P7 ORW Presentation - Work Supports Strategies

Report
North Carolina
Department of
Health & Human
Services
NC FAST and Work Support Strategies
Operational Readiness
Workshop
July – August 2013
1
Agenda
Time
Agenda Topics
Presenter
9:00-9:15
Welcome & Introductions
Workshop Team
9:15-9:45
NC FAST Project Update
Readiness Team
9:45-11:15
P7 Ecosystem & Division of
Responsibilities
P7 Liaisons
11:15-12:00
DMA Update
DMA
12:00-1:00
Lunch: Work Support Strategies
Update
WSS Team
1:00-2:00
Managing Applications & Cases
P7 Liaisons
2:00-3:30
Break-Out Discussion:
Communications Strategy
All
3:30-4:00
Questions & Answers
Workshop Team
2
North Carolina
Department of
Health & Human
Services
NC FAST
Project Update
July 2013
3
Project Update









ePASS
Document Management
Deployment Update
Help Desk
Schedule Update
Training Update
County Security Configuration
Project 7 Update
Project 3 Update
4
ePASS – Statewide Volumes
2010
2011
2012
2013 – through July
FNS Screenings
40,687
72,323
68,946
34,372
FNS Potential
Eligibility
28,212
51,545
49,433
25,391
FNS Applications
3,333
37,505
51,870
23,487
FNS Electronic Apps
0
0
0
10,689
MA Screenings
0
0
12,211
16,478
MA Applications
0
0
9,955
10,803
Quick Screens
28,071
56,999
57,468
29,846
EA Screenings
13,765
22,710
20,188
9,758
EA Potential
Eligibility
3,835
5,438
4,488
2,087
Transaction
The number of FNS Electronic Apps has gone up over 4,000 in a month
5
Document Management Update








Completed functional and detail design documents (integration with NC FAST)
Completed County Guidelines document
Completed development and testing (integration with NC FAST)
FileNet production architecture is readied for configuration
Deployed document management capability as part of Project 2&6 Pilot rollout
Working on County Sync Guide
Working on draft functional and detail design documents for county sync piece
Preparing to initiate development of county sync capability
6
Document Management Update



Document management design document has been posted in FAST Help
A webinar will be scheduled to discuss the design document
A job aid has been posted providing guidance on what should be scanned
7
Deployment Update








Upgraded NC FAST to P2&6 version of code; a significant upgrade to the
base NC FAST system
Working through identified defects; continuing build activities and defect fix
activities
Continue to identify and prioritize Cúram tickets
Refining data conversion approach in preparation for Hard Launch
Continue submitting test conditions, scripts, and test data sheets for
Business team review
Respond to Business team comments and receive sign-off for test
conditions and scripts
Continue to plan and execution of Cycle 3 – Day in the Life execution cycle
and Frequency 1,2,3,4,5 scripts
Refining internal team communication protocol to streamline getting updates
to the counties
8
Help Desk Update







