Third Party Liability

1. Third Party Liability MFWCCA Conference 2008 Duluth 10/08,09/2008

2. Benefit Recovery COB/TPL Jan Taylor, Manager Benefit Recovery Section DHS Health Care Operations Jan.taylor@state.mn.us 651-431-3139

3. Benefit Recovery Section • Responsible to ensure that MHCP is payer of last resort; all other resources must be used to fullest extent • Partner with financial worker staff in many ways to gain information and fulfill responsibilities • Important that clients understand their responsibilities about TPL

4. Units within BRS • Health Insurance Unit • Tort Liability Unit • MA Lien and Estate Recovery Unit • Medicare Revenue Enhancement (LTC) See Handout Pg. 1—BRS Contact List

5. Health Insurance Unit Maintain the TPL Resource File in MMIS • Reviewing county added TPL records (including those interfaced from PRISM) • Incoming faxes from medical providers—updates • Reviewing Possible Insurance Cases for unknown TPL See Handout—Attachment A

6. Health Insurance Unit • Bill health insurers for retro coverage --Processing TPL payments/denials • Review & Approve Cost Effective Health Insurance policies • File updates with data match results • Child support (daily) • Tricare (annually) • Other insurance carriers (current RFP)

7. Medicare & LTC Insurance are TPL • Regardless of where the payment of benefits is directed • LTC insurance must be coded as a policy in MMIS/TPL Resource • Providers of LTC services must bill and report receipt of payment on the claims submitted to MHCP

8. Do Not Treat LTC Insurance Proceeds as Income/Assets • If the policy is not specifically “income replacement” it is TPL • If benefits are payable as a result of home care services or NF services = TPL • Client or personal rep must pay the benefits to the nursing home

9. Coverage Types Expanded • MMIS has new Coverage Types for the expanded benefits of LTC insurance • 13—Nursing Home Only • 27—Nursing Home + Home Care* • 28—Nursing Home Only (Partnership Qualified)* • 29—Nursing Home + Home Care (Partnership Qualified)* *New Coverage Types were Implemented February 2008; See LTCP Bulletin #08-21-08.

10. Services Covered by Managed Care Organization (MCO) • If SNF or Home Care services are covered by an MCO, LTC insurance benefits are payable to the MCO • The LTC insurance payments must be reported on the claims submitted to the MCO • The MCO is secondary to LTC insurance benefits

11. New Initiatives for Improved Efficiency • Quality improvement process (Lean/Kaizen) used for three major BRS processes • County staff members participated in a short-term “Focus Group” to review draft products and provide input

12. Cost Effective Health Insurance • Decision Tree (In Development) • Decision Tree (State Agency Staff) • “Standard Work” Document in Use for BRS Staff

13. Process Changes Identified • CEHI Form is being revised (Draft) • MMIS Request for “Combo Screen” of data relevant to CE review • Use of Fax for Future Requests and Workflow Changes

14. State Plan Amendment to CMSSee Handout—Attachment B

17. Tort Liability Unit • Pursues TPL Related to Accidents/Injuries --Grant money may be part of BRS Claim • “Leads” to Cases • Client has a duty to report • Attorney for client is looking for medical expenses paid as related to the injury • Medical Service Questionnaires are generated • Refer calls/correspondence to BRS

18. Tort Liability • Types of Tort TPL • Workers’ Compensation (DOLI data match) • Auto no-fault/auto litigated • Homeowners’ Insurance • Medical Malpractice • Product liability (rx drugs, devices, etc.) • Personal Liability • Class Action or Multiple Plaintiff Cases

19. MSQ Process • “Standard Work” (final) • FAQs Document (See Handout—Att. D) • MMIS Changes • Improve compliance with form completion/return • Reduce turn-around time

20. Form Revision • Simplify form & use “flash print” or “script” process rather than hard copy forms (pin-feed)

21. DHS 2237/2237ASee Handout—Att. C

25. Proposed New MSQProcess • Daily process and direct mail of First/Sec. Notice MSQs • Move parameters on notices up (from 90 days to 60 days to 45 days) • Rely on county staff to apply closing guidelines at Worker Message

26. MA Lien & Estate Recovery • County agency staff send MA Lien Referral Worksheets and SNT Referrals to BRS • BRS staff file MA property liens when appropriate and monitor SNT clients • County Agency staff file estate claims upon the death of the last surviving spouse • BRS provides technical assistance to county collections staff

27. Medicare Revenue Enhancement (MREP) • Program to ensure that Medicare benefits are used first for LTC Services • LTC facilities required to submit documentation for review of potential cases • Technical assistance provided to LTC facilities re: Medicare, and other requirements

28. Deficit Reduction Act (DRA) & LTC Partnerships • MN passed implementing language effective 07/01/06 based on DRA authority given to states • More people will be buying LTC insurance which may or may not be Partnership qualified • All LTC insurance has the effect of protecting assets (by virtue of providing the benefit)

29. Goals • Effective communication with external customers (develop and maintain presence on public and county websites, etc.) • More efficient processes with better results • Continue to review & implement changes

30. Questions? Your Thoughts?