DSS ADMINISTRATIVE LETTER NO. 02-2002
DSS ADMINISTRATIVE LETTER: 09-2001
ADULT AND FAMILY SERVICES
THE INFORMATION IN THIS LETTER APPLIES TO MECKLENBURG COUNTY ONLY
DATE: December 20, 200l
SUBJECT: Policy for Mecklenburg County Managed Care Education And Enrolment
DISTRIBUTION: County Directors of Social services
Medicaid, Work First, and Special Assistance Supervisors and Caseworkers
Public Consulting Group (Health Benefits Advisor)
The purpose of this letter is to provide directions for educating and enrolling eligible Mecklenburg County Medicaid recipients in a managed care program.
HMO risk contracting, Carolina ACCESS, and ACCESS II/III are Medicaid managed care programs that link Medicaid recipients with a primary care provider who is responsible for providing and coordinating most of their health care needs. Managed care improves access to medical care for recipients and provides a more effective medical delivery system for the state and county.
Since its implementation in 1996, Health Care Connection, Mecklenburg County’s Medicaid managed care program, has been the primary medical delivery system for Medicaid recipients who reside in Mecklenburg County. Health Care Connection is a Medicaid managed care program whereby the Division of Medical Assistance (DMA) contracts with licensed Health Maintenance Organizations (HMOs) to provide and coordinate medical services for certain Medicaid eligibles on a full-risk capitated basis.
Beginning January 7, 2002, Health Care Connection will be expanded to offer Carolina ACCESS/ACCESS II enrollment in addition to HMOs. Carolina ACCESS/ACCESS II is a Medicaid managed care program whereby certain Medicaid eligibles are required to select a primary care provider (PCP) to manage and coordinate their health care needs. Thus, eligible Mecklenburg County Medicaid recipients will have the option of enrolling with an HMO or a Carolina ACCESS/ACCESS II provider.
The current process for enrolling recipients in a managed care program will change beginning January 7, 2002. Enrollment with an HMO or a Carolina ACCESS/ACCESS II provider will be accomplished by entering the appropriate seven-digit provider or managed care exempt number in the Carolina ACCESS field on the individual screen of the DSS-8125. All current HMO exempt numbers will be converted to corresponding managed care exempt numbers, e.g., 9099503 will convert to 9999903. A list of the new exempt numbers is included.
Recipient education and enrollment in Mecklenburg County is the responsibility of Public Consulting Group (PCG), the County Department of Social Services’ Eligibility Caseworkers, and DMA. Public Consulting Group is considered to be the lead agency with regard to recipient education and enrollment. However, potential Medicaid eligibles should be educated about managed care by their caseworker during the initial point of contact, which is normally when the individual makes an application. Recipients should also be provided managed care education at the time of their re-certification for Medicaid.
Step 1. Educate the applicants/recipients about HMOs and Carolina ACCESS.
Step 2. Give each applicant/recipient an HMO-Carolina ACCESS ‘Recipient Handbook’ and point out the plan comparison charts.
Step 3. Let applicant/recipient review the Medicaid Provider Directory to choose a Health Plan and/or provider.
Step 4. Complete each area of the Managed Care Enrollment Form.
Step 5. When completed, place the Managed Care Enrollment Form in the appropriate place as designated by DSS.
Step 6. Refer applicants/recipients to PCG to address special needs or health care provider concerns.
Step 7. Assign CA/HMO exempt number 9900030 or the appropriate managed care exempt number when the application is made/approved.
If you have any questions regarding Mecklenburg County managed care education and enrollment, please contact DMA’s Managed Care Section at 919-857-4022.
Nina Yeager, Director
Division of Medical Assistance
Pheon Beal, Director
Division of Social Services
(This material was researched and prepared by Darryl Frazier, Program Operations Supervisor in the Managed Care Section.)
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.