News for Newborns! TennCare Newborn Presumptive Eligibility (NPE) - - PowerPoint PPT Presentation

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News for Newborns! TennCare Newborn Presumptive Eligibility (NPE) Presentation to the Tennessee Hospital Association August 8, 2014 FFM Challenges Federally-facilitated marketplace (FFM) having difficulties with eligibility. Particularly

SLIDE 1

News for Newborns!

TennCare Newborn Presumptive Eligibility (NPE)

Presentation to the Tennessee Hospital Association August 8, 2014

SLIDE 2

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.

SLIDE 3

New Options for Providers

 Newborn Presumptive Eligibility (NPE):

NPE for uninsured newborns; and
Streamlined birth reporting for CoverKids.

 New option for emergency TennCare.

SLIDE 4

NPE Process

 Uninsured applicant completes one-page

NPE form for newborn at qualified entity

(QE).

 Applicant must sign and date NPE form.  QE employee:

determines NPE on basis of info on form; and
shall then sign and date NPE form.

SLIDE 5

When is NPE Period Effective?

Coverage effective on Date of APPLICATION, not simply DOB.

(Oh my.)

SLIDE 6

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).

SLIDE 7

Helping with 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.

SLIDE 8

Determining NPE

 QE employees (not contractors) compare:

self-attested household income on NPE form to
TennCare limit for that household size.

 Income table is on form instructions (on

back of NPE form).

SLIDE 9

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.

SLIDE 10

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.

SLIDE 11

NPE Submission 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.

SLIDE 12

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.

SLIDE 13

Emergency TennCare Alternative

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

women.

 Woman must apply by date of delivery

to cover delivery.

 Expedited application process for

hospitals/birthing centers.

SLIDE 14

Next Steps

 Legal Agreements  Technology  Training

SLIDE 15

Legal Agreements with QEs

 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).

SLIDE 16

Legal Agreements (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.

SLIDE 17

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.

SLIDE 18

Training Front-Line Staff

 Webinar next Wednesday (Aug. 13th) at

9:30 am CT.

 Step-by-step guide to determine the right

course of action for each patient.

 Visit www.tenncaretopics.com for FAQs,

taped webinar and more information.

SLIDE 19