Significant increase in call volumes last week
Identified limitation with current phone system causing some calls to roll to
voice mail; new phone system on order
If users call the Help Desk and are unable to speak to someone or cannot
leave a voicemail message, send your issue via email.
Agents work to resolve tickets in the order in which they are received
NC FAST Help Desk can be reached at [email protected] or 919855-3200, Option 3
Help Desk is available Monday – Thursday, 8:00 a.m. – 6:00 p.m. and
Friday, 8:00 a.m. – 10:00 a.m., 11:00 a.m. – 6:00 p.m.
Please report only one incident/issue per email.
9
Help Desk Metrics
Open Tickets (as of date)
Tier 2
Tier 3/Config/User Setup
Tier 3 Dev/Other
Total Tier 2/3
7/22/2013
741
4
249
994
7/23/2013
797
8
265
1070
7/24/2013
818
5
276
1099
7/25/2013
859
6
293
1158
7/26/2013
914
6
293
1213
Tickets Resolved (daily)
Tier 2
Tier 3/Config/User Setup
Tier 3 Dev/Other
Total Tier 2/3
7/22/2013
93
2
5
100
7/23/2013
91
4
3
98
7/24/2013
92
3
2
97
7/25/2013
79
1
1
81
7/26/2013
76
3
3
82
10
P2&6 Schedule Update
Alleghany
Northampton
Ashe
Surry
Stokes
Rockingham
Caswell
Gates
Warren
Person
Hertford
Halifax
Forsyth
Avery
Caldwell
Davie
Madison
Iredell
Swain
McDowell
Rutherford
Lincoln
Graham
Martin
Chatham
Dare
Pitt
Johnston
Lee
Cabarrus
Harnett
Stanly
Tyrrell
Wilson
Rowan
Gaston
Polk
Nash
Wake
Randolph
Catawba
Bertie
Franklin
Davidson
Burke
Buncombe
Guilford
Orange
Yadkin
Alamance
Wilkes
Watauga
Beaufort
Hyde
Greene
Wayne
Moore
Lenoir
Craven
Macon
Cherokee
Clay
Union
Hoke
Anson
Duplin
Scot
land
P2&6 Soft Launch Key
Pilot
August 5
Phase 1
August 12
Phase 2
August 19
Phase 3
September 9
Jones
Sampson
Onslow
Carteret
Robeson
Bladen
Pender
Phase 4
September 30
Columbus
Brunswick
11
P2&6 Training Update









Over 40 trainers have gone through Train-the-Trainer
Launched the NC FAST Learning Gateway
Posted web-based training (WBT) content into Learning Gateway
Exposed Pilot counties to preliminary version of classroom training
Delivered WBT and instructor-led content to Pilot counties and state office
Initiated training of southeast counties
Wrapping up development of final classroom training activities
Feedback from Pilot and state office delivery has been quite positive
Expectations:

Use of Captivate simulations

Training scenarios

Sandbox availability

Availability of program subject matter experts
12
County Security Configuration
County
Reception
Unit
Eligibility Unit
1
Eligibility Unit
2
Reception
Supervisor 1
Eligibility
Supervisor 1
Eligibility
Supervisor 2
Reception
Worker 1
Eligibility
Worker 1-1
Eligibility
Worker 2-1
Reception
Worker 2
Eligibility
Worker 1-2
Eligibility
Worker 2-2
Reception
Worker 3
Eligibility
Worker 1-3
Eligibility
Worker 2-3
User Role:
Inquiry Only
User Role:
Eligibility Worker
13
Project 7 Update



Business team continues to work closely with DMA to:

Finalize Project 7 requirements

Complete documentation for State Plan Amendments (SPA), elected state
options, targeted enrollment strategies, and federal hub waiver
Design team completed joint design sessions for functionality needed to be
ACA compliant; finalizing review and sign-off

Intake and assessment for Medicaid/NCHC

Integration with federal data hub for account transfers and verifications

Eligibility determination/redetermination under MAGI and non-MAGI rules

Coordination of appeals processing with FFM

Implementation of federal and state mandated reports and notifications
Interfaces team began federal data services hub Wave 4 testing with CMS
14
Project 3 Update






