1 Department of Medical Assistance Services Department of Medical Assistance Services – Eligibility and Enrollment Unit June Department of Medical Assistance Services MMIS WebEx Training

2 Department of Medical Assistance Services Agenda Health Insurance Premium Assistance (HIPP) Plan First Non-Resident Aliens (NRA’s) Contacting the FAMIS CPU MMIS Web-Help

3 Department of Medical Assistance Services HIPP & HIPP for Kids Are cost saving programs for Medicaid members Reimburses some or all of the employee portion of group health insurance premium for members who have employer sponsored group health insurance through their own or their family member’s employment

4 Department of Medical Assistance Services About HIPP The Commonwealth of Virginia has two Medicaid related premium assistance programs that are administered by the Department of Medical Assistance Services (DMAS): –HIPP –HIPP for Kids

5 Department of Medical Assistance Services HIPP for Kids HIPP For Kids is a premium assistance program for members under the age of 19 who are eligible for or enrolled in qualified employer-sponsored coverage. 5 Department of Medical Assistance Services

6 Department of Medical Assistance Services HIPP for Kids (cont.) When determined cost effective, the entire health insurance premium is reimbursed. Cost sharing may apply to non-covered copayments, deductibles, and other expenses not covered by the primary insurer. 6 Department of Medical Assistance Services

7 Department of Medical Assistance Services HIPP for Kids - Eligibility A household member must be eligible for Medicaid and be less than 19 years old Must have/be able to get insurance through employer Employer sponsored health insurance must meet program criteria 7 Department of Medical Assistance Services

8 Department of Medical Assistance Services HIPP HIPP-is a premium assistance program for members who are Medicaid eligible and are enrolled in qualified employer- sponsored coverage that may be available to people with Medicaid that helps pay part or all of their health insurance premiums 8 Department of Medical Assistance Services

9 Department of Medical Assistance Services HIPP Eligibility A household member must be enrolled in full-coverage Medicaid Must have/be able to get insurance through your employer Employer sponsored health insurance must meet program criteria, including cost effectiveness 9 Department of Medical Assistance Services

10 Department of Medical Assistance Services HIPP Unit Contact Applications and questions regarding HIPP or HIPP for Kids by the LDSS: –HIPP Inbox at: –Fax: Attention HIPP Unit (804) or, –Mail: Department of Medical Assistance Services HIPP Unit 600 E. Broad Street, 12 th Floor Richmond, VA Department of Medical Assistance Services

11 Department of Medical Assistance Services HIPP Unit Contact Tiaa Lewis HIPP/Buy-in Unit Supervisor Department of Medical Assistance Services

12 Department of Medical Assistance Services Plan First - Overview Limited Medicaid benefit –Covers regular family planning and screening services, including birth control, and –Pregnancy prevention services only

13 Department of Medical Assistance Services Plan First (cont.) As of April 1, 2013: 37,150 members enrolled in Plan First Approximately 17% are over child-bearing age (VDH reports years old) Material is available to share with individuals to help make informed choice about enrolling in Plan First or opting out

14 Department of Medical Assistance Services Plan First – Contact Plan First Website: Medicaid Member Helpline:

15 Department of Medical Assistance Services Non-Resident Aliens LDSS agencies certify and enroll for labor and delivery services for NRA’s if the following criteria is met: –Admission and delivery date are the same –Discharge date must be; Within allowed three days for vaginal delivery Within allowed five days for Cesarean section delivery The length of stay calculation does not include the discharge date

16 Department of Medical Assistance Services Non-Resident Aliens Dialysis services are authorized can be authorized for six months Documentation verifying out-patient treatment plan must; –Contain begin date of dialysis –Diagnosis –Be signed by a physician At the end of the six month period a new certification must be completed

17 Department of Medical Assistance Services Emergency Medical Certification Form (EMC) Form Number: eng Found in the Forms Section on the SPARK Page When submitting to DMAS: –Separate each date of service –Complete Section I (and Section III if certifying labor and delivery services)

18 Department of Medical Assistance Services Pending Certifications Questions regarding outstanding certifications may be directed to: Jamene Cox, LPN DMAS Payment Processing Unit (804)

19 Department of Medical Assistance Services Emergency Services in the MMIS

20 Department of Medical Assistance Services Emergency Services in the MMIS (cont.)

21 Department of Medical Assistance Services Emergency Services in the MMIS (cont.)

22 Department of Medical Assistance Services Emergency Services in the MMIS (cont.) Enrolling a Member in Emergency Services Medicaid; –MMIS User’s Guide, Chapter C, Page C-43 – mnls/mmis_chapter_c_enrollment.pdfhttp://dmasva.dmas.virginia.gov/Content_atchs/dss- mnls/mmis_chapter_c_enrollment.pdf Incorrect Emergency Services eligibility entries in the MMIS must be corrected by DMAS. Complete a Coverage Correction Form and submit to: –The Eligibility and Enrollment Unit

23 Department of Medical Assistance Services FAMIS CPU Broadcast 7424 – secure electronic submission of coverage correction requests now available at Additional contact methods: – – PDF versions of the communication form can be sent to the FAMIS CPU at –Fax – Communication forms may be faxed to the FAMIS CPU at –Courier (pouch) – Communication form to the FAMIS CPU via the courier

24 Department of Medical Assistance Services MMIS Web-Help Provides additional information about the screen from which it was accessed Tables with valid values are accessible by choosing the hyperlink at the corresponding field definition Eligibility rules and error message definitions are available at the bottom of the help section

25 Department of Medical Assistance Services MMIS Web-Help (cont.) MMIS Web-Help is accessed by selecting the Help button:

26 Department of Medical Assistance Services MMIS WebHelp (cont.) Table of Contents Data for screen from which Web-Help was accessed

27 Department of Medical Assistance Services MMIS WebHelp (cont.) To view valid values, select the hyperlink of the corresponding table.

28 Department of Medical Assistance Services MMIS WebHelp (cont.)

29 Department of Medical Assistance Services Thank you… Thank you for viewing this presentation. Continue to send questions and comments about this training or ideas for future trainings to: Eligibility and Enrollment issues should be sent to the Enrollment Inbox at Patient Pay enrollment questions or issues should be sent to the Patient Pay Inbox at