Public Provider Reimbursement Revenue Operations Function 101 Provided
Public Provider Reimbursement Revenue Operations Function 101 Provided For: Service Coordinator Institute July 19, 2016
Organization of Presentation • • Mass Health Financial Eligibility Requirements Mass Health Eligibility & Categories Revenue Staff: Conversions Revenue Staff: Redeterminations Some Basic Information: Waiver Enrolled Individuals Revenue Forms Revenue Staff Contact Information 2
Mass. Health Financial Eligibility Requirements • Countable Asset Limits Cannot Be Greater Than $2000 Per Individual Or $3000 Per Couple For Mass Health. • What Assets Are Counted? Cash, Bank Accounts, Securities, Pensions, Annuities, Retirement Accounts, Real Estate, Vehicles • What Are The Income Limits? – Category Guideline That Applies: 133% Federal Poverty Guideline (FPG) – 2016 Monthly Income Level (Family of 1) = $ 1, 317 – 2016 Annual Income Level (Family of 1) = $15, 804 – If On The DDS Waiver 2016 Monthly Income Level (Family of 1) = $2, 199, annualized is $26, 388 • What Income Is Counted? Wages, Salary, Tips, Social Security Benefits, Pensions, Annuities 3
Mass. Health Financial Eligibility Requirement Continued • What Is My Family Size? Members Of Immediate Family Including Children Under 19, Any Of Their Children, Children Away At School. • Are There Special Rules For Seniors And People Needing Long. Term Care? – Those Eligible For Mass Health Except Their Incomes Are Too High Can Qualify By Meeting A Deductible. Spending Down Your Assets. 4
Mass Health Eligibility & Categories • A Department of Developmental Services (DDS) individual applies for Mass Health (MH). When eligibility is approved by Mass Health the individual is placed in a MH Category and considered “open” on MH. • The MH Category determines their insurance coverage for services. • There are waiver billable and non-waiver billable categories. • Billing is based on the waiver billable category for DDS individuals on the waiver. • The Department of Developmental Services individuals applying for the DDS waiver, are required to be in a waiver billable MH category. • Mass Health provides a listing of waiver eligible codes specific to the DDS Waivers which UMass Medical School (UMMS) Benefit Specialists monitor and manage. • UMMS Public Provider Reimbursement Specialists work closely with DDS Area Staff providing Mass Health Benefit assistance. 5
Revenue Staff: Conversions • • • Conversion Steps Monitored and Managed by UMMS Revenue Department: – UMMS Benefit Specialist determines if the DDS client is open on Mass Health (MH) – If client is open on MH the Benefit Specialist determines if the individual is in a waiver billable code. If not then conversion to a waiver billable code is necessary. – For Waiver Enrolled clients not in a billable code the Benefits Specialist sends an Asset Request Letter with Representative Payee conversion. – For Waiver clients send Mass Health the completed conversion packet, upon receipt of all necessary information. Conversion Packet = Asset Request Packet – To Representative Payee (Rep Payee) • Asset Request/Conversion Letter • Mass Health Eligibility Review Form for Home & Community-Based Services Waiver for Persons with an Intellectual Disability (HCBSW-Conversion Form) • Mass Health Authorized Representative Designation Form (ARD) – To Mass Health • Documents from Rep Payee conversion packet (above with No conversion letter) • Meditech prints of: Waiver & LOC screens Revenue Department role is to monitor and manage the above. 6
Revenue Staff: Redeterminations • Redeterminations are an annual client review process initiated by Mass Health. A review can either be administrative or an actual review. – Administrative reviews: clients are responsible for returning the review only if there are significant financial changes. • Total Assets > $2000 if single or $3000 if married • Client or spouse’s monthly income changed over the last year • Client received new types of income – Reviews: clients are responsible for returning completed review with all required information by a deadline. • Revenue Department role is to monitor, manage and track the above. 7
