New s for New borns! TennCare Newborn Presumptive Eligibility (NPE) - - PowerPoint PPT Presentation

New s for New borns!

TennCare Newborn Presumptive Eligibility (NPE)

Presentation to the Tennessee Hospital Association August 13, 2014

FFM Challenges

 Federally-facilitated marketplace (FFM)

having difficulties with eligibility.

 Particularly true for non-TennCare moms.  When presenting for delivery, these

women are often:

• Uninsured; or
• Enrolled in CoverKids.

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New Options for Providers

 Newborn Presumptive Eligibility (NPE):

• NPE for eligible newborns; and
• Streamlined birth reporting for CoverKids.

 New option for emergency TennCare.

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New born Presum ptive Eligibility ( NPE)

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W hat is NPE?

 Allows qualified entities to determine

eligibility for newborns if mother not in TennCare.

 Gives newborn NPE coverage while

parents complete full TennCare application.

 Effective August 18th.

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Distinguishing NPE

 NPE is not “deeming”

• Deeming is for mothers already in TennCare at

delivery.

• TennCare continues to deem.

 NPE is different than PE for pregnant

women.

• Local health departments continue to

determine PE for pregnant women.

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NPE Process

 If mother not in TennCare, applicant

completes one-page NPE form for newborn at qualified entity (QE).

 Applicant must sign and date NPE form.  Applicant does not need to submit any

verifications.

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NPE Process ( cont’d)

 QE employee determ ines NPE

• Compares income and HH size with TennCare

limits (on back of form); and

• Explains determination to applicant.

 QE employee shall then sign and date

NPE form.

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NPE Process ( cont’d)

QE employee shall also:

 If approving NPE, explain that applicant

must complete a full TennCare application by the end next month.

 Explain that the baby may lose eligibility if

the applicant does not apply by the end of next month.

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NPE Process ( cont’d)

QE employee shall also:

 If denying NPE, explain that the applicant

can also apply at www.healthcare.gov.

 Whether approved or denied, the

employee shall give the applicant a hard copy of the FFM application form.

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W hen is NPE Period Effective?

Coverage effective on Date of APPLI CATI ON, not simply DOB.

(Oh my.)

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Helping w ith NPE Form

 QE employees can assist with NPE form.  Common questions:

• What counts as income?
• Who counts toward household size?
• Is SSN for mother or newborn required?
• Which MCO to choose? (ahem !)

 Instructions (on back of NPE form), training

materials, and FAQs will help.

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Qualified Entities ( QEs)

 QEs limited to hospitals and birthing

centers only.

 QEs shall comply with responsibilities and

State requirements (more below).

 QEs must have legal agreements and

SFTP2 access with TennCare (more below).

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QE Responsibilities

QE shall ensure that:

 Employees are appropriately trained.  Applicants & employees complete NPE form.  Employees explain:

• If approved, applicant must apply at FFM by end of

next month (or lose eligibility); and

• If denied, applicant can apply for TennCare and
• ther programs at healthcare.gov.

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QE Responsibilities ( cont’d)

QE shall:

 Give applicant full application after

making determination.

 Promptly submit approvals to TennCare.  Maintain NPE form for seven (7) years.

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NPE Subm ission Process

 Fax NPE forms during August.  Transition to submission of Daily Newborn

Spreadsheet via SFTP2 by Labor Day.

 Newborn’s eligibility will appear in

TennCare Online Services within several days.

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Birth Reporting in CoverKids

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Birth Reporting for CoverKids

 Mothers in CoverKids (CK) report birth by

phone to CK.

 CoverKids enrolls newborn in CK or NPE-

TennCare.

 Effective date for NPE is date on which

birth reported.

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Alternative to Em ergency TennCare

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Em ergency TennCare Alternative

 Who gets emergency TennCare?  CoverKids as alternative for pregnant

women.

 Woman must apply by date of delivery

to cover delivery.

 Expedited application form for hospitals/

birthing centers at www.coverkids.com.

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Making I t Happen!

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Next Steps for QEs

 Legal Agreements  Technology  Training

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QE Legal Agreem ents

 TennCare must have a Trading Partner

Agreement (TPA) and a Business Associate Agreement (BAA) with each QE.

• We already have TPAs with many, so for these

we only need a BAA (Form 1).

• For others, we need a TPA (Form 2) and a new

BAA (Form 3).

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QE Legal Agreem ents ( cont’d)

 Distributing list noting which form

required for each hospital (along with

forms).

 Contact andrei.dumitrescu@tn.gov or call

615-507-6855 with questions.

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QE Technology Needs

 QEs will need SFTP2 server access to post

“Daily Newborn Spreadsheet”.

 Hospitals with TPAs already transmit data

to TennCare using similar approach.

 Distributing SFTP2 server access

instructions.

 Contact don.oaks@tn.gov or call 615-

507-6334 with questions.

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QE Front-Line Staff Training

Visit www.tenncaretopics.com for:

 Step-by-step guide  Continually-updated FAQs  Taped webinars  NPE form & Daily Newborn Spreadsheet

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Stum p the Chum p!

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