Team is composed of Services Business Lead Tracey Duncan, an NC
FAST Business Analyst and 3 SMEs from DCDEE
Continue to reassess the business requirements
Reassessment of the Child Care Subsidy business requirements should
be complete in August
Requirements for Energy Assistance (CIP and LIEAP) will then be
addressed with a SME from Economic Services
Fit gap analysis is planned to begin in August, with the goal of beginning
functional design in October
Deployment is targeted for late 2014
15
North Carolina
Department of
Health & Human
Services
Project 7
FFMI
P7 ‘Ecosystem’ & Division of Responsibilities
16
The New P7 Ecosystem
MA
Application
FDSH
PATHWAYS
Electronic
In-person,
by phone,
mail-in
Database
Interface
State Verification
Systems
17
The New P7 Ecosystem
 New Streamlined application for MA
 Additional questions required for an MA eligibility
determination under current rules and/or FNS
 Depending on programs for which the applicant is
eligible, benefits may begin at different times
 Additional electronic verifications from federal sources
may be used
 Ineligible applications will be transferred to the
FFM/Health Insurance Marketplace for potential
Advanced Payment Tax Credit (APTC) or Cost-Sharing
Reduction (CSR) eligibility
18
The New P7 Ecosystem
What is New?
•
•
•
•
•
•
What has changed?
Potential for increase in
applications with roll-out of
ACA
May need to refer customers
to the FFM/Health Insurance
Marketplace
•
Caseworkers will ask new questions
when customers are applying for MA
Potential for new work queues
for Streamlined applications
submitted via ePASS
•
MA applications completed on ePASS
may now be submitted electronically
A link will be added to ePASS to allow
applicants to connect directly to the
FFM/Health Insurance Marketplace
Entirely new web-based
access point for customers
Potential for new work queues
for Streamlined applications
submitted via FFM
Applications may be
transferred from the FFM to
NC FAST and vice versa
•
•
‘One-Stop shop’ now available for
customers; whether looking for
Medical Assistance or shopping for
insurance plan
19
MA Applications Completed via the DSS
Streamlined
Application
keyed by
caseworker
MAGI Notice
Generated and Held
by NC FAST.
Traditional
determination/
additional program
requested?
Enroll in
MAGI
program
Benefits under MAGI programs
will not begin until January 1,
2014.
Send
application to
FFM
Answer additional
questions for
traditional MA
(and FNS, if requested)
Enroll in
Traditional MA
and/or FNS
If eligible for FNS but not for traditional
MA, enroll in FNS and MAGI. Note:
benefits will begin on different dates.
20
MA Applications Completed via ePASS
Streamlined
Application
keyed by
applicant
Applicant
registers for
NCID
MAGI Notice
Generated and Held
by NC FAST.
Traditional
determination/
additional program
requested?
Enroll in
MAGI
program
Benefits under MAGI programs
will not begin until January 1,
2014.
Send
application to
FFM
Answer additional
questions for
traditional MA
(and FNS, if requested)
Enroll in
Traditional MA
and/or FNS
If eligible for FNS but not for traditional
MA, enroll in FNS and MAGI. Note:
benefits will begin on different dates.
21
MA Applications Completed via the FFM
Streamlined
Application
completed
through FFM
Seeking
Financial
Assistance
?
Enrolled in
QHP of
choice
Potentially
MA
eligible?
Calculate
APTC/CSR
Full
determination
requested?
Application
transferred to
NC FAST
22
Key Points
 Beginning October 1, 2013 – the Streamlined Application will always
be completed FIRST when applicant is seeking Medical Assistance.
 To receive a determination based on ‘traditional’ rules (between
10/1/2013 and 12/31/2013) and/or to apply for FNS in addition to
MA, additional questions will need to be answered.
 Regardless of the entry point, the Medicaid/NCHC determination will
ultimately be done in NC FAST.
 Benefits under MAGI programs will not begin until January 1, 2014
 As of January 1, 2014 – MAGI rules become the standard for most
Family & Children’s MA programs.
 Applicants who do not qualify for Medicaid/NCHC may still be
eligible for APTC/CSR (federal subsidies) to help pay for insurance
and should utilize the FFM/Health Insurance Marketplace.
23
North Carolina
Department of
Health & Human
Services
P7 Division of
Responsibilities:
DHHS/FFM/FFMI
24
Health Insurance Marketplace
25
Health Insurance Marketplace
26
Customer Assistance
If a customer requires
assistance completing
the streamlined
application for
Medicaid/NCHC while
at the local DSS, they
are assisted by the
caseworker.
If a customer requires
assistance completing
the streamlined
application for
Medicaid/NCHC while
using ePASS, they are
advised to call the
DHHS Customer
Service Center.
If a customer requires
assistance completing
the streamlined
application for
Medicaid/CHIP while
using the FFM, they
are advised to call the
Federal Call Center
and/or Navigator.
27
Customer Assistance
Provide customers with information that assists with the following:
• submitting the eligibility application
• clarifying distinctions in QHPs
• making informed decisions during the health plan selection process
Can assist in all different types of marketplaces
• State-based Marketplace
• State Partnership Marketplace
• Federally-facilitated Marketplace
Funded through State and Federal grants
Must complete comprehensive training to become a navigator.
28
Customer Assistance
Serve many of the same functions as Navigators including:
• Providing education to customers
• Assistance completing applications
Organizations can apply online to be designated by the Marketplace
to certify application counselors. Some examples of organizations
include:
• Social service agencies
• Hospitals
• Community health centers
No funding mechanism available for this program
Must complete comprehensive training to be a Certified
Application Counselor.
29
Customer Assistance
Navigators
Non-Navigator
assistance
personnel
Certified
application
counselors
Agents and
Brokers
State-based
Marketplace
Yes
Optional for
states
Yes
Optional for
states
State
Partnership
Marketplace
Yes
Yes
Yes
Yes, if state
permits it
Federallyfacilitated
Marketplace
Yes
Not applicable;
Navigators
provide this
assistance
Yes
Yes, if state
permits it
*Source: cms.gov
30
Navigators
 Role: To assist the customer in applying for an insurance
affordability program



