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IHWP Healthy Behaviors Strategy Discussion

IHWP Healthy Behaviors Strategy Discussion. October 6 th and 8 th , 2014 Iowa Primary Care Association. Impacted Medicaid Populations.

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IHWP Healthy Behaviors Strategy Discussion

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  1. IHWP Healthy BehaviorsStrategy Discussion October 6th and 8th, 2014 Iowa Primary Care Association

  2. Impacted Medicaid Populations • All Marketplace Choice Plan (CoOportunity Health and Coventry) patients and Wellness Plan patients (general Wellness Plan and Meridian HMO) patients must complete the Healthy Behaviors to avoid cost-sharing. • DWP patients also have to complete a risk assessment • IHWP patients determined to be medically exempt are not subject to cost-sharing if they do not complete the Healthy Behaviors, but are encouraged to complete them.

  3. Why are the Healthy Behaviors Important to Complete? • Supports the patient in retaining their health care coverage • Greater likelihood for patients to access and experience continuity in their health care • Helps waive any possible contribution (premium) for the next year of enrollment • Premium Amounts • Individuals with Income 0-50 Percent of the FPL: $0 (no premiums) • Individuals with Income 50-100 Percent of the FPL: $5 per month • Individuals with Income 100-133 Percent of the FPL: $10 per month

  4. Why are the Healthy Behaviors Important to Complete? (cont.) • Helps waive any possible contribution (premium) for the next year of enrollment • Nonpayment of Premiums • Individuals with Income 50-100 Percent of the FPL: Nonpayment of premiums will result in debt subject to collection by Iowa. No loss of coverage will occur, until the time of annual renewal. • Individuals with Income 100-133 Percent of the FPL: Nonpayment of premiums will result in disenrollment from the Iowa Health and Wellness Plan. • For IowaHealth+ members, we must have 50% of the patients complete them to avoid a claw back of the ACO incentives by IME

  5. Key Clarifications • Timeline differences • Patients have one full year to complete the two Healthy Behaviors (based on their date of enrollment into the program) • Providers are measured on their performance on the calendar year (December 31st, 2014) • HRA completion differences for patients versus providers • Patients must complete the HRA • Providers must incorporate the results of the patient’s HRA into the patient’s care plan

  6. Information on IME Reenrollment Efforts • Former IowaCare patients’ income is subject to the new MAGI methodology which is causing some to move from the WP to the MCP or off the IHWP completely • Former IowaCare patients are not completing the reenrollment paperwork and are dropping off the program (more info in future slides) • Former IowaCare patients are placed into a “tentative” assignment status for 90 days and IME is now NOT including these patients in the assignments lists until their 90 day window to change their PCP assignment is up • Patients could be changing their PCP – this can technically occur anytime during the year if the patient provides IME with an approved reason for wanting to switch their PCP outside of the 90-day tentative status period • All the above factors except the MAGI methodology will impact Wellness Plan patients who need to reenroll into the program during the 2015 calendar year

  7. October Healthy Behaviors Report

  8. Impact of IowaCare Reenrollments • IowaCare reenrollments occurring June through November (30 days notice) • Have to complete renewal forms by due date otherwise their coverage will be cancelled • If turned in up to 90 days after the initial due date, their coverage will be reinstated – means no lapse in coverage similar to retroactive coverage • After 90 days, a new application must be submitted where only 90 days of retroactive coverage can be provided (some lap in coverage)

  9. Impact of IowaCare Reenrollments • Lots of movement with the IowaCare reenrollments between WP, MCP, traditional Medicaid • Always verify eligibility using the IME systems • If members do not have their renewal form • Can use a blank form • Can contact local offices to request a new form be mailed out • Can do a new application

  10. Future Reenrollment Efforts • IME getting ready to start renewals for those enrolling in January • Issued on 10/31 and due 12/31 • Same renewal form as former IowaCarepatients • Same 90 days available for reinstatement of coverage if they miss their deadline • Members need to directly change their addresses with IME/DHS • DHS customer service center is the fastest route compared to DHS case workers

  11. Additional Key Information • IME recently expanded the Wellness Exam criteria – found in Informational Letter 1425 • IME Informational Letter 1415 includes information about billing for the HRA specifically for FQHCs and RHCs • IME Healthy Behaviors Mailings • Discrepancies in data between IME reports and FQHC reports • Lag in claims for wellness exams • HRA data is more timely, but lots of factors impacting the reports

  12. Discussion of Strategies to Support This Work • PCA work to identify a process to better track patients ever assigned to a Practice Manager (PCP) • Questions, comments, additional challenges • Health center strategies and workflows that are working • Efforts between dental and medical • Reminder of resources on the PCA website

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