Our presentation today is short but full of what we hope is useful information for your practice. We will go over the basics of the Kentucky HEALTH

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2 Our presentation today is short but full of what we hope is useful information for your practice. We will go over the basics of the Kentucky HEALTH program and what you need to know for 7/1. We will highlight some of the work our Community Engagement team is doing to educate our member community. And lastly, we will cover ways to make sure you are prepared for go-live on 7/1. Lets get started! 2

3 So, what is Kentucky HEALTH? Kentucky HEALTH, which stands for Helping to Engage and Achieve Long Term Health, is the Commonwealth s new health and well-being program for non-disabled low-income adults on Medicaid. The program Seeks to break the cycle of poverty through efforts on several fronts: Encourages members to improve their health by incentivizing preventive care, participation in disease management programs, and healthy lifestyles. Embraces private market policies and principles to familiarize members with commercial health insurance coverage to prepare them for the commercial market. Focuses on addressing Kentucky's growing drug abuse epidemic. Focus on engaging members in the community, either through employment or preparing for employment, as well as volunteer activities. Kentucky HEALTH aims to achieve this by using key components: 1. Cost Sharing where members will have premiums or copayments. 2. My Rewards Account where members will have the opportunity to earn funds for completing certain activities and courses. 3. Deductible Account which will track members non-preventative services to show the true cost of healthcare. 3

4 4. Community Engagement/PATH program encourages members to become involved in their community and seek employment opportunities. 5. Education and Training provides courses members can take to clear penalties, to earn funds for their My Rewards Account and to meet their Community Engagement Requirements. 6. Premium Assistance which helps members gain access to a commercial primary insurance through their employer. 3

5 Approximately 88% of Passport s current membership will be impacted by the KYH program. While pregnant women, children, medically frail and former foster care children are not cost share or community engagement required, they are still part of the KYH bucket as these populations could or will transition from these categories and into the ABP. 4

6 Passport s KYH population received new insurance cards as of June 21 st. The new cards feature the KYH logo in the upper right-hand corner, making it easy to identify a KYH member upon presenting to your office. 5

7 Providers can also identify their KYH members by what we call the member line of business or, LOB. This is a 4-digit code that will indicate the Kentucky HEALTH plan the member is currently enrolled in. Please note the member LOB is specific to Passport Health Plan only and is visible in the provider portal when viewing member eligibility. This is not something you will see on any other MCO portal or within HealthNet. If the 1 st digit is a W this will indicate a Kentucky HEALTH member. The 2 nd digit will indicate the type of member such as child, Former Foster Care, Medically Frail, etc. The 3 rd digit will indicate if a member has retroactive coverage, notice the R. The 4 th digit will show the members cost share requirement. Notice the C will indicate they are copay required. This code will be present under the member policy benefit name section of a members profile within the provider portal. The LOB key is also available on our website under the Kentucky HEALTH section of the provider tab. This could be a useful tool to have for you office staff especially those that check eligibility and cost share requirements on a regular basis. 6

8 The image you see here is a snapshot from our provider portal. This will appear when a provider performs an eligibility search on a specific member. Once the member ID is entered and searched, click on the members name and their profile will appear. The members LOB along with the description will appear under Policy Benefit Name within the eligibility section. A quick tip for PCP s: if you download the member panel roster from the portal, you will be able to filter the report for KYH members only or Medically Frail members only using the member LOB. This can help provide a quick snapshot of your Passport patients. 7

9 The Kentucky HEALTH program consists of 2 benefits packages: the Alternative Benefit Plan, often referred to as the ABP, and the State Plan. The Alternative Benefit Plan is designed to provide individuals with a commercial insurance experience with cost sharing and deductible accounts. This benefit plan is aligned with Fee-For-Service Medicaid. Members will receive dental and vision benefits through their My Rewards Account with the exception of 19 and 20 year olds as they will continue to receive EPSDT services therefore will still have access to dental and vision. Non-emergent medical transportation is also non-covered within the ABP. The Kentucky State Plan is consistent with current Medicaid benefits. Members will have cost sharing and deductibles. Members also have access to dental, vision via their MCO and non-emergent medical transportation via the State. 8

10 The listed populations are impacted by KYH. Traditional Medicaid Adults and Medicaid Expansion Adults will see the impact of KYH on 7/1 in the form of paying premiums and community engagement requirements however, pregnant women, children, medically frail adults and former foster care children will not be cost share or community engagement until they transition from those categories. It is important to note that the only population that may never transition from one of these categories is medically frail, depending on the members condition. Individuals who are part of Medicaid waivers such as home and community based waiver, michelle p waiver, etc. are not impacted by KYH. 9

