insurance_Provider Enrollment and Online Provider Lookup - Strategy

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					                               Health and Human Services Commission
                     FREW Medical and Dental Initiatives

Proposal                Attachment 2: Online Provider Enrollment Simplification & Online Provider
                                              Lookup Enhancement Project
                                                  (Draft as of February 23, 2009)
                       In an effort to streamline the provider enrollment process and to encourage providers to
                       enroll in the Texas Medicaid Program, the Health and Human Services Commission
                       (HHSC) directed the Medicaid Claims Administrator, Texas Medicaid and Healthcare
                       Partnership (TMHP), to develop and implement an online provider enrollment
                       application. The application was launched on the TMHP website in March 2008. Since
                       its release, over 6,500 applications for individuals, groups or performing providers have
                       been submitted and successfully enrolled into the Texas Medicaid Program.

                       House Bill 2042, 80th Legislature, Regular Session, 2007, directed HHSC to establish
                       and administer an electronic, searchable, internet-based database of all participating
                       providers in the Texas Medicaid Program.

                   The legislation required that the database include at least the following for each
                   participating provider:
                       • Provider name
                       • Specialty
                       • Location
                       • Office Hours (including any office hours outside of regular business hours)
       Background:     • Telephone number
                       • Accepting new patients
                       • Any practice limitations (including specific age range limitations)
                       • Other languages spoken
                       • Any waiver programs that the provider participates in

                       HHSC worked closely with TMHP to develop the Online Provider Look-up (OPL)
                       based on the legislative requirements. The OPL was launched in November 2007 and to
                       date has had over 300,000 hits. The OPL also allows providers the ability to easily
                       update their provider information that is displayed on the OPL through the TMHP secure
                       portal and changes are made in real-time

                       The OPL is utilized by providers, clients, state agencies and contractors to locate
                       Medicaid providers and has proven to be a success. HHSC has received positive
                       feedback from providers and the community in relation to the OPL. HHSC has
                       continually reviewed the functionality of the OPL and is submitting this proposal to
                       make modifications to the search capabilities based on feedback from internal and
                       external users.


                     Modify the current online application by:
      Description of
                      Adding the ability to easily maneuver through the online application.
          Proposal:
                      Writing the provider agreement in layman’s terms so providers can easily
                     understand the agreement and expectations.

                                                  1 of 6                                        February 2009
                              Health and Human Services Commission
                      FREW Medical and Dental Initiatives

Proposal               Attachment 2: Online Provider Enrollment Simplification & Online Provider
                                             Lookup Enhancement Project
                                                 (Draft as of February 23, 2009)
                       Creating an expedited enrollment application for providers that are deemed into
                      the program, such as Vendor Drug Pharmacies.
                       Allow group providers to create a template which can be used for multiple
                      enrollment applications for the groups performing providers.
                       Allow providers to review the application online prior to final submission.
                       Allow a group provider to begin an application for a performing provider and for
                      the performing provider to complete and submit it for processing.
                       Modify workflow to reduce processing time by up to 12 weeks for provider
                      enrollment exception requests (e.g. waiver of Medicare enrollment requirement).
                       Various other changes that will make the application more user friendly.


                      Modify the current OPL by adding the following features:
                       Adding additional programs such as ICM and Foster Care to the search criteria
                       Allowing the user to refine their search and display only the provider
                      information they deem necessary
                       Creating simple, easy to understand definitions for the specialties displayed on
                      the OPL
                       Adding capability for a multiple zip code search
                       Enabling direct access for providers to update their provider information from
                      the OPL (to a secure portal)
                       Adding phone number to search results

                      The proposed changes to the OPL will allow providers and clients to perform
                      searches easier and more efficiently and the proposed changes to the online
                      enrollment application will simplify and streamline the enrollment process for
                      providers even further.

                      The provider enrollment process in place today is based on requirements contained
                      within the Code of Federal Regulations, Medicare and Medicaid rules and regulations,
                      and state licensing requirements that are specific to each provider type. The online
                      provider enrollment application allows providers to enroll into the Medicaid program
                      using questions and application requirements tailored to the type of provider that is
                      completing the application.
   Current Texas
   Medicaid Policy:   In November 2007, HHSC implemented the OPL in order to be in compliance with
                      Frew v. Hawkins Corrective Action Order: Adequate Supply of Healthcare
                      Providers and House Bill 2042, 80th Legislature, Regular Session, 2007, which
                      directed the Commission to establish and administer an electronic, searchable, internet-
                      based database of all participating providers in the Texas Medicaid Program. The OPL
                      can be found on the Texas Medicaid and Healthcare Partnership website
                      (www.tmhp.com).

                                                2 of 6                                        February 2009
                              Health and Human Services Commission
                       FREW Medical and Dental Initiatives

Proposal                Attachment 2: Online Provider Enrollment Simplification & Online Provider
                                              Lookup Enhancement Project
                                                 (Draft as of February 23, 2009)

                       The OPL allows users to search for an active Texas Medicaid provider that is
                       participating in any of the Medicaid models (fee for service, Primary Care Case
                       Management, STAR, STAR+PLUS). Users can search for providers based on zip code
                       or county. The results returned for each provider will contain information such as
                       provider name; specialty; location; office hours; telephone number; is the provider
                       accepting new patients; any practice limitations (including specific age range
                       limitations); other languages spoken; and any waiver programs that the provider
                       participates in within the Texas Medicaid program.

