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. 2

New Options for Providers  Newborn Presumptive Eligibility (NPE) : ◦ NPE for eligible newborns; and ◦ Streamlined birth reporting for CoverKids.  New option for emergency TennCare. 3

4 New born Presum ptive Eligibility ( NPE)

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 18 th . 5

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. 6

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. 7

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. 8

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. 9

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. 10

W hen is NPE Period Effective? Coverage effective on Date of APPLI CATI ON, not simply DOB. (Oh my.) 11

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. 12

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) . 13

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 other programs at healthcare.gov. 14

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. 15

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. 16

17 Birth Reporting in CoverKids

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. 18

19 Alternative to Em ergency TennCare

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. 20

21 Making I t Happen!

Next Steps for QEs  Legal Agreements  Technology  Training 22

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) . 23

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. 24

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. 25

QE Front-Line Staff Training Visit www.tenncaretopics.com for :  Step-by-step guide  Continually-updated FAQs  Taped webinars  NPE form & Daily Newborn Spreadsheet 26

27 Stum p the Chum p!