11 Cost sharing introduces members to commercial plan features by way of premiums and copays. Kentucky HEALTH members will initially begin in the premium plan and have a monthly premium ranging from $1-$15. Invoices were mailed on June 21 st with a due date of 60 days from the date of the invoice. Members can make their premium payment in a variety of ways: Over the phone by calling the number on their invoice or our member services department, online via the website listed on the invoice, by mail or in person at our Louisville or Prestonsburg locations. Members who do not make timely premium payments will be subject to varied nonpayment penalties. For those that are at or below 100% FPL they will transition to the copay plan and be required to pay copays for applicable services. For those that are above 100% FPL they will either be disenrolled if they never made their initial premium payment or they will be suspended if they were an ingoing paying member and stopped making their payments. It is important to note that members will never have both premiums and copays. It is one or the other. For a list of copay required services and their rates, please refer to the Kentucky HEALTH and Passport Provider Quick Reference Guide located on in the Kentucky 10

12 HEALTH section of the provider tab on our website, passporthealthplan.com. Please note there have been a few minor changes to these copays: urgent care no longer has copays and Rural Health Clinics, Federally Qualified Health Centers and Primary Care Centers now have copays. We are in the process of updating the QRG, please keep checking our website for the latest and greatest version! Medically frail and former foster care children (up to age 26) are cost share optional meaning they have the ability to opt into the premium plan and obtain access to a My Rewards Account if they wish. Regardless of if these specified populations opt in or not, they will always have access to vision and dental via their MCO. The benefits to opting into this plan is to have a safety net in the event a member ever transitions from medically frail or after age 26 for former foster care. 10

13 Third parties with the exception of MCO s can make a premium payment on behalf of the member. To do so simply log into the member payment portal and click one-time payment. Enter the myeasymatch code found on the members invoice, as you can see on this slide it is in the lower left-hand corner of the invoice. Continue to follow the payment prompts. When the payment has been submitted a confirmation number will be generated and the payer will have the ability to print or save a copy of the receipt. Third party payment using the myeasymatch code can also be made via phone by calling the number listed on the invoice. 11

14 Members who are up-to-date on their premium payments will have access to a My Rewards Account. This account allows members to earn dollars by completing various activites ranging from preventatives services to community engagement activities. These dollars can be used to pay for dental and vision services as members who are enrolled in the Alternative Benefits Plan will not have access to vision and dental benefits via their MCO. Vision and dental providers have the ability to submit a funds reservation request via Kentucky HealthNet in order to receive payments for services. To reserve funds, a provider must be registered for access to HealthNet. Upon logging in providers will enter the applicable procedure codes they plan to perform on the date of service. Once the codes are entered, the appropriate fee schedule dollar amount tied to those codes will populate and allow the provider to reserve the funds. If the member has enough funds to cover the total amount requested in the reservation, a confirmation will be generated. If the member does not have enough funds, the request will be denied. My Rewards Account is only available to those who are actively paying their monthly premiums on time. Members who have defaulted to the copay plan or who have become suspended/disenrolled with not have access to their My Rewards Account. Members can view their account status and balance at any time by logging into their 12

15 Citizen Connect account. Members cannot use their MRA funds to pay their monthly premiums or copays. 12

16 The deductible account functions as a tracking mechanism for non-preventative services. All Kentucky HEALTH members regardless of their plan will receive monthly deductible account statements showing the true cost of their healthcare. Each member will begin with a $1000 starting balance. Upon each non-preventative service being performed, the fee schedule rate paid to the provider will also be deducted from the members $1000 deductible account. There is no penalty in the event a members depletes the $1000 however, if there is a positive balance at the end of the calendar year the member has the opportunity to roll over 50% of the remaining balance into their My Rewards Account. 13

17 Community engagement otherwise known as PATH which stands for Partnering to Advance Training and Health is a unique program centered around community engagement and employments initiatives for Kentucky HEALTH members. It is designed to build and strengthen Kentucky s workforce/ Members who are identified as required to complete community engagement activities will be notified 90 days prior to their requirement start date. These members must complete 80 hours of qualifying activities per month. Members can log into their Citizen Connect account to search for, register and track community engagement activities. All completed activities for the current month must be entered and accounted for by the 7 th of the following month to prevent any penalties or suspensions. Children, pregnant women, medically frail, primary caregivers of a tax dependent, fulltime students, full-time employees and individuals meetings SNAP/KTAP requirements are exempt from the community engagement requirement. The community engagement requirement is being rolled out in phases. The first county to begin this requirement on July 1 is Campbell County in Northern Kentucky. For more information on the timeline please visit the Kentucky HEALTH section of the provider tab on our website. 14

