CSHCS - Customer Support Section (CSS) Update

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

2. PROCEDURAL CHANGESSINCE OCTOBER 2012 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

3. REMINDERS Backdating initial coverage Payment Agreements Adding Providers

4. BACKDATING INITIAL COVERAGE • 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.).

5. BACKDATING INITIAL COVERAGE • 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)?

6. BACKDATING INITIAL COVERAGEfor Travel Assistance 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.

7. BACKDATING INITIAL COVERAGE • 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)

8. BACKDATING RENEWAL COVERAGE • 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)

9. PAYMENT AGREEMENT 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)

10. PAYMENT AGREEMENT • 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

11. PAYMENT AGREEMENT • 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)

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

13. ADDING PROVIDERS FOR MHP MEMBERS • CurrentlyCSS 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

14. ADDING PROVIDERS FOR MHP MEMBERS • 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

15. QUESTIONS ?

16. CHAMPS CLIENT VIEW

17. CHAMPS CLIENT VIEW

18. CHAMPS CLIENT VIEW

19. CHAMPS CLIENT VIEW

21. CHAMPS CLIENT VIEW Client Name Client Name Client Name Client Name

22. QUESTIONS ?

26. CHAMPS CLIENT VIEW