http://www.dmas.virginia.gov/ 1

Department of Medical Assistance Services

Department of Medical Assistance Services – Eligibility and Enrollment Unit

June2013

http://www.dmas.virginia.gov 1

Department of Medical Assistance Services

MMIS WebEx Training

http://www.dmas.virginia.gov/ 2

Department of Medical Assistance Services

Agenda

• Health Insurance Premium Assistance (HIPP)

• Plan First• Non-Resident Aliens (NRA’s)• Contacting the FAMIS CPU • MMIS Web-Help

http://www.dmas.virginia.gov/ 3

Department of Medical Assistance Services

HIPP & HIPP for Kids• Are cost saving programs for Medicaid

members• Reimburses some or all of the employee

portion of group health insurance premium for members who have employer sponsored group health insurance through their own or their family member’s employment

http://www.dmas.virginia.gov/ 4

Department of Medical Assistance Services

About HIPP

• The Commonwealth of Virginia has two Medicaid related premium assistance programs that are administered by the Department of Medical Assistance Services (DMAS):

–HIPP–HIPP for Kids

http://www.dmas.virginia.gov/ 5

Department of Medical Assistance Services

HIPP for Kids

HIPP For Kids is a premium assistance program for members under the age of 19 who are eligible for or enrolled in qualified employer-sponsored coverage.

5

Department of Medical Assistance Services

http://www.dmas.virginia.gov

http://www.dmas.virginia.gov/ 6

Department of Medical Assistance Services

HIPP for Kids (cont.)

• When determined cost effective, the entire health insurance premium is reimbursed. Cost sharing may apply to non-covered copayments, deductibles, and other expenses not covered by the primary insurer.

6

Department of Medical Assistance Services

http://www.dmas.virginia.gov

http://www.dmas.virginia.gov/ 7

Department of Medical Assistance Services

HIPP for Kids - Eligibility

• A household member must be eligible for Medicaid and be less than 19 years old

• Must have/be able to get insurance through employer

• Employer sponsored health insurance must meet program criteria

7

Department of Medical Assistance Services

http://www.dmas.virginia.gov

http://www.dmas.virginia.gov/ 8

Department of Medical Assistance Services

HIPP

• HIPP-is a premium assistance program for members who are Medicaid eligible and are enrolled in qualified employer-sponsored coverage that may be available to people with Medicaid that helps pay part or all of their health insurance premiums

8

Department of Medical Assistance Services

http://www.dmas.virginia.gov

http://www.dmas.virginia.gov/ 9

Department of Medical Assistance Services

HIPP Eligibility

• A household member must be enrolled in full-coverage Medicaid

• Must have/be able to get insurance through your employer

• Employer sponsored health insurance must meet program criteria, including cost effectiveness

9

Department of Medical Assistance Services

http://www.dmas.virginia.gov

http://www.dmas.virginia.gov/ 10

Department of Medical Assistance Services

HIPP Unit Contact Applications and questions regarding HIPP or HIPP for Kids by the LDSS:

– HIPP Email Inbox at: HIPP@DMAS.virginia.gov,– Fax: Attention HIPP Unit (804) 612-0020 or,– Mail:

Department of Medical Assistance Services HIPP Unit600 E. Broad Street, 12th FloorRichmond, VA 23219

10

Department of Medical Assistance Services

http://www.dmas.virginia.gov

http://www.dmas.virginia.gov/ 11

Department of Medical Assistance Services

HIPP Unit Contact

Tiaa Lewistiaa.lewis@dmas.virignia.gov

HIPP/Buy-in Unit Supervisor 804-786-0690

11

Department of Medical Assistance Services

http://www.dmas.virginia.gov

http://www.dmas.virginia.gov/ 12

Department of Medical Assistance Services

Plan First - Overview

• Limited Medicaid benefit – Covers regular family planning and screening

services, including birth control, and– Pregnancy prevention services only

http://www.dmas.virginia.gov/ 13

Department of Medical Assistance Services

Plan First (cont.)• As of April 1, 2013: 37,150 members

enrolled in Plan First• Approximately 17% are over child-bearing

age (VDH reports 19-44 years old)• Material is available to share with

individuals to help make informed choice about enrolling in Plan First or opting out

http://www.dmas.virginia.gov/ 14

Department of Medical Assistance Services

Plan First – Contact Plan FirstEmail: PlanFirst@dmas.virginia.gov Website: www.planfirst.org

