Healthcare Update - September 2018
Key Highlights This Month:
As mentioned during the August METS discussion forum, the Enterprise Architecture Board (EAB) made a motion that the METS Program Management Team (PMT) should conduct an analysis by November 1, 2018, to develop:
a) An agreed upon understanding of what functionality the system should perform to be operationally efficient, and to be in compliance with federal and state requirements;
b) A high level timeline and resource estimate for achieving the functionality identified;
c) Specific priorities from the counties for the functionality improvements to be considered in the next 2 to 3 years, that include measurement goals to define what success looks like.
PMT continues its work on this request
The METS 18.3.1 release is scheduled for the weekend of September 14 -16, 2018. The following work will be included:
- Notices: There are 12 defect tickets that will be resolved in 18.3.1. The changes implemented by the Notices project will primarily impact Auto-Renew, Need-to-Renew & Modified Need-to-Renew notices.
- Defect Management: Defect Management is implementing several changes that state and county workers will notice at renewals.
In addition, there is an outstanding error that affects clients in the client portal that is being resolved. Currently some clients receive 403 & 404 errors that do not respond to standard troubleshooting. The root cause for that issue is being resolved in this release.
- Annual Changes: The FPL Annual Changes project will load the 2018 FPL tables for MCRE/IA/UQHP into METS. In addition, the Advanced Premium Tax Credit (APTC) and Unassisted Qualified Health Program (UQHP) limits are updated and the Employee Sponsored Insurance (ESI) affordability standards are updated. The Income & Asset Guidelines will be subsequently updated to reflect these changes.
- Interface Redesign: The Interface Redesign project team is finishing work that includes streamlining and refining how information moves from METS to MMIS at Initial Application, Manual Renewal and Change in Circumstance. This will resolve a number of interface issues and provide faster, more accurate interface of coverage information. Defects we expect to see resolved include:
- Various defects where the wrong MPET interfaced to MMIS
- Several defects where the incorrect dates interfaced to MMIS either after CIC or renewal.
- Defects where coverage does not interface for certain member relationships: Aunt/Uncle/Niece
- Reduce the number of rejections by MMIS, which will result in more cases interfacing.
Due to the extension of open enrollment to January 13, 2019, the METS 18.4.1 Winter Release Projection Deployment date has been shifted to January 6, 2019.
A federal lawsuit has resulted in an estimated $85 million being returned in 2018 to Minnesota for MinnesotaCare. This is funding that the federal government cut last fall, eliminating cost-sharing related payments. The Centers for Medicare & Medicaid Services (CMS) worked with the State on a new funding formula. It is unknown at this point whether these adjustments will be made for 2019.
Estate Claim Minimum Report (From SIR): Beginning in August, the Minnesota Department of Human Services (DHS) began placing a new report, Estate Claim Minimum Report (ECMR), in your county's MN–ITS mailbox each Monday. You will get one report for each decedent on your county's weekly Death Data Match report, which is also placed in your county's MN–ITS mailbox each Monday. The ECMRs are an essential resource for your county in efficiently recovering the federal minimum recoverable amount of Medical Assistance (MA) benefits received by MA members who are now deceased.
Requested Actions Needed From MACSSA:
New Trends in This Area:
The Periodic Data Matching (PDM) Field Test is still in progress. Very few system issues have been reported, and the assessment work group reports a low call volume thus far. The September 2018 PDM cutoff batch ran on September 7, 2018, and 2,567 integrated cases were selected for processing.
Issues/Concerns Regarding This Topic:
Effective January 1, 2019, Medicare Cost plans will end in most counties. Affected people are receiving notices from Medicare and their Medicare plan that will explain the changes, and they will need to change plans to ensure they have coverage.
Counties continue to report issues/concerns with changes to Cost Effective Health Insurance (CEHI) forms and procedures. The following feedback was shared with DHS at the August County Roles and Responsibilities (CRR) meeting:
- The forms are too long and wordy – concerns that the clients will not read them
- Difficulty determining dental and vision policy
- Cost-effective flowchart can be confusing
All states were required to have an Asset Verification System (AVS) in place by October 2013. However, the MN Legislature did not appropriate funds to implement this system until 2018. Minnesota is currently under a CMS corrective action plan to implement AVS no later than February 1, 2019. The populations impacted include people age 65 and older, disabled, blind as well as those whose assets deem to them (spouses and sponsors). MN is launching an implementation project to identify configurations needed. County representation on the project will be sought.