Transition Apr-15 1 Agenda Background Why the transition - - PowerPoint PPT Presentation

EEMAP and Back Office Transition

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Apr-15

Agenda

• Background
• Why the transition
• Current Activities
• Transition Plan
• County/DH distributed activities
• Other Considerations
• Questions

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Background – EEMAP Contract

• The Department currently contracts with MAXIMUS

(EEMAP vendor) to provide CHP+ and Medicaid eligibility and enrollment services.

• The EEMAP contract also includes the operation of

a CHP+ customer service center.

• The contract’s effective date was July 20, 2010 and

is set to expire on June 30, 2015.

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Background – Back Office Contract

• Contracted employees hired, trained and housed by

HCPF since October 2013.

• Assist MAXIMUS with aging PEAK Inbox cases
• Process applications and conduct research for the

Department of Corrections

• Process mixed case and paper applications from

Connect for Health

• Provide over-the-phone application assistance to

clients

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Transition: Where and Why

• County Offices -
• Infrastructure
• Customer Service
• Demonstrated performance
• Unanimous County support
• Denver Health –
• Demonstrated performance and partnerships
• Governmental Agency
• Cost Savings
• Location
• Contract executed March 1, 2015

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Current EEMAP & Back Office Activities

• Back Office
• Phone application processing
• Department of Corrections Applications
• Scope of work for C4 mixed case processing
• EEMAP
• Fee and Premium Administration
• Fee Exception Report processing
• CHP+ Customer Call Center
• Manual Enrollment/Disenrollment Tasks
• CHP+ Appeals and Grievances
• PEAK Inbox Exceptions
• On-going Case Management

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Activities moving to Denver Health

Transition - Phase I

• Back Office Work
• Phone application processing
• Assistance to Department of Corrections
• Scope of work for C4 mixed case processing

(Pending Connect for Health Approval)

• Escalated case research and resolutions

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Activities moving to Denver Health

Transition - Phase II

• EEMAP Work:
• Fee and Premium Administration
• Fee Exception Report processing
• Process Payment Refund requests & NSF
• Accept and process walk-in payments
• CHP+ Customer Call Center
• Integrate with HCPF’s contact center
• Manage existing CHP+ client 1-800 number

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Activities moving to Denver Health

Transition - Phase II (continued)

• EEMAP Work:
• Manual Enrollment Tasks
• Process requests from Managed Care Organizations
• Track and report volumes
• Disenrollment Tasks
• Process disenrollment reports from Department
• Process disenrollments based on client notifications
• CHP+ Appeals and Grievances
• Voter Registration Assistance

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DH Growth Plan

• Hire additional Trainer and Quality Analyst
• Complete
• Hire 28-30 Enrollment Specialists
• Completing interviews, initial wave April 13th
• Hire 2-4 Clerical Support Specialists
• Completing interviews, initial wave April 13th
• Training begins April 14th
• Start taking phone calls and processing D.O.C (Department of

Corrections) applications NLT April 27th

• May 1st End of Phase 1
• Fully implemented June 30th

EEMAP Org Chart

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Estimated Timeline - Denver Health

• Phase I
• Estimated start date: April 27, 2015
• Phase II
• Estimated start date: May 22, 2015

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Activities moving to Counties

• EEMAP Work:
• Distribute Maximus’ caseload to client’s county of

record for on-going case maintenance/RRRs

• QA/QC
• Appeals
• Transfer Maximus’ PEAK Inbox case assignment

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Case Assignment

County of Residence MAXIMUS Med-Only Applications Through PEAK With real time eligibility determination (with no exceptions) Eligibility determination is automatic, so no intervention Ongoing case management X Without real time eligibility determination (with exceptions) authorization not successful Eligibility determination Exception at individual clearance X X Exception at case clearance X X Exception at application submittal (interfaces don't work, etc.) X X Ongoing case management X Combo cases through PEAK With real time eligibility determination (with no exceptions) Med determined automatic, Food and/or Cash will go to COR X Ongoing case management X Without real-time eligibility determination (with exceptions) Eligibility determination Exception at individual clearance X Exception at case clearance X Exception at application submittal (interfaces don't work, etc.) X Ongoing case management X MA only cases applying through COR mail, fax, or in-person X MA + Combo program case applying through COR mail, fax, or in-person X MA only cases applying through MAXIMUS mail, fax, or in-person X X

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Other Transition Considerations

• Communication Plan
• Notification to counties, clients and other stakeholders
• HCPF currently drafting communication
• Estimated release, early April
• Audits – QA/QC
• Counties are not be held liable for errors in transferred

cases

• January, 2007 Director Letter
• Appeals and Case Files
• HCPF currently developing a transition appeals process
• HCPF working with Maximus on case file transfer
• Agency Letter to be drafted ensuring counties are not held liable for

information or determinations made prior to case transfer

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Agency Letter

Total Appeals - Maximus

Total appeals by month Feb-15 Jan-15 Dec-14 Broken down as follows: Appeal docketed with OAC – Hearing Scheduled 12 10 20 Hearing occurred – Still Awaiting ALJ Ruling 4 2 Hearing occurred and received ALJ decision but waiting on FAD from Office of Appeals 27 26 24 Number of appeals completed FAD but need corrective action taken

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Estimated Timeline - Counties

• Based on CBMS Build Schedule:
• Estimated start date: May 22, 2015

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Questions or Concerns?

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Contact Information

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Mike Wagner County Liaison - HCPF michael.wagner@state.co.us Brad Membel, MBA, MHA, FACHE Director of Enrollment Services – Denver Health Bradford.Membel@dhha.org

Thank You!

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