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Our presentation today is short but full of what we hope is useful information for your practice. We will go over the basics of the Kentucky HEALTH program and what you need to know for 7/1. We will highlight some of the work our Community Engagement team is doing to educate our member community. And lastly, we will cover ways to make sure you are prepared for go-live on 7/1. Lets get started! 2
So, what is Kentucky HEALTH? Kentucky HEALTH, which stands for Helping to Engage and Achieve Long Term Health, is the Commonwealth’s new health and well -being program for non-disabled low-income adults on Medicaid. The program Seeks to break the cycle of poverty through efforts on several fronts: • Encourages members to improve their health by incentivizing preventive care, participation in disease management programs, and healthy lifestyles. • Embraces private market policies and principles to familiarize members with commercial health insurance coverage to prepare them for the commercial market. • Focuses on addressing Kentucky's growing drug abuse epidemic. • Focus on engaging members in the community, either through employment or preparing for employment, as well as volunteer activities. Kentucky HEALTH aims to achieve this by using key components: 1. Cost Sharing where members will have premiums or copayments. 2. My Rewards Account where members will have the opportunity to earn funds for completing certain activities and courses. 3. Deductible Account which will track members non-preventative services to show the true cost of healthcare. 3
4. Community Engagement/PATH program encourages members to become involved in their community and seek employment opportunities. 5. Education and Training provides courses members can take to clear penalties, to earn funds for their My Rewards Account and to meet their Community Engagement Requirements. 6. Premium Assistance which helps members gain access to a commercial primary insurance through their employer. 3
Approximately 88% of Passport’s current membership will be impacted by the KYH program. While pregnant women, children, medically frail and former foster care children are not cost share or community engagement required, they are still part of the KYH bucket as these populations could or will transition from these categories and into the ABP. 4
Passport’s KYH population received new insurance cards as of June 21 st . The new cards feature the KYH logo in the upper right-hand corner, making it easy to identify a KYH member upon presenting to your office. 5
Providers can also identify their KYH members by what we call the member line of business or, LOB. This is a 4-digit code that will indicate the Kentucky HEALTH plan the member is currently enrolled in. Please note the member LOB is specific to Passport Health Plan only and is visible in the provider portal when viewing member eligibility. This is not something you will see on any other MCO portal or within HealthNet. If the 1 st digit is a W this will indicate a Kentucky HEALTH member. The 2 nd digit will indicate the type of member such as child, Former Foster Care, Medically Frail, etc. The 3 rd digit will indicate if a member has retroactive coverage, notice the R. The 4 th digit will show the members cost share requirement. Notice the C will indicate they are copay required. This code will be present under the ‘member policy benefit name’ section of a members profile within the provider portal. The LOB key is also available on our website under the Kentucky HEALTH section of the provider tab. This could be a useful tool to have for you office staff – especially those that check eligibility and cost share requirements on a regular basis. 6
The image you see here is a snapshot from our provider portal. This will appear when a provider performs an eligibility search on a specific member. Once the member ID is entered and searched, click on the members name and their profile will appear. The members LOB along with the description will appear under Policy Benefit Name within the eligibility section. A quick tip for PCP’s: if you download the member panel roster from the portal, you will be able to filter the report for KYH members only or Medically Frail members only using the member LOB. This can help provide a quick snapshot of your Passport patients. 7
The Kentucky HEALTH program consists of 2 benefits packages: the Alternative Benefit Plan, often referred to as the ABP, and the State Plan. The Alternative Benefit Plan is designed to provide individuals with a commercial insurance experience with cost sharing and deductible accounts. This benefit plan is aligned with Fee-For-Service Medicaid. Members will receive dental and vision benefits through their My Rewards Account with the exception of 19 and 20 year olds as they will continue to receive EPSDT services therefore will still have access to dental and vision. Non-emergent medical transportation is also non-covered within the ABP. The Kentucky State Plan is consistent with current Medicaid benefits. Members will have cost sharing and deductibles. Members also have access to dental, vision via their MCO and non-emergent medical transportation via the State. 8
The listed populations are impacted by KYH. Traditional Medicaid Adults and Medicaid Expansion Adults will see the impact of KYH on 7/1 in the form of paying premiums and community engagement requirements however, pregnant women, children, medically frail adults and former foster care children will not be cost share or community engagement until they transition from those categories. It is important to note that the only population that may never transition from one of these categories is medically frail, depending on the members condition. Individuals who are part of Medicaid waivers such as home and community based waiver, michelle p waiver, etc. are not impacted by KYH. 9
Cost sharing introduces members to commercial plan features by way of premiums and copays. Kentucky HEALTH members will initially begin in the premium plan and have a monthly premium ranging from $1-$15. Invoices were mailed on June 21 st with a due date of 60 days from the date of the invoice. Members can make their premium payment in a variety of ways: Over the phone by calling the number on their invoice or our member services department, online via the website listed on the invoice, by mail or in person at our Louisville or Prestonsburg locations. Members who do not make timely premium payments will be subject to varied non- payment penalties. For those that are at or below 100% FPL they will transition to the copay plan and be required to pay copays for applicable services. For those that are above 100% FPL they will either be disenrolled if they never made their initial premium payment or they will be suspended if they were an ingoing paying member and stopped making their payments. It is important to note that members will never have both premiums and copays. It is one or the other. For a list of copay required services and their rates, please refer to the Kentucky HEALTH and Passport – Provider Quick Reference Guide located on in the Kentucky 10
HEALTH section of the provider tab on our website, passporthealthplan.com. Please note there have been a few minor changes to these copays: urgent care no longer has copays and Rural Health Clinics, Federally Qualified Health Centers and Primary Care Centers now have copays. We are in the process of updating the QRG, please keep checking our website for the latest and greatest version! Medically frail and former foster care children (up to age 26) are cost share optional meaning they have the ability to opt into the premium plan and obtain access to a My Rewards Account if they wish. Regardless of if these specified populations opt in or not, they will always have access to vision and dental via their MCO. The benefits to opting into this plan is to have a safety net in the event a member ever transitions from medically frail or after age 26 for former foster care. 10
Third parties with the exception of MCO’s can make a premium payment on behalf of the member. To do so simply log into the member payment portal and click one-time payment. Enter the myEasyMatch code found on the members invoice, as you can see on this slide it is in the lower left-hand corner of the invoice. Continue to follow the payment prompts. When the payment has been submitted a confirmation number will be generated and the payer will have the ability to print or save a copy of the receipt. Third party payment using the myEasyMatch code can also be made via phone by calling the number listed on the invoice. 11
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