18 Education and Training is an extension of the PATH program. Members can complete health and financial education classes to earn My Rewards Account credits, credits towards their community engagement requirements as well as end penalty periods. Members can locate certified classes via the Citizen Connect portal. 15

19 While individuals who are receiving premium assistance via the state will not be Passport members we still understand the importance of educating our provider community as a whole on the KYH program. Our provider quick reference guide has information regarding the premium assistance program. Beginning in 2019, some members may be required to obtain employer sponsored insurance. DMS will identify these members and educate accordingly. 16

20 Medically frail members may be identified one of 2 ways: via MCO claims data or a provider attestation. Passport has conducted an 18 month claims lookback and has identified, based on the claims data, approximately 15,000 members as being medically frail. These members have been sent to DMS and are showing as medically frail within Kentucky HealthNet as well as our provider portal. We have also identified approximately 13,000 members as potentially medically frail based on their claims data. Our Care Connector team will be working with these members to educate them on what medically frail is and the need for a provider attestation form. Our Care Connectors are also available for providers in the event they have any questions about the form or the submission process. Once the attestation form is submitted to Passport, please allow 7-10 business days from date of receipt to the member showing as medically frail within our portal if they are deemed as such. Every member we receive an attestation form on will receive a letter from Passport indicating they have either been deemed medically frail or the did not meet the criteria for such. In the event a members medically frail status as been denied, they do have the right to appeal this decision with Passport. In the event you believe one of your members could be medically frail, please check our 17

21 provider portal to see if they already have the medically frail designation. If they do not, please complete a medically frail clinician attestation form and submit it to Passport. When completing the attestation form it is important to use the condition guide as a companion as the attestation must have the required codes listed. If these codes are not present on the form, it will be marked as incomplete and a letter will be sent to the provider stating such. This form along with the condition guide can be found on our website under the Forms and Claims Information and Kentucky HEALTH section of the provider tab. The submission information in listed on the last page of the attestation form as well as in our quick reference guide. 17

22 Passport has a dedicated Member Services and Community Engagement team here to help our member community with any questions and concerns they may have surrounding KYH. Members may access us by calling Member Services or they can utilize out website, passporthealthplan.com to obtain information regarding their benefits and what may be changing for them. Members can also access passporthealthplan.com/together to be taken directly to information regarding KYH. We have created a member guide to KYH that helps educate our member community on the different aspects of the KYH program and what they can do to prepare for these changes such as keeping their address up-to-date and providing current information regarding their employment to DMS. Our Community Engagement team has numerous scheduled member education session that began on June 12 and run until October 31 st. These sessions allow members to come and learn about KYH in person as well as speak directly to a Passport KYH SME. We feel that this open communication will help our members understand the important role they play in taking charge of their health and wellbeing. We have also scheduled Community Outreach session that are open to the general public. For more information regarding these events or to find a session close to you, please visit and click Find Us in the Community under 18

23 the member tab. Passport s Community Engagement team is also utilizing Heallthify, a resource database, to assist members in finding additional resources to help solve for social determinants of health. 18

24 There are several things providers can do to ready themselves for the July 1 go-live date. 1. Make sure you are signed up for KY HealthNet and the passport provider portal. This will be important for your office staff as they will need to check each member s eligibility on the date of service to determine if a copay will need to be collected or if a member has been suspended or disenrolled. 2. If you are not signed up for the Passport Provider Portal logon now and selfregister! Here you will find information regarding a members cost share requirement, see if they are listed as Medically Frail and other information. 3. Review the Kentucky HEALTH website for program information and a list of FAQ s. Visit passporthealthplan.com and review the Kentucky HEALTH section, download the provider quick reference guide and the member line of business key. As we know, Kentucky HEALTH is an evolving program and likely to have changes. Our website will always have updated information and can be used as a one-stop-shop for all things Kentucky HEALTH and Passport! 4. Schedule a site visit with your provider representative to learn more about the KYH program and ask questions. Our Provider Relations Representatives are eager to assist you and your office staff any way we can. 5. Sign up for Passport s enews! We use enews as a way to educate our network on any changes, reminders and upcoming learning opportunities in real time. 19

25 Passport and our Provider Relations Representatives are committed to helping our provider network through this major change to Medicaid. Use us as a resource for your office staff and contact us with any questions you may have! 19

26 As we ve mentioned throughout this presentation, there are many avenues you can go through to get the information you need for a smooth transition to the Kentucky HEALTH program. Think of these resources as your tool kit for Kentucky HEALTH! Our website, passporthealthplan.com contains a wealth of knowledge and has great printable resources for your office. Our member and provider services team is also a great resource to lean on in the event you have questions. Passport remains committed to assisting our member community and provider network throughout the coming months as the KYH program continues to roll out. 20

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