Monday, 25 August 2008-Thursday, 18 September 2008 Outstationed Eligibility Workers Seven meetings were held with community health center outstationed eligibility workers, hospital outstationed eligibility workers, and Med-QUEST Eligibility Branch supervisors. Present Hilo (08/25/08): Gail Inoue (Med-QUEST), Fay Jack (Bay Clinic), Jeanine Kaninau (Keeau Family Health Center), Barbara Luksch (Hawaii Covering Kids), Camille Mehau (Pahoa Family Health Center), and Susan Taira (Hilo Medical Center). Kauai (09/03/08): Barbara Luksch (Hawaii Covering Kids), Raelyn Shepherd (Kauai Veterans Memorial Hospital and Samuel Mahelona Memorial Hospital), June Munoz (Kauai Community Health Center), Iris Venzon (Med-QUEST), and Charlene Yamamoto (Kauai Community Health Center). Kona (08/26/08): Florence Ashihara (Med-QUEST), Erika Blake (Kona Community Hospital), Norma Crouch (West Hawaii Community Health Center), Barbara Luksch (Hawaii Covering Kids), and Emily Takaya (North Hawaii Community Hospital). Lanai (09/11/08): Alton Aoki (Med-QUEST), Wilma Koep (Lanai Community Health Center), and Barbara Luksch (Hawaii Covering Kids). Maui (09/08/08): Natasha Andaya (Community Clinic of Maui), Leilani Carlson (Maui Memorial Medical Center), Barbara Luksch (Hawaii Covering Kids), Cristina Muñoz-Barrantes (Community Clinic of Maui), Gail Omura (Med-QUEST), Penny Schneider (Community Clinic of Maui), Cassandra Stewart (Outreach Services), and Helen "Gigi” Tavares (Maui Memorial Medical Center). Molokai (09/18/08): Cedric Alonzo (Molokai Community Health Center), Debora Eala (Molokai Community Health Center), Linda Lidstone (Med-QUEST), Barbara Luksch (Hawaii Covering Kids), and Rietta Toffelsen (Molokai Community Health Center). Oahu (09/05/08): Chez Black (Kalihi-Palama Health Center), Garance Gorman (Waikiki Health Center), Kevin Higa (Med-QUEST), Norma Kaunamano (Waimanalo Health Center), Cougar Lind (Med-QUEST), Barbara Luksch (Hawaii Covering Kids), Michelle Malufau (Koolau Loa Community Health Center), Kookie Moon-Ng (Med-QUEST), Jasmin Nepomuceno (Kokua Kalihi Valley), Regina Quimpo (Waimanalo Health Center), Teri Roe (Waianae Coast Comprehensive Health Center), Cassandra Stewart (Outreach Services). 1. Welcome and Introductions Barbara thanked everyone for attending the meetings and explained the purpose was an informal discussion about current Med-QUEST eligibility topics. 2. Handouts a. Hawaii Covering Kids Outreach Flyer and Order Form b. QUEST and Keiki Care Comparison Chart c. Applications Registered Data by Med-QUEST Office Location d. Med-QUEST PPD 08-006 “Application Not Signed by the Applicant” e. Sample HAWI System Approval, Denial, and Pending Notices f. Hospital Outstationed Eligibility Workers List g. PERM Implementation Recommendations 3. Enrolling Uninsured Children in Health Insurance Programs Keiki Care began April 1 and our goal is for all communities to enroll 100% of their children in health insurance. It was explained Keiki Care begins the first of the month after the application is approved which means we must enroll eligible children and youths before they require emergency health services to assure coverage for these expenses. 4. Hospital Patient Financial Services and Community Health Center OEWs Barbara reviewed the updated handout and the groups discussed coordinating activities to better serve mutual customers. 5. Approval, Denial, and Pending Notices It is very difficult for customers to understand information on these HAWI-generated forms, therefore the Hawaii Covering Kids Application Simplification Workgroup will revise the letters and field test through outstationed eligibility workers. 6. PERM 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 Hawaii Covering Kids Process Simplification Task Force’s goal has been to develop internal Med-QUEST procedures that eliminate application and renewal error rates without forcing customers to go on scavenger hunts. Barbara reviewed the Process Simplification Task Force’s filter diagram and recommendations for Med-QUEST applications and renewals. The PERM Team is meeting later in September and Barbara will email all outstationed eligibility workers a revised version. Asset verification will be required for those who are not exempt. If an applicant has a pay stub available, it was recommended OEWs attach copies to expedite Med-QUEST’s process. 7. Form 1100N: Invalid or Incomplete Application If an application does not have a name, mailing address, and signature it is not a legal application and is not registered at the Med-QUEST office. The application is returned with Form 1100N attached. We reviewed PPD 08-006 and discussed acceptable documents if someone cannot submit an application on her or his own behalf. We noted some language on Form 1100N is difficult for customers to understand and the Application Simplification Workgroup should revise it. 8. Oahu Operations That Work Well and What Needs Improvement a. Operations Working Efficiently: Leave a message Med-QUEST eligibility workers call back within 24-hours, complete 1123 and send with application to get customer information, call supervisor if eligibility workers does not call back within 24-hours and supervisors respond by email within 48-hours, eligibility workers who view OEWs as community partners to help their customers, Med-QUEST application is simple to complete, Med-QUEST customer service hotline helps with application information in detail including closure notice date, some eligibility workers prefer email messages, asking for extension by email or in writing when the customer cannot get some documents in time, and when faxing do not use a cover sheet and put 1100A on top (before 1100 or 1108). b. Operations Needing Improvement: Barbara will meet with Vickie Napuelua, Oahu Section Administrator, and Alan Takahashi, Med-QUEST Eligibility Branch Administrator, to review and request the problems be resolved as soon as possible. 9. Honolulu Office Process Improvement Pilot Project Kookie explained Outreach Services was awarded the contract and it will begin. The following will occur for Alpha S-Z (Unit 117) and Queen’s Hospital applications using the contracted staff: a. Applications that come by mail or fax will be pulled, registered, and placed in case folders. b. Next Day: Cases assigned to Med-QUEST eligibility workers. c. Pending notices will be sent to the contracted agency for follow-up with customer. Agency will offer customer assistance to obtain information and/or verifications. d. Eligibility determination will be completed within 30 days. As the pilot project progresses, changes may be made to optimize application processing operations. The OEWs requested if the pilot project shows success within the first month that implementation be spread to other units. 10. Other Da Kine a. Malama i na Keiki 10 for outreach workers, outstationed eligibility workers, and Med-QUEST frontline staff is 13 March 2009. b. Several eligibility questions arose during our conversations. Barbara researched them with Med-QUEST’s Policy and Program Development Office and updated the question and answer Guide. It was emailed to OEWs and Med-QUEST supervisors and posted on the Hawaii Covering Kids web site: Workshop Questions and Answers. c. The Process Simplification Task Force tweaked 8000J based on federal regulations and a revised version was emailed to OEWs.