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

2.  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

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

4.  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

5.  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

6.  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

7.  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

8.  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

9.  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

10.  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 201310

11.  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 201311

12.  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 201312

13.  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 201313

14.  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 201314

15. QUESTIONS ? April 201315

16. CHAMPS CLIENT VIEW April 201316

17. CHAMPS CLIENT VIEW April 201317

18. CHAMPS CLIENT VIEW April 201318

19. CHAMPS CLIENT VIEW April 201319

20. April 201320

21. CHAMPS CLIENT VIEW April 201321 Client Name

22. QUESTIONS ? April 201322

23. April 201323

24. April 201324

25. April 201325

26. CHAMPS CLIENT VIEW April 201326

27. April 201327