Acronyms

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WELCOME
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Acronyms

• HIPP Health Insurance Premium Payment Program
• HOS HIPP Operations Specialist
• EGHP Employer Group Health Plan
• TPL Third Party Liability
• CIS Client Information System
• CAO County Assistance Office

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OBRA of 1990

• Establish the requirement for all states to
  implement a HIPP Program
• Review Medical Assistance Population
• Identify clients who have access to group health
  insurance through employment
• Cost analysis

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Pennsylvania was held accountable by

• HCFA now CMS (Centers for Medicare and Medicaid
  Services)
• July 1994 the PA HIPP Program was implemented

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Background

• Automated Referral Process
• Automated Cost Analysis Process

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Automated HIPP System

• Case Tracking
• Cost Analysis
• Policy and Benefit Information
• Payment Generation
• Savings History
• Savings Adjustments
• Letter File

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Recognition

• CMS has recognized Pennsylvania as the number one
  HIPP Program in the country
• National TPL Conference in Boston
• Published in 2 National Trade Magazines
• Visits/Inquiries from other states
• Washington, DC

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Fiscal Year Savings

• 110M
• 27,000 Enrolled Recipients

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Regional Offices

• Chestnut Ridge
• Clarks Summit
• Harrisburg
• Torrance
• Warren

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Medicaid Eligibility

• Eligibility is determined by the caseworker in
  the CAO

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The Three Questions

• Current Employment
• Employment ended in the past 30 days
• Anyone have a serious illness/pregnant
• A yes to the 1st or 2nd question generates a
  HIPP referral

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The Letter

• Explains the HIPP Program
• HIPP Referral
• Postage Paid Return Envelope
• Client is required to complete and return within
  10 days

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Reminder

• Just because a referral is submitted to HIPP does
  not mean that the case will be enrolled. A cost
  analysis must be performed and the case found
  cost effective before enrollment can take place.

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Processing the HIPP Referral

• Referrals are screened
• - Priority
• - Deadlines
• Average number of letters
• - 6,000 to 8,000 letters weekly

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Assignment of Cases

• Referrals which we believe to have the potential
  to be enrolled into the HIPP Program are assigned
  to the HIPP Operations Specialist (HOS).

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The HOS contacts Employer

• Who is eligible for Insurance
• Identify the policy benefits and limitations
• Amount and frequency of the premium

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Determining Cost Effectiveness

• Managed Care Capitation Cost
• EGHP Cost
• Compare cost of premium any deductibles or
  uncovered services against the weighted
  capitation rates for both physical and behavioral
  health
• Updated yearly

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Not Cost Effective

• If the client was previously contacted, an
  Ineligibility Notice is sent. No further action
  is taken by HIPP.

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Cost Effective

• Payment Method Established
• Enrollment Notice sent to client
• Employer Agreement sent to Employer

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HIPP Payment Cycle

• Payments generated monthly
• Payment cycle is 15th of the month to 14th of the
  following month
• CIS Eligibility
• Tape created for Treasury

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Changes

• A Change Report Form is mailed with the HIPP
  Remittance Explanation form each month

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Cases that are Cost Effective

• Cost Sharing with employer
• One Premium Amount
• HIPP pays one flat rate
• MC pays an individual capitation fee

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Accessing Services

• Clients enrolled in the HIPP Program use their
  ACCESS card in addition to the cards from their
  employer to receive services.
• It is the clients responsibility to use a
  provider that accepts the ACCESS card and their
  employers insurance.

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HIPP Facts

• HIPP is a cost containment program for the
  Department of Public Welfare
• HIPP is not an entitlement to MA clients.

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Questions

• Are there any questions at this time regarding
  HIPP?

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THANK YOU!!!