Can be a person or organization
May assist with Streamlined application completion, or complete
on behalf of the applicant
Explaining APTC/CSRs or insurance options to customers
 Navigators are not responsible for:



Assisting customers with ‘Traditional’ MA applications
Explaining North Carolina DMA policy
Contacting the DSS
It has not been determined if Navigator’s will be
assisting customers with ePASS (Streamlined) applications
31
DSS Caseworkers
 Role: Take applications for Medical Assistance (and
FNS/SNAP, if applicable)


Will manage integrated cases in NC FAST (Income Support
and/or Insurance Affordability)
May refer ineligible applicants to the Health Insurance
Marketplace as an alternative to Medicaid/NCHC
 Caseworkers are not responsible for:
Helping customers navigate the FFM/Health Insurance
Marketplace
 Helping customers complete the application on the FFM/Health
Insurance Marketplace
 Explaining specific details regarding APTC/CSRs or insurance
options to customers
Consider having the website and/or phone number for the
Health Insurance Marketplace to give customers a place to start.

32
NC FAST
 Role: Provide an eligibility determination for MAGI and
non-MAGI programs and issue benefits when applicable


Will notify case worker via a task in a designated work queue
when an application is received from ePASS or the FFM
Will notify applicant of eligibility result and/or when their
application is transferred to the FFM
 NC FAST is not responsible for:



Providing an eligibility determination for APTC/CSR
Notifying customers of insurance plan options
Enrolling customers in QHP
33
North Carolina
Department of
Health & Human
Services
DMA Update
34
North Carolina
Department of
Health & Human
Services
Lunch and Work
Support Strategies
Update
35
North Carolina
Department of
Health & Human
Services
P7: Managing
Applications & Cases
Streamlined App / Multiple Dispositions & Integrated
Cases / The Evidence Broker / Impacts to the Universal
Worker
36
North Carolina
Department of
Health & Human
Services
Streamlined Application
Demonstration
Note: The following includes
preliminary screen shots which are
subject to change.
37
Streamlining the Process
What is the Streamlined Application?



A simplified application used to apply for all Insurance
Affordability programs
Used whether applying via the FFM, ePASS, or the DSS
Will be the first application used when the customer is seeking
Medical Assistance
38
Getting Started with the application.
Customer must agree to privacy statement before continuing.
The first page of the streamlined application gathers details about the primary applicant.
The second page gathers additional details about the primary applicant.
Are there any other people in the household?
Enter details about the additional household member.
Enter additional details about the household member.
Review the household member summary. Are there more people to add?
How are the household members related?
Identify the tax filers in the household.
Identify the tax dependents in the household.
Review the Household Summary. Make changes if necessary before continuing.
Indicate household members who earn income.
Enter income details.
Are there any income deductions that can be deducted on an income tax return.
Review expected annual income.
Similar income information is collected for additional household members (if applicable).
Additional household information is collected, beginning with details on medical bills.
Indicate household members who are tobacco users or are incarcerated.
Additional questions are asked to determine if household members qualify under MAGI.
Review the summary screen and make necessary changes before continuing to next screen.
Documentation needed from the customer displays before the application is submitted.
North Carolina
Department of
Health & Human
Services
Streamlined Application
Demonstration Q&A
61
MAGI vs. Non-MAGI
MAGI
Non-MAGI
Streamlined application
Non-MAGI Medical Assistance
application
Eligibility determination and
enrollment can begin as early as
October 1, 2013
Eligibility determination and
enrollment are on-going currently
Coverage begins as early as
January 1, 2014
Coverage begins on the day
indicated by policy
MAGI becomes the new standard
for most Family and Children’s
Medicaid programs after January 1,
2014
Non-MAGI-based programs
continue to use Non-MAGI Medical
Assistance application
62
Potential for Multiple Dispositions
The application process for all MA programs will start with the streamlined
application after October 1, 2013.


