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

EEMAP and Back Office Transition Apr-15 1

Agenda • Background • Why the transition • Current Activities • Transition Plan  County/DH distributed activities • Other Considerations • Questions 2

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. 3

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 4

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 5

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 6

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 7

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 8

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 9

DH Growth Plan  Hire additional Trainer and Quality Analyst  Complete  Hire 28-30 Enrollment Specialists  Completing interviews, initial wave April 13 th  Hire 2-4 Clerical Support Specialists  Completing interviews, initial wave April 13 th  Training begins April 14 th  Start taking phone calls and processing D.O.C (Department of Corrections) applications NLT April 27 th  May 1 st End of Phase 1  Fully implemented June 30th

EEMAP Org Chart 11

Estimated Timeline - Denver Health • Phase I  Estimated start date: April 27, 2015 • Phase II  Estimated start date: May 22, 2015 12

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 13

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 14

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 15

Agency Letter 16

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 0 Hearing occurred and received ALJ decision but 27 26 24 waiting on FAD from Office of Appeals Number of appeals completed FAD but need 0 0 0 corrective action taken 17

Estimated Timeline - Counties • Based on CBMS Build Schedule:  Estimated start date: May 22, 2015 18

Questions or Concerns? 19

Contact Information 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 20

Thank You! 21