MedicaidMember Helpline: 804-786-6145

http://www.dmas.virginia.gov/ 15

Department of Medical Assistance Services

Non-Resident Aliens• LDSS agencies certify and enroll for labor and

delivery services for NRA’s if the following criteria is met:– Admission and delivery date are the same– Discharge date must be;

• Within allowed three days for vaginal delivery• Within allowed five days for Cesarean section delivery

• The length of stay calculation does not include the discharge date

http://www.dmas.virginia.gov/ 16

Department of Medical Assistance Services

Non-Resident Aliens• Dialysis services are authorized can be authorized

for six months• Documentation verifying out-patient treatment

plan must;– Contain begin date of dialysis– Diagnosis– Be signed by a physician

• At the end of the six month period a new certification must be completed

http://www.dmas.virginia.gov/ 17

Department of Medical Assistance Services

Emergency Medical Certification Form (EMC)• Form Number: 032-03-0628-06-eng • Found in the Forms Section on the SPARK

Page• When submitting to DMAS:

– Separate each date of service– Complete Section I (and Section III if certifying

labor and delivery services)

http://www.dmas.virginia.gov/ 18

Department of Medical Assistance Services

Pending Certifications• Questions regarding outstanding

certifications may be directed to:

Jamene Cox, LPNDMAS Payment Processing Unit(804)225-4213Jamene.Cox@dmas.virginia.gov

http://www.dmas.virginia.gov/ 19

Department of Medical Assistance Services

Emergency Services in the MMIS

http://www.dmas.virginia.gov/ 20

Department of Medical Assistance Services

Emergency Services in the MMIS (cont.)

http://www.dmas.virginia.gov/ 21

Department of Medical Assistance Services

Emergency Services in the MMIS (cont.)

http://www.dmas.virginia.gov/ 22

Department of Medical Assistance Services

Emergency Services in the MMIS (cont.)• Enrolling a Member in Emergency Services Medicaid;

– MMIS User’s Guide, Chapter C, Page C-43– http://dmasva.dmas.virginia.gov/Content_atchs/dss-mnls/mmis

_chapter_c_enrollment.pdf

• Incorrect Emergency Services eligibility entries in the MMIS must be corrected by DMAS. Complete a Coverage Correction Form and submit to:– The Eligibility and Enrollment Unit

Enrollment@dmas.virginia.gov.

http://www.dmas.virginia.gov/ 23

Department of Medical Assistance Services

FAMIS CPU

• Broadcast 7424 – secure electronic submission of coverage correction requests now available at www.famis.org

• Additional contact methods: – Email – PDF versions of the communication form can be sent to the FAMIS CPU at

DSSComm@acs-inc.com – Fax – Communication forms may be faxed to the FAMIS CPU at 1-888-221-9402– Courier (pouch) – Communication form to the FAMIS CPU via the courier

http://www.dmas.virginia.gov/ 24

Department of Medical Assistance Services

MMIS Web-Help• Provides additional information about the

screen from which it was accessed• Tables with valid values are accessible by

choosing the hyperlink at the corresponding field definition

• Eligibility rules and error message definitions are available at the bottom of the help section

http://www.dmas.virginia.gov/ 25

Department of Medical Assistance Services

MMIS Web-Help (cont.)MMIS Web-Help is accessed by selecting the Help button:

http://www.dmas.virginia.gov/ 26

Department of Medical Assistance Services

MMIS WebHelp (cont.)

Table of Contents

Data for screen from which Web-Help was accessed

http://www.dmas.virginia.gov/ 27

Department of Medical Assistance Services

MMIS WebHelp (cont.)To view valid values, select the hyperlink of the corresponding table.

http://www.dmas.virginia.gov/ 28

Department of Medical Assistance Services

MMIS WebHelp (cont.)

http://www.dmas.virginia.gov/ 29

Department of Medical Assistance Services

Thank you…Thank you for viewing this presentation. Continue

to send questions and comments about this training or ideas for future trainings to:

mmiswebex@dmas.virginia.gov. Eligibility and Enrollment issues should be sent to

the Enrollment Inbox at enrollment@dmas.virginia.gov

Patient Pay enrollment questions or issues should be sent to the Patient Pay Inbox at

patientpay@dmas.virginia.gov