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Delaware PERM Pilot Round 1

Delaware PERM Pilot Round 1. Jennifer Harris Social Service Administrator Quality Control Phone: (302) 255-9119 Email: Jennifer.Harris@state.de.us. DHSS Organizational Background. Division of Medicaid and Medical Assistance (DMMA) Long Term Care Medicaid SSI Medicaid.

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Delaware PERM Pilot Round 1

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  1. Delaware PERM PilotRound 1 Jennifer Harris Social Service Administrator Quality Control Phone: (302) 255-9119 Email: Jennifer.Harris@state.de.us

  2. DHSS Organizational Background Division of Medicaid and Medical Assistance (DMMA) • Long Term Care Medicaid • SSI Medicaid Division of Social Services (DSS) • All other MA types (Including MAGI) • Food Benefits • TANF • Child Care • Division of Management Services- Bureau of Quality Control • Reviews Medicaid, Food Benefits and Child Care

  3. Delaware Quality Control-Background • Staff complete both Food Benefit and Medicaid Reviews • Small staff • 8 full time review staff • 2 casual-seasonal staff (limited hours) • 1 supervisor/1 administrator • 1 temporary employee (Child care reviews only)

  4. Delaware Pilot #1 Approach • Sampled 170 Medicaid; 30 CHIP • Sampled at individual level • Sampled twice • 12/2013 • 2/2014 • Simplified approach to reviews given CMS flexibility in pilot guidance

  5. Delaware Approach • Reviewed various timing options for sampling • Reviewed number of staff vs number of cases to be completed • Prior contractor use • Determined best option- hire contractor to complete 100 of the reviews • Contractor completed the second sample (2/2014)

  6. Splitting reviews between contractor and state staff Benefits: • State staff maintain knowledge • State staff given more time to complete reviews • Reviews were sampled from 12/2013(in 2/2014) • Reviews were staggered for completion- 2 reviews required weekly • Spread 100 over 3 months (state staff)

  7. Delaware Approach Contractor benefits: • Final reporting • Determining root causes • Development of the work documents such as building budget in Excel spreadsheet for MAGI • Completion of reviews 100 reviews- State monitored sample of correct cases and reviewed all errors and administrative errors • Decision making for the round 2 pilot • Sample plan for round 2

  8. Challenges…. • Timeframe between CMS pilot guidance and sampling proposal deadline • Delays in getting approval to get RFP posted • New policy for QC staff • New system for QC staff • New type of review (guidelines, work papers, tracking) • New eligibility system

  9. Challenge Solutions • Hired Contractor • Contactor completed 100 reviews • State Staff completed 100 reviews • Assist state due to small QC department- • Assists with completion of reviews • Assists with reporting requirements • Assists with development of documents used in reviews

  10. Challenge Solutions Continued…. • State Staff Training • Training provided for new system- QC staff participated • No training provided by department on MAGI policy • Training Guide Developed

  11. Results-Actives • Active Medicaid- 4 errors • 2 cases- Income did not count • 1 case- Prior review not completed caused system issues • 1 case- Household size incorrect • Active CHIP-0 errors

  12. Results-Negatives • Negative Medicaid- 7 errors • 1 case- Incorrect household size • 1 case- Documentation in case file not used • 1 case- Client not provided 30 days to respond • 1 case- Denied without using self-attested income • 1 case- Denied for no interview • 1 case- Income incorrectly budgeted • 1 case- Non-taxable income included in budget • Negative CHIP- 0 Errors

  13. Questions??

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