Some Basic Information: Waiver Enrolled Individuals • • MH Authorized Representative Designation (ARD) Form Needs To Be Completed By All Individuals Involved In Completing Any MH Form (Should MH Need To Be Contacted, An ARD Needs To Be On File For MH To Speak With Someone Calling In) Watch The Mailbox Where An Individual Resides (As This Is Where Mass Health (MH) Forms Are Mailed) Respond Promptly To MH Mailings (If Submitting close To The Due Date, Contact MH To Ensure It Gets Processed) It Is Best To Provide All Supporting Documents With The Form (If Submitted After The Fact Include The Individuals Social Security Number On The Documents. ) Not All MH Staff Are Well Versed In The Adult Waivers. (If Instructed To Apply For MH That Does Not Ask About Assets It Is the Wrong Eligibility For The Adult Waivers) Assets Are Usually Requested/Required By MH Whenever The Following Occurs: – Turning 65 years Old – Adult Waiver Enrollment – Going Into Long Term Care If Asset Verification Is Needed For MH Eligibility, Combined Liquid Assets Cannot Be Over $2, 000. If There Any Questions As To Which Form Is Needed And/Or Where It Needs To Be Submitted: Contact UMMS Revenue (Contact information reference on last page). 8
REVENUE FORMS (Commonly used but not all inclusive) ** All Forms Can Be Requested From UMMS Revenue Staff ** 1] Mass Health Eligibility Review Form for Home & Community-Based Services Waiver for Persons with an Intellectual Disability (HCBSW-Conversion Form) Who completes form: Representative Payee 2] Mass Health Authorized Representative Designation Form (ARD) Who completes form (depends on circumstances): Representative Payee and/or Revenue Department 3] Mass Health Eligibility Review for Seniors & Certain People Needing Long-Term-Care Services (MER – Redetermination Form) Who completes form: Representative Payee 4] Application For Health Coverage For Seniors And People Needing Long Term Care Services (SACA 2) Who completes form: Representative Payee 5] Massachusetts Application for Health and Dental Coverage and Help Paying Costs (ACA 3) Who completes form: Representative Payee 9
REVENUE FORMS - CONTINUED (Commonly used but not all inclusive) ** All Forms Can Be Requested From UMMS Revenue Staff ** Conversion/Asset Request Packet A] Consists of completed forms: - Mass Health Eligibility Review Form for Home & Community-Based Services Waiver for Persons with an Intellectual Disability (HCBSW-Conversion Form) - Mass Health Authorized Representative Designation Form (ARD) The supporting financial documents required to be filed with Conversion Form are: - Verification of all Benefits received such as: Social Security, Veterans, Rail Road, Civil Service Pension - Bank account statements - Burial account - Funeral contract - Special needs trusts - Employment paystubs - Life insurance policies - Pension, 401 K, IRA, Annuities B] Meditech screen prints of: Waiver & LOC 10
Revenue Staff Contact Information UMASS PPR Staff: Bob Schipani, Associate Director Nancy Kuzmeskus, PPR Manager Linda Mc. Kee, Assistant PPR Manager Erica Emerick, Assistant PPR Manager 617 -624 -7839 413 -205 -0846 413 -205 -0873 978 -774 -5000 x 373 Thebob@massmail. state. ma. us Nancy. Kuzmeskus@massmail. state. ma. us Linda. Mckee@massmail. state. ma. us Erica. Emerick@massmail. state. ma. us Central West Staff (CW): Diana Blackshear, PPR Specialist 413 -205 -0840 Greg de. Villier, PPR Specialist (Including: SETA) 413 -205 -0904 Carline Hillman, PPR Specialist (Including: SEPL/SRS)413 -205 -0928 Mary. Adele Moore, PPR Specialist 413 -205 -0900 Diana. Blackshear@massmail. state. ma. us Greg. De. Villier@massmail. state. ma. us Carline. Hillman@massmail. state. ma. us Mary. Adele. Moore@massmail. state. ma. us Metro Staff (ME): Sherese Thompson, PPR Specialist 781 -788 -5235 Sherese. Thompson@massmail. state. ma. us North East Staff (NE): Susan Burke, PPR Specialist Susan Lacroix, PPR Specialist 978 -744 -5000 x 136 978 -744 -5000 x 594 Susan. Burke@massmail. state. ma. us Susan. Lacroix@massmail. state. ma. us South East Staff (SE): Ryan Kelly, PPR Specialist Esther Marius-Chery, PPR Coordinator 508 -384 -6718 508 -384 -1697 Ryan. Kelly@massmail. state. ma. us Esther. Marie. Marius. Chery@massmail. state. ma. us 11
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