CSHCS - Customer Support Section (CSS) Update ….where it all begins….

 Newly eligible Clients who have full Medicaid are not required to complete an Application for enrollment  Enrollment begin date for new clients who are MHP members may be retroactive a maximum of 6 months from the month the approved medical was received  Coverage begins on first day of the month  Coverage ends on the last day of the month, except when client ages out PROCEDURAL CHANGES SINCE OCTOBER 2012 April 20132

 Backdating initial coverage  Payment Agreements  Adding Providers REMINDERS April 20133

 GM Section 10.4  Coverage may be retroactive up to six months (from the month the Application is received) if, during that time:  All CSHCS medical and non-medical eligibility requirements were met; and  Medical services related to the qualifying diagnosis(es) were rendered; and  There is no other responsible payer (e.g. Medicaid, private insurance, etc.). BACKDATING INITIAL COVERAGE April 20134

 Retro coverage does not guarantee that providers of services already rendered will accept CSHCS payment  CSHCS does not reimburse families directly for payments made to providers  Questions to ask:  Are providers willing to bill CSHCS ?  If family paid out of pocket, are providers willing to reimburse family (e.g. pharmacy copays)? BACKDATING INITIAL COVERAGE April 20135

 CSHCS coverage may be made retroactive up to 90 days for the purpose of covering travel assistance  Requests for travel assistance reimbursement must be submitted to MDCH within 90 days after the date of the travel as indicated on the MSA-0636 form  Retroactive coverage does not extend the 90 day time period for submitting reimbursement requests  Requests received by MDCH more than 90 days after the date of the travel will be denied, regardless of retroactive coverage. BACKDATING INITIAL COVERAGE for Travel Assistance April 20136

 MYTH BUSTERS!  CSHCS will always backdate initial coverage up to one year as long as the family sends a letter addressed to Rebecca Start (not true)  If private insurance says it will cover services but then denies, CSHCS will backdate up to one year from month the Application is received (myth)  The three Children’s Hospitals always refer potentially eligible families to CSHCS (local PR activities are critical) BACKDATING INITIAL COVERAGE April 20137

 When the information required for renewal is submitted within ONE YEAR of the date coverage ended and the client remains eligible for CSHCS,  Renewal coverage may be backdated a maximum of TWO months from the month renewal information was received (if needed) BACKDATING RENEWAL COVERAGE April 20138

 GM Section 9  Fee to join CSHCS  Due upon receipt of payment agreement notification (i.e. coupon letter)  As a convenience, families may pay in 12 installments  Payment Agreement revenue is used exclusively for CYSHCN (not put in State general fund) PAYMENT AGREEMENT April 20139

 Use the Financial Worksheet (MSA-0742) to project income for the IRPA if there has been a dramatic change in income since last Federal 1040  Use the Payment Agreement Amendment form (MSA- 0927) when there is a change in family size, income, etc. during the contract period  Amendment applies to current payment agreement only PAYMENT AGREEMENT April

 MYTH BUSTERS!  If we don’t use CSHCS coverage, the payment agreement will be cancelled (untrue)  If we don’t pay for the first month, coverage will automatically terminate and the payment agreement will be cancelled (wrong)  I have time to decide if we should enroll since CSHCS will backdate up to a year from the month they receive my signed IRPA (incorrect) PAYMENT AGREEMENT April

 Why do we authorize providers on the Client Eligibility Notice (CEN)? 1.Identify the client’s ‘system of care’ (sub-specialists)  Applies to all CSHCS clients  Assure client has access to appropriate care 2.Claims processing (CHAMPS)  Does not apply to clients with full Medicaid except for CSHCS-only services paid through the CHAMPS system (e.g. orthodontia) ADDING PROVIDERS April

 Currently CSS is not adding providers to the Client Eligibility Notice (CEN) unless services were provided during the time client was not a MHP member  CONCERNS: If the provider is authorized on the CEN:  Client/family may assume the MHP will cover care even if MHP guidelines are not followed  Providers may assume they can provide services without coordinating with the MHP ADDING PROVIDERS FOR MHP MEMBERS April

 The Dilemma:  Identify client’s ‘system of care’ (sub-specialists)  CHAMPS ready for claims processing should client lose Medicaid coverage  MHPs do not ‘authorize’ providers  Is provider in the MHP network?  Do services require prior authorization?  Is the provider willing/able to work with the MHP?  Member Handbook – MHP Website – MHP Member Services ADDING PROVIDERS FOR MHP MEMBERS April

QUESTIONS ? April

CHAMPS CLIENT VIEW April

CHAMPS CLIENT VIEW April

CHAMPS CLIENT VIEW April

CHAMPS CLIENT VIEW April

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CHAMPS CLIENT VIEW April Client Name

QUESTIONS ? April

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CHAMPS CLIENT VIEW April

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