Coverage for the MAGI based determinations does not begin until January 1, 2014
Customers should be given the opportunity to see if they currently qualify for a MA program
under the traditional (non-MAGI based) rules
Result: During the single application process, an Authorization/Disposition will
need to be completed for the Streamlined and ‘traditional’ MA and/or FNS
application(s).
Streamlined
Application
MA and/or FNS
Application
MAGI
Non-MAGI
Identical information
prepopulates on the
Non-MAGI application
63
Potential for Multiple Integrated Cases
‘Streamlined’
Medical
Assistance
Application
Submit
Insurance
Affordability
(Integrated Case)
Product
Delivery
Case
Identical information
populated from
MAGI application
Income Support
Application
(P26 Interview Questions)
Evidence
Submit
Income
Support
Evidence
Broker
Evidence
(Integrated Case)
Product
Delivery
Case
64
The Evidence Broker
 The Evidence Broker is the functionality within NC FAST that allows
evidence to be transferred from one integrated case to another
 With multiple integrated cases there will be two types of evidence,
identical and non-identical


Identical evidence is evidence that is used in the same way and is the same
evidence type in both integrated cases
Non-identical evidence is evidence that is not used in the same way in both
integrated cases
 Once enabled, the Evidence Broker will broadcast the identical
information so that it can be then used on the other “target”
integrated case
 Caseworkers will be able to accept or reject the evidence in the
target case either manually piece by piece or in bulk at once
 When evidence is entered in one case that could be broadcast to
the other integrated case, the caseworker will receive a task
informing them that they have evidence to accept or reject
65
Incoming Evidence: Identical
Note: These screens are subject to change
66
Incoming Evidence: Non-Identical
Note: These screens are subject to change
67
Impacts to the Universal Worker
 One Case Worker

Customers will still have the ability to apply for multiple programs at the same time with one
caseworker, whether there is a MAGI-based program involved or not.
 Reception, Tasks, Work Queues

Other universal worker functionality associated with P2&6 such as work queues, reception,
and tasks will remain essential to the NC FAST process.
 Potential Multiple Dispositions

After completing the MAGI application, the customer may continue on to the Non-MAGI
(and/or FNS) questions to see if he or she is eligible for Medical Assistance (or FNS) prior to
1/1/14. Therefore, a caseworker may have two dispositions to complete.
 Potential Multiple Integrated Cases

One caseworker will be able to manage both integrated cases through the use of the
evidence broker, which will allow identical information to be shared amongst these cases.
68
North Carolina
Department of
Health & Human
Services
Breakout Discussion:
Communication
Strategies
69
The “Woodwork” Group
 Increased awareness of the Affordable Care Act is
expected to bring potential customers out of the
woodwork.



Those who are currently eligible but not enrolled: DMA research
suggests that 69,683 individuals will gain coverage in 2014.
Those who would potentially be eligible under a Medicaid
expansion: Approximately ½ million additional applicants who
will not be eligible may still want to apply.
Expect an impact, not only to numbers of Medicaid applicants,
but to other programs as well.
70
Estimated Medicaid Expansion Population in 2014
71
North Carolina
Department of
Health & Human
Services
Breakout Session
Report Out:
Communication
Strategies Highlights
72
North Carolina
Department of
Health & Human
Services
Questions and Answers
73
North Carolina
Department of
Health & Human
Services
Thank You for participating today!
You will receive an email shortly
with a link to a survey. Your
comments & suggestions will help
us plan future workshops.
74

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