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

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 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 uninsured newborns; and ◦ Streamlined birth reporting for CoverKids.  New option for emergency TennCare. 3

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. 4

When is NPE Period Effective? Coverage effective on Date of APPLICATION, not simply DOB. (Oh my.) 5

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) . 6

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. 7

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). 8

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. 9

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. 10

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. 11

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. 12

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. 13

Next Steps  Legal Agreements  Technology  Training 14

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) . 15

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. 16

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. 17

Training Front-Line Staff  Webinar next Wednesday (Aug. 13 th ) 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. 18

Stump the Chump! Ask questions now… …or email brian.haile@tn.gov. 19