Arizona State Hospital Patient BenefitsMedicare If a patient has Medicare upon admission, we are...

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Arizona State Hospital Patient Benefits Kimberly Goff, Patient Benefits Manager Kelly Ostroski, Social Service Representative

Transcript of Arizona State Hospital Patient BenefitsMedicare If a patient has Medicare upon admission, we are...

Page 1: Arizona State Hospital Patient BenefitsMedicare If a patient has Medicare upon admission, we are able to enroll them in a prescription drug coverage plan (Part D). Part A – Hospital

Arizona State

Hospital

Patient

Benefits

Kimberly Goff, Patient Benefits Manager

Kelly Ostroski, Social Service Representative

Page 2: Arizona State Hospital Patient BenefitsMedicare If a patient has Medicare upon admission, we are able to enroll them in a prescription drug coverage plan (Part D). Part A – Hospital

Main Topics

Affordable Healthcare Act

Arizona Health Care Cost

Containment System (AHCCCS)

Social Security Administration

SMI Determinations

Page 3: Arizona State Hospital Patient BenefitsMedicare If a patient has Medicare upon admission, we are able to enroll them in a prescription drug coverage plan (Part D). Part A – Hospital

Affordable Care Act (ACA)

and what it means for patients

National Health Insurance Marketplace

Links state healthcare programs

(AHCCCS) to the national health care

system and public programs such as

Nutrition Assistance, Cash Assistance and

Social Security

Verifies eligibility through the Federal Hub

Page 4: Arizona State Hospital Patient BenefitsMedicare If a patient has Medicare upon admission, we are able to enroll them in a prescription drug coverage plan (Part D). Part A – Hospital

How it Links Federal Health

Insurance Marketplace

Social Security

Administration AHCCCS

Page 5: Arizona State Hospital Patient BenefitsMedicare If a patient has Medicare upon admission, we are able to enroll them in a prescription drug coverage plan (Part D). Part A – Hospital

Changes

October 1st 2013

Arizona Health Care Cost Containment System

(AHCCCS) is linked with the Federal Health

Insurance Marketplace

Health-e-Arizona becomes Health-e-Arizona Plus

Open enrollment with the Marketplace begins

January 1st 2014

Marketplace coverage begins

March 2014

Open enrollment closes

Page 6: Arizona State Hospital Patient BenefitsMedicare If a patient has Medicare upon admission, we are able to enroll them in a prescription drug coverage plan (Part D). Part A – Hospital

Taxes and Exempt Groups Under the law, most individuals who can afford it will be

required to obtain basic health insurance coverage or

pay a fee to help offset the costs of caring for uninsured

Americans. If affordable coverage is not available to an

individual, he or she will be eligible for an exemption.

Exempt Groups:

Forensic patients – classified as incarcerated

Veterans who are enrolled with the VA

Page 7: Arizona State Hospital Patient BenefitsMedicare If a patient has Medicare upon admission, we are able to enroll them in a prescription drug coverage plan (Part D). Part A – Hospital

Forensic Patient

Benefits

Page 8: Arizona State Hospital Patient BenefitsMedicare If a patient has Medicare upon admission, we are able to enroll them in a prescription drug coverage plan (Part D). Part A – Hospital

SMI Determinations

and New AHCCCS Category

Request SMI determination from the Regional

Behavioral Health Authority (RBHA)

Clinic and evaluator is assigned to complete

the SMI evaluation by conducting an

interview and/or medical records review

Supplemental Security Income Medical

Assistance Only (SSI MAO)

Eligibly Fact Sheet www.azahcccs.gov

Page 9: Arizona State Hospital Patient BenefitsMedicare If a patient has Medicare upon admission, we are able to enroll them in a prescription drug coverage plan (Part D). Part A – Hospital

AHCCCS Arizona’s Medicaid Agency

Forensic patients are not eligible to be enrolled with AHCCCS while at the Arizona State Hospital

AHCCCS applications can be submitted 45 days from discharge

Health-e-Arizona Plus and AHCCCS Online www.healthearizonaplus.gov

Freedom to Work Program for individuals who are working and

have a disability

MARK Program

Page 10: Arizona State Hospital Patient BenefitsMedicare If a patient has Medicare upon admission, we are able to enroll them in a prescription drug coverage plan (Part D). Part A – Hospital

Social Security SSI – Supplemental Security Income

Based upon income, resources and disability or age (65 and older)

SSDI – Supplemental Security Disability Income Based upon disability and the “recent work” and “duration of

work” tests

Reinstatements Applying for Social Security

90 days prior to discharge

Online Report

Interview

Function Report/Medical Records

Day of Discharge

Appointments – Psychiatric and Physical Evaluations

Page 11: Arizona State Hospital Patient BenefitsMedicare If a patient has Medicare upon admission, we are able to enroll them in a prescription drug coverage plan (Part D). Part A – Hospital

Payor Financials

Overview of the patient’s finances,

insurance and benefits

Medicare prescription drug coverage

and rights as a Medicare patient

Can be used to show proof of income for

AHCCCS applications

Page 12: Arizona State Hospital Patient BenefitsMedicare If a patient has Medicare upon admission, we are able to enroll them in a prescription drug coverage plan (Part D). Part A – Hospital

Medicare

If a patient has Medicare upon admission, we are able to enroll them in a prescription drug coverage plan (Part D).

