Recording

Hospital Presumptive Eligibility Program Webinar
A vital tool for providing potentially-eligible individuals with on-the-spot Medi-Cal coverage

Webinar Recorded Live on June 19, 2014

Hospitals can play an important role in reducing the number of uninsured through the Hospital Presumptive Eligibility (HPE) program. The HPE program will allow all hospital Medi-Cal providers — including any clinic on a hospital’s license — to provide potentially-eligible individuals with temporary, full-scope Medi-Cal benefits.

Overview

Is your hospital taking advantage of this unique opportunity?
Now hospitals can play an important role in reducing the number of uninsured through the Hospital Presumptive Eligibility (HPE) program.

Under the ACA, California’s Department of Health Care Services (DHCS) created the HPE program to allow all hospital Medi-Cal providers — including any clinic on a hospital’s license — to provide potentially-eligible individuals with temporary, full-scope Medi-Cal benefits. Presumptive eligibility is based only on the patient’s self-attested information for three areas: income, household size and state residency. Benefits will be available for up to two months for newly-eligible Medi-Cal patients. (Some restrictions apply for pregnant women.)

This webinar introduced the HPE program, explained the benefits to patients and providers, and walked through the process to be an approved provider. If you’ve already applied, you received program updates, learned how to check your hospital’s application status and heard how to expedite the approval process.

Recommended for:

Chief operating officers, chief financial officers, patient financial services directors, reimbursement directors, revenue cycle directors, managed care directors, contracting departments, compliance officers, in-house legal counsel, financial consultants.

Agenda

Embracing a culture of coverage

  • Federal rule and state legislation provides tools for hospitals
  • Partnering with DHCS to benefit patients and hospitals

For the patient — HPE program overview

  • Program benefits — real-time presumptive eligibility
  • Eligibility requirements and limitations
  • Enrollment period and continuation of benefits

For the provider — program participation requirements

  • Provider participation categories
  • Application process — provider election form and agreement
  • Participation requirements — records management, training
  • Performance standards, corrective action, disqualification
  • Use of eligibility and enrollment vendors
  • Program updates

The provider application

  • “Active” provider status — how to know you’ve been approved
  • Denied providers — what to do if you’re not on the “active” list

Provider resources

  • Election form and agreement
  • User guide and manual
  • Key contacts — where to turn with your questions

The provider perspective — a hospital case study

Faculty

René Mollow has been with the California Department of Health Care Services (DHCS) since 1995, focusing primarily on Medi-Cal. Ms. Mollow is currently serving as the deputy director for health care benefits and eligibility, where she is responsible for the planning, development, promotion, implementation, and evaluation of health care services and delivery systems under Medi-Cal. In addition, she assists the Directorate and state legislature in determining program direction consistent with legislative intent and consults with the Director concerning issues of significant policy impact.

Delena Fong is a research analyst II in the Medi-Cal Eligibility Division of DHCS where her work has been focused on the Hospital Presumptive Eligibility (HPE) program. As the HPE project lead, she is responsible for providing HPE Program policy guidance according to regulations and for the development of HPE Program training and program materials. In addition, Ms. Fong also monitors HPE Program operation activities, including HPE provider contract agreement processing, HPE Training Web Portal, HPE Medi-Cal Application Web Portal, HPE data reporting, and HPE customer service.

Margaret Beltran-Espinoza is a manager at Scripps Health where she works as a Department of Public Resources Specialist. Prior to joining Scripps Health in 1996, Ms. Beltran-Espinoza was a patient public funding assistance contractor and also worked on special assignments for the Health and Human Services Agency in the areas of Child and Adult Protective Services, Appeals, Program Review and Development, Computer Implementation Program, Social Security & Legal Aid, Juvenile Court and Child Dependent Advocacy.

Amber Kemp is vice president of Health Care Coverage with the California Hospital Association (CHA). Ms. Kemp provides advocacy and support regarding government-funded programs and other health care coverage policy issues affecting California hospitals and health systems. She has an extensive background in Medi-Cal and previously worked in the director’s office at the DHCS where she managed implementing the Medi-Cal Section 1115 Waiver for the Delivery System Reform Incentive Payments (DSRIP) for designated and non-designated public hospitals. Prior to joining DHCS, she served as a special assistant to state Board of Equalization member Betty Yee.

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