Maryland Enrollment Broker Overview

1. Maryland Enrollment Broker Overview Maryland Medicaid’s Primary Adult Care Program, Managed Care Organizations and Baltimore Substance Abuse Treatment Provider Forum April 14, 2010

2. Overview • Policy Studies Inc. (PSI) is a Colorado-based company with a 25-year mission of doing “socially useful work”. We are a national leader in cost-effective administration of public programs that include public health insurance, child support enforcement and workforce development. • Policy Studies Inc. (PSI) was awarded the Maryland Enrollment Broker Services contract and began operations on October 1, 2005; Primary Adult Care (PAC) enrollment services became effective on July 1, 2006. Government Health Services

3. Role of the Enrollment Broker • To provide timely and adequate information and education to eligible HealthChoice and PAC beneficiaries. • To perform all functions directly related to the voluntary enrollment of eligible beneficiaries into a Managed Care Organization (MCO) and the selection of a Primary Care Provider (PCP). • To provide outreach, education and enrollment assistance to Special-Needs populations throughout the State. Government Health Services

4. Call Center • Staffed Monday thru Friday, 7am – 7pm. • Staff consists of both English and Bilingual Customer Service Representatives. • Process new enrollments, transfers, Annual Right to Change (ARC) requests and other customer service inquiries. Government Health Services

5. Outreach and EducationUnit • Provides education and enrollment assistance to eligible and potentially eligible program recipients within various county, state and community-based sites. • Conducts HealthChoice education presentations to recipients, county, state and community partners. • Participates in health fairs, seminars and various other community-based initiatives to promote the “self-selection” process to recipients. Government Health Services

6. 2009 Performance Summary Government Health Services

7. The Enrollment Process Eligible recipients may enroll by using one of the following methods: • Telephone – Call 1-800-977-7388 (HealthChoice) or 1-866-676-5880 (Primary Adult Care), Monday-Friday, 7am – 7pm. • In-person – Meet with a Field Enrollment Counselors at select state, county and community sites throughout the State. • Mail – Mail the completed Enrollment and Health Services Needs forms to the Enrollment Broker. Government Health Services

8. MD Enrollment Broker Exclusive PAC-FAX Enrollment Line Purpose As another method of enrollment, for newly eligible approved Medicaid Recipients who have limited, or no access, to call the Enrollment Broker to enroll in the Primary Adult Care (PAC) Program. You can now assist them while they are in your offices, by sending a Fax with the fully completed enrollment informationdirectly to the Enrollment Broker Offices at 410-951-8322. Procedure • Complete the PAC-FAX Enrollment Line Facility Registration Form. (Handout) • Complete a PAC-FAX Cover Sheet with all necessary contact information. (Handout) • You will need to Fax us a completed PAC Enrollment Form (1-Page), and a completed Health Services Needs Form (2 -Pages), and we will process the enrollment within 24-48 hours from the date the Fax is received. You can contact the Eligibility Verification System (EVS) within 12 days from the Fax date to verify the enrollment. (Handouts) • Please submit either the pre-printed PAC Enrollment Form, plus the pre-printed Health Services Needs Form the recipient should have received in the PAC Enrollment Packet mailed to them, or you must complete the required information on blank PAC Enrollment/Health Services Needs Forms and FAX them to us. • See “Completing the PAC-FAX Enrollment form for complete fax enrollment information. (Handout) Reminder! – Only eligible Recipients can be enrolled in PAC - All others will be rejected! Government Health Services

9. Enrollment Time Cycle • COMAR regulations state the recipient has 21 days to choose an MCO. However, our system gives 28 days which affords the EB the opportunity to mail out the enrollment packets to the recipients Example of Enrollment Process • Eligibility 4/12/10 • PCT span placed on system 4/12/10 • PCT span begin date 28 days in the future 5/28/10 (28 days in future) • Transmission sent to Enrollment Broker (4/13/10) • Enrollment Broker has seven days to get enrollment packets to recipients (Including mailing and delivery by Post Office and weekends) • If recipient does not choose an MCO by 5/10/10 one will be automatically assigned. Government Health Services

10. Handouts • Completing the PAC-FAX Enrollment Form • Facility Registration Form • PAC-FAX Cover Sheet • PAC Comparison Chart (rev. 01/10) • PAC Enrollment Form – Training Copy • PAC Enrollment Form - Blank • PAC Health Services Needs Form • Outreach / Presentation Request Form Government Health Services

11. Q & A Session Notes: Government Health Services