Delaware PERM Pilot Round 1 Jennifer Harris Social Service Administrator Quality Control Phone: (302)

DHSS Organizational Background Division of Medicaid and Medical Assistance (DMMA) Long Term Care Medicaid SSI Medicaid Division of Medicaid and Medical Assistance (DMMA) Long Term Care Medicaid SSI Medicaid Division of Social Services (DSS) All other MA types (Including MAGI) Food Benefits TANF Child Care Division of Social Services (DSS) All other MA types (Including MAGI) Food Benefits TANF Child Care Division of Management Services- Bureau of Quality Control Reviews Medicaid, Food Benefits and Child Care Division of Management Services- Bureau of Quality Control Reviews Medicaid, Food Benefits and Child Care 2

Delaware Quality Control-Background Staff complete both Food Benefit and Medicaid Reviews Small staff 8 full time review staff 2 casual-seasonal staff (limited hours) 1 supervisor/1 administrator 1 temporary employee (Child care reviews only) 3

Delaware Pilot #1 Approach Sampled 170 Medicaid; 30 CHIP Sampled at individual level Sampled twice – 12/2013 – 2/2014 Simplified approach to reviews given CMS flexibility in pilot guidance 4

Delaware Approach Reviewed various timing options for sampling Reviewed number of staff vs number of cases to be completed Prior contractor use Determined best option- hire contractor to complete 100 of the reviews Contractor completed the second sample (2/2014) 5

Splitting reviews between contractor and state staff Benefits: State staff maintain knowledge State staff given more time to complete reviews – Reviews were sampled from 12/2013(in 2/2014) – Reviews were staggered for completion- 2 reviews required weekly – Spread 100 over 3 months (state staff) 6

Delaware Approach Contractor benefits: Final reporting Determining root causes Development of the work documents such as building budget in Excel spreadsheet for MAGI Completion of reviews 100 reviews- State monitored sample of correct cases and reviewed all errors and administrative errors Decision making for the round 2 pilot Sample plan for round 2 7

Challenges…. Timeframe between CMS pilot guidance and sampling proposal deadline Delays in getting approval to get RFP posted New policy for QC staff New system for QC staff New type of review (guidelines, work papers, tracking) New eligibility system 8

Challenge Solutions Hired Contractor – Contactor completed 100 reviews – State Staff completed 100 reviews – Assist state due to small QC department- Assists with completion of reviews Assists with reporting requirements Assists with development of documents used in reviews 9

Challenge Solutions Continued…. State Staff Training – Training provided for new system- QC staff participated – No training provided by department on MAGI policy – Training Guide Developed 10

Results-Actives Active Medicaid- 4 errors – 2 cases- Income did not count – 1 case- Prior review not completed caused system issues – 1 case- Household size incorrect Active CHIP-0 errors 11

Results-Negatives Negative Medicaid- 7 errors – 1 case- Incorrect household size – 1 case- Documentation in case file not used – 1 case- Client not provided 30 days to respond – 1 case- Denied without using self-attested income – 1 case- Denied for no interview – 1 case- Income incorrectly budgeted – 1 case- Non-taxable income included in budget Negative CHIP- 0 Errors 12

Questions?? 13