Health Planning Council
Case Managers Meeting
March 7th, 2014
Updates
· This month is the final month of the contract
· We will be sending out a 1 year 1 page contract renew
· March 31st is the last day of the contract; invoices are due 30 days after.
· Guidance have been sent out, please remember that guidance’s are suggestions, and please don’t turn away any clients due to financial reasons, call HPC if any questions and we can try and work something out.
AICP/ADAP/ACA
· There is going to be a Pilot Program, a select group of clients will be chosen and we will need to try and enroll them into ACA by March 31st-We have yet to receive the list.
· Some of the clients will remain on ADAP and RW
· Call HPC if you need a navigator
Charlotte County
· Charlotte County is stopping RW, HOPWA, and AICP/ADAP services. Desoto is going to be taking and is going to be providing services in Charlotte County at the Virginia B Andes Clinic.
Clear Health Alliance
· Mary Kay Brothers was a speaker and spoke about the new Medicaid Managed Care.
· There are going to be 4 plans:
o Staywell/Wellcare
o Sunshine
o Integral
o Prestige
· Medipass is going to be going away
· Everyone that qualifies must be in a Managed Care Plan by May 1st
· Clear Health Alliance specializes in clients with HIV
· DentaQuest is going to be handling clients dental needs
RW Policies and Procedures and Forms
· All forms that are needed can be found on the HPC website
· Case Management Invoice and Superbill
o Case Management Invoice
§ Must be submitted electronically in Excel
§ Due by the 10th of every month
o Superbill
§ Must be submitted electronically in Excel
§ Due by the 10th of every month
· FTTY Report
o Due by the 10th of every month
o If late there will be a fine of $100 a day
o If there are technical issues, please let HPC know so no penalty will occur
· CareWare Audits
o Every month a CareWare Audit is performed
§ HOPWA- it is going to be 5% of you agencies HOPWA Clients, supervisors will need to return a HOPWA checklist on the chosen clients file
§ RW- Will be 5 Clients, the agencies will be rotated
o Due but the 10th of every month
o There has yet to be any fines, due to the fact that this was a new procedure, we are now going to be applying fines for those that are late
· Standard Authorization
o We have updated the Standard Authorization Form to include an exception section.
o The exception section is for items that are not on the formulary
o The dental fee schedule has not changed
· Mental Health
o There are no new changes for Mental Health, everything has stayed the same.
· Pharmaceutical Policy
o Refer to the Pharmaceutical and Formulary Policies prior to requesting medications.
o All requests for uninsured clients must be faxed to Sarasota County Pharmacy
o If not possible to use SCHD Pharmacy to render services the exceptions request should be completed
· Health Insurance Premium Assistance
o Refer to the Health Insurance Policy
o There must be a one-time AICP denial/ or letter from the employer that states that they do not accepts 3rd party checks
o Premium Invoice
· Health Insurance Copy/Deductible
o Refer to the Health Insurance Policy
o There must be a one-time AICP denial/ or letter from the employer that states that they do not accepts 3rd party checks
o Explanation of Benefits page
HOPWA Policies and Procedures and Forms
· We are required to use HOPWA state Form which can be found on the HPC website.
· On the HOPWA Assistance Form, where it states the Property Appraiser Strap #, there only the last 4 digits are required. We no longer need a copy.
o HOPWA Rent/ Mortgages
§ Every request needs to include the HOPWA Assistance Form
§ For first time HOPWA Rent/Mortgages- pertinent pages from the lease needs to be included
§ The shelter form is allowed however, it’s the exception not the rule. There needs to be an explanation in the clients file why there is no Lease.
AICP Policies and Procedures and Form
· Every request should include the AICP Request to pay Health Insurance Premium/Special Services Form
· There are no changes when it comes to AICP, the policies and procedures have stayed the same.