded programs, PERM could affect application self-declaration and children’s passive renewals. However, it has been decided that we will continue our current renewal procedures, including passive renewals for children and hard copy documents for adult-only cases. It was noted that adults and children are drawn together as an economic unit and our workgroup must outline Med-QUEST’s procedures to assure there are no error rates. Random sample recipient households will be chosen to verify household composition. Furthermore, there will be an ancillary business contract to review 120 cases per month, crosscheck information with a PERM checklist, contact the recipient, make collateral contacts, and send a certified letter. 2. Renewals It was noted that CFR do not require a signature for renewals. The three renewal scenarios are: a. Adult-Only Cases: Must submit copies as instructed on 1100B-2. b. Child-Only Cases: Continue with passive renewals. c. Adults with Children Cases: Passive renewals were never intended for any adults, therefore we decided two options: * Continue with 1100B-1. If the form is not returned, close the adult from the case and continue the children’s health insurance. Our rationale is that everyone’s assets change, therefore the renewal form is expected to list changes and have a signature. This is our first choice, but we must wait for information from a Hawai‘i State Department of Human Services consultant. * Add a line similar to 1100B-2 explaining if there is an adult receiving health insurance, the form must be returned with copies of income and assets and a signature. 3. PERM Filter Machine We updated our diagram and added branches for residency, household composition, earned income, unearned income, and assets. Note: Earned income is derived from active participation in a trade or business, including wages, salary, tips, commissions, bonuses, and temporary disability insurance. Unearned income is any income from investments and other sources unrelated to employment services, including social security benefits, supplemental security income, retirement income, veteran’s benefits, worker’s compensation, unemployment insurance benefits, school grants and scholarships, child support, and alimony. 4. Application Ex Parte Reviews a. Residency: If an approval or denial letter is sent to the applicant and it is not returned, that verifies the applicant lives in Hawaii. Med-QUEST eligibility worker (EW) keeps the returned envelope in the case file as proof of whereabouts unknown. Citizenship documents with a Hawaii address, crosschecking the telephone book, and internet searches are also acceptable. b. Household Composition: Randomly call one recipient in sample households and speak with a household member listed on the application. Other options are checking case file for a picture identification with a household member’s address. c. Earned Income: EW will crosscheck with SWICA and BEER. If there is no match, EW will send a pending notice requesting for copies. d. Unearned Income: EW will crosscheck with BDX, SDX, IRS, UIB and Keiki System. Chris will research interfaces for veteran’s benefits and worker’s compensation. 5. Next Steps a.Everyone: Think of creative ways to use ex parte reviews for assets; talk to colleagues in other states. b. Alan: Complete matrix column for “What MQD Eligibility Workers Should Do.” c. Rochelle: Review matrix to determine accuracy. d. Chris: Update Hawaii Administrative Rules on matrix. Research unearned income interfaces for veteran’s benefits and worker’s compensation. e. Barbara: Add citizenship and photo identification CFR information to matrix, update filter diagram, and update recommendations. Thursday, 31 January 2008 Process Simplification (PERM Team) Present: Barbara Luksch (Hawaii Covering Kids), Rochelle Sparko (Legal Aid Society of Hawaii), Alan Takahashi (Med-QUEST Eligibility Branch), and Christine Wong (Med-QUEST Policy and Program Development Office). Next Meeting: 1 May 2008 at 1:00 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. Hawai‘i will be audited in 2008. Our team’s goal 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. Recommendations We reviewed and revised the final list of recommendations. 2. Filter Diagram We completed DRAFT 1 of our filter diagram for applicants.