Part A – Hospital Insurance

Part B – Medical Insurance

Part C – Medicare Advantage (also known as a Medicare Health Plan which is an opportunity to receive Part A and Part B through a Medicare Advantage organization or approved company)

Part D – Prescription Drug Coverage The Arizona State Hospital contracts with Cigna

www.SSA.gov

Page 13: Arizona State Hospital Patient BenefitsMedicare If a patient has Medicare upon admission, we are able to enroll them in a prescription drug coverage plan (Part D). Part A – Hospital

Pop Quiz

At what point in a patient's stay are Payor

Financials completed?

When do forensic patients become

eligible for AHCCCS?

Can patients work and still be eligible for

AHCCCS?

Page 14: Arizona State Hospital Patient BenefitsMedicare If a patient has Medicare upon admission, we are able to enroll them in a prescription drug coverage plan (Part D). Part A – Hospital

Civil Campus

Patient Benefits

SMI Determinations

AHCCCS

Social Security

Medicare

Payor Financials

ALTCS

Page 15: Arizona State Hospital Patient BenefitsMedicare If a patient has Medicare upon admission, we are able to enroll them in a prescription drug coverage plan (Part D). Part A – Hospital

SMI Determinations

Must be evaluated by RBHA

Page 16: Arizona State Hospital Patient BenefitsMedicare If a patient has Medicare upon admission, we are able to enroll them in a prescription drug coverage plan (Part D). Part A – Hospital

AHCCCS

SMI/MAO Category

Adult Category

Freedom to Work Category

Page 17: Arizona State Hospital Patient BenefitsMedicare If a patient has Medicare upon admission, we are able to enroll them in a prescription drug coverage plan (Part D). Part A – Hospital

Social Security (Start process 90 days from discharge)

Reinstatement

We notify Social Security at time of discharge

Patient take discharge papers to local office

30 day wait period and payments will begin.

New Claim Sign consents

Complete online report

Set up interview date and time

Complete interview

Complete function reports and send medical records.

We notify social security at time of discharge

Patient takes discharge papers to local office

Appointments for exam

3-6 month wait for decision

Page 18: Arizona State Hospital Patient BenefitsMedicare If a patient has Medicare upon admission, we are able to enroll them in a prescription drug coverage plan (Part D). Part A – Hospital

Medicare

Must have A and/or B to qualify for D

Part A and B cover medical

Part D covers medications

Currently contracted with Cigna

Page 19: Arizona State Hospital Patient BenefitsMedicare If a patient has Medicare upon admission, we are able to enroll them in a prescription drug coverage plan (Part D). Part A – Hospital

Payor Financials

Payor Financial form

Insurance and Benefits form

Medicare forms, if applicable

Page 20: Arizona State Hospital Patient BenefitsMedicare If a patient has Medicare upon admission, we are able to enroll them in a prescription drug coverage plan (Part D). Part A – Hospital

ALTCS

Trumps AHCCCS

Now will stay with ALTCS while at AzSH.

Page 21: Arizona State Hospital Patient BenefitsMedicare If a patient has Medicare upon admission, we are able to enroll them in a prescription drug coverage plan (Part D). Part A – Hospital

Pop Quiz Time

How far out from discharge can we start

the process for social security?

Can you have Medicare Part D without

Part B?

Can AzSH complete SMI evaluations?

Page 22: Arizona State Hospital Patient BenefitsMedicare If a patient has Medicare upon admission, we are able to enroll them in a prescription drug coverage plan (Part D). Part A – Hospital

RESOURCES Kimberly Goff – 602-220-6128

Kelly Ostroski – 602-220-6351

AHCCCS - www.healthearizonaplus.gov

Social Security – www.ssa.gov

Magellan ( Maricopa county) – 602-222-9444

Cenpatico (Gila, Pinal, Yuma, La Paz, Cochise, Greenlee,

Graham) – 866-495-6735

NARBHA (Mohave, Coconino, Apache, Navajo, Yavapai) – 877-756-4090

CPSA (Pima) – 520-622-6000

http://www.healthearizonaplus.gov/
http://www.ssa.gov/
Page 23: Arizona State Hospital Patient BenefitsMedicare If a patient has Medicare upon admission, we are able to enroll them in a prescription drug coverage plan (Part D). Part A – Hospital

Questions?


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