Client Contact Forms

1. Client Contact Forms

2. Why Collect Data? • Review: SHINE Program Goal • The objective of the SHINE Program is to provide Massachusetts Medicare beneficiaries with access to accurate, unbiased health insurance information, counseling and assistance • SHINE is partially federally grant funded • Requirement of grant that SHINE provide data to measure performance/achievement of program goal • Performance compared nationally • SHINE funding level based on performance

3. Why Collect Data, cont. • Requirement of grant that SHINE conduct targeted outreach to certain populations and collect data • Targeted SHINE populations: • General Medicare population • Populations considered “hard to reach” due to: • Race, culture background, and ethnicity • Limited English proficiency • Dual Eligibles with Mental Illnesses or Disabilities • Beneficiaries with disabilities • Individuals eligible for the low income subsidy for prescription drug coverage

4. Client Contact Form (CCF) • Data collected through Client Contact Forms (CCF’s) • Collected on paper then entered into computer system • CCF must be completed for each contact between counselor and client • Client contact= All contacts between a counselor and a client • Contacts may be conducted by phone or in person

5. Completing a Client Contact Form • *Asterisk's= Field MUST be filled out • Grant requirement • Check all appropriate boxes in each category, many accept multiple responses • Review each CCF to ensure accuracy prior to submitting to Regional Director • Must be submitted MONTHLY

6. Section 1-3:Client Identifying Information • Zip code of Client Residence: Most important information that MUST be collected • Agency: Where you are counseling • Date of Contact: Date of each contact with a client • Fill out a separate CCF even if meeting with same client multiple times

7. Section 4 & 5:Information About the Contact

8. Section 6: Race-Ethnicity & Language

9. Section 7 & 8:Income and Disability Information • Client Monthly Income • If Below 150% FPL, eligible for LIS • Receiving or Applying for SS Disability • If under 65 and on Medicare, would always check YES

10. Section 9:Prescription Drug Assistance • Check everything that you helped the client with in this section

11. Section 10:Time Spent and Status of Contact • Total Time Spent: • Includes travel time, time spent preparing for the appointment, time spent researching before or after the session

12. Section 11: CMS Special Use Fields & Potential Financial Assistance Provided • State collects data from this section for state specific reports • MIPPA (Medicare Improvements for Patients and Providers Act): Expectation is that every counselor screen clients for LIS and MSP • One Care: One Care data entry • Potential Financial Assistance Provided:Provides data showing how much money SHINE counselors saved beneficiaries by providing them with information and assistance • Very important to fill out so accurate beneficiary savings can be determined

13. How to Collect Data • Preferred method= “self-report” • Self-reporting is the most consistent and valid source of information • Client can choose from several categories to describe themselves • Some clients may be concerned when asked certain questions they may feel are personal • Be sensitive to concerns and explain why you are collecting the data and what is done with it • Most often, once individuals understand the purpose of the question, they are happy to cooperate

14. Race-Ethnicity • Question: Client Race-Ethnicity • Categories should be read/shown to client for them to choose applicable category(s) • Examples of how to ask this question: • “Which of the following best represents your racial or ethnic heritage? Choose all that apply ” • “Which categories best describes your race or ethnicity? You can choose one or more categories”

15. Primary Language • Question: Client Primary Language Other Than English • Primary language refers to the language that a person acquires in earliest childhood; also, the primary language of a community • Also referred to as native language or mother tongue • Examples of how to ask this question: • “Is English your primary language?” • “Do you have a primary language other than English?”

16. Income • Question: Client Monthly Income • This question asks whether a clients income is below 150% of the Federal Poverty Limit (FPL) or at or above 150% of the FPL • To avoid making the client reveal their income which may make some clients uncomfortable, just ask whether income is below/at or above 150% FPL limit • SHINE counselors do not need to know a clients exact income • Counselors responsibility is only to SCREEN for potential benefit program eligibility • Example of how to ask this question: • “Is your income below (list the current 150% FPL), or is it at or above that amount?”

17. SHIP NPR(State Health Insurance Assistance Programs National Performance Reporting) • Website where CCF’s are entered and data collected • All counselors entered into website • Will receive an email asking to verify your email address, this will activate your account (must respond w/in 24 hrs) • Another Important feature of SHIP NPR= Used to obtain your CMS Unique ID •  Unique ID allows you to call CMS Customer Service using the designated phone number for SHINE counselors • To receive assistance, must provide your CMS Unique ID • Will receive email with instructions on how to obtain your Unique ID