                       Costs are associated with technology and operational changes that must be
                       performed by the claims administrator, Texas Medicaid & Healthcare Partnership
                       and represent a one time cost to the state.
                       Provider enrollment and OPL enhancements - $1,566,698 million- all funds
                         OPL enhancements - $53,908 GR and $529,075 all funds

 Fiscal Assumptions      Provider enrollment enhancements - $103,762 GR and $1,037,623 all funds
        and Impact:      The state assumes a 90/10 federal matching rate for technology system
                          modifications.


                       Fiscal Impact:
                         SFY 2009 $78,335 general revenue ($783,349 all funds)
                         SFY 2010 $78,335 general revenue ($783,349 all funds)

                       Online enrollment applications are in place in a few other states and they differ
                       based on state specific enrollment requirements.
                       Many states have an online directory for medical assistance programs. The OPL
       Other States:
                       was modeled on various criteria that major insurance carriers utilize for their
                       member look up services. This provided for standardization across the programs.




                                                 3 of 6                                      February 2009
                              Health and Human Services Commission
                       FREW Medical and Dental Initiatives

Proposal                Attachment 2: Online Provider Enrollment Simplification & Online Provider
                                              Lookup Enhancement Project
                                                 (Draft as of February 23, 2009)
                       Advantages:
                          The changes to the online provider enrollment application will provide a
                            more efficient means for providers to enroll and lead to faster enrollment
Application to Texas        into the Medicaid program.
                   –      The changes to the OPL will allow for more refined searches to allow users
                            easier access to information to locate and contact a provider in the Medicaid
     Advantages &
                            program.
   Disadvantages to
       Funding this       Provider and user feedback has been included in the development process.
         Proposal:
                       Disadvantages:
                           None.

                                                    Increase
                          Increase the         participation
                            number of            of medical               Improve
                         children who            and dental           Appropriate
       Meets FREW                                                                             Improve
                               receive            providers          Utilization of
   related Objective                                            X                         Coordination      X
                             THSteps              who serve             Medically
                                                                                               of Care
                          medical and            children in            Necessary
                         dental check-            the Texas               Services
                                    up            Medicaid
                                                   Program
                                                         This Option should be considered in
                       Stand Alone Option       X        conjunction with other FREW Strategic
             Other                                       Initiatives
     Considerations


                                    1115 Waiver                                   Rules
   State and Federal
                                    Other Waiver(s)                               Legislation
         Approval(s)    Federal                                     State
           Required:                State Plan
                                    Amendment
                       Affected Stakeholders
                             HHSC, DSHS, DADS Medicaid operating areas
    Implementation
   Considerations &          Texas Medicaid providers
       Timeframes:
                             Texas Medical Association (TMA)
                             Texas Pediatric Society (TPS)

                                                4 of 6                                          February 2009
                  Health and Human Services Commission
           FREW Medical and Dental Initiatives

Proposal    Attachment 2: Online Provider Enrollment Simplification & Online Provider
                                  Lookup Enhancement Project
                                    (Draft as of February 23, 2009)
                 Texas Academy of Family Physicians
                 Texas Dental Association
                 Texas Osteopathic Medical Association
                 Texas Association for Home Care
                 Texas Hearing Aid Association
                 Texas Orthopedic Association
                 Texas Organization of Rural and Community Hospitals
                 Texas Hospital Association
                 Texas Association of Rural Health Clinics
                 Texas Association of Community Health Centers
                 Texas Assoc. for Home Care, Inc.
                 Texas Optometric Association, Inc
                 Texas Assoc. of Residential Care Communities
                 Texas Council of Community ICF/MR Centers
                 Texas Pharmacy Association
                 Texas Ambulance Association


           Systems & Resource Considerations
                 These changes will require modifications to the Medicaid Management
                  Information System (MMIS), portal and other automated systems operated
                  by the contract Medicaid Claims Administrator.
           Other Considerations
                 Minimal impact on other delivery systems operated by the Texas Medicaid
                  program but with a dependency on the claims payment system, MMIS.
                 Training providers on how to use the modified enrollment process and
                  training users on the new OPL search functionality.
                 Since the cost for the system modifications are in excess of $1 million, an
                  Advance Planning Document (APD) must be submitted to CMS for review
                  and approval to allow for a federal match.
           Implementation Timeframes (in months)


                                   5 of 6                                      February 2009
                            Health and Human Services Commission
                     FREW Medical and Dental Initiatives

Proposal              Attachment 2: Online Provider Enrollment Simplification & Online Provider
                                            Lookup Enhancement Project
                                              (Draft as of February 23, 2009)
                           A minimum of six to nine months to complete system modifications.


 HHSC Interagency The internal Frew Workgroup provided unanimous support for this proposal and
      Workgroup requested that HHSC staff consider performance measures to assess the
 Recommendation: effectiveness of this tool.

                     The Frew Advisory Committee provided unanimous support for this proposal.
                     They recommended that HHSC make:
                        1) quality data improvements to the current system for incorrect information,
   FREW Technical
                        2) continuously test the tool,
Advisory Committee
  Recommendation:       3) include a specific data element for THSteps providers,
                        4) develop easy protocols for providers to update their information on-line,
                           and
                        5) consider providing links to provider offices with an active webpage.




                                             6 of 6                                      February 2009

				
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