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Vol. 11, No. 18 October 1, 2015

One Month 'til Open Enrollment!

In this issue...

It's OCTOBER! That means:

  • It's ONE MONTH til Open Enrollment 3.0!
  • It's the start of ICD-10 Codes!
  • It's time to enroll in energy and heating assistance programs!

We'll talk about each of these headlines in today's Update newsletter, in addition to other breaking news stories: changes to BadgerCare Plus for pregnant immigrant women and children, the FSET program, and new health care cost data. Also, there's still time to both enroll in our "Building Blocks of Health Coverage Workshop" and increase your odds of winning seats at Lambeau Field in our next Packer Ticket Prize Drawing! Our November 3 workshop is filling up--take a few minutes to register today. See details below. All this and more, including a Q & A on refugee eligibility for BadgerCare Plus, Ops Memos, Provider Updates and other ForwardHealth announcements, HealthWatch Coalition updates, and a few articles we enjoyed, and thought you might too! Happy Reading!

Enjoy this "free" version of the newsletter! Are you a member of HealthWatch Wisconsin? Click on the red button below to start reading the full version of this newsletter! Remember to enter your login and password when prompted.

If you are new to the Training Portal, simply click "register" after clicking on the red button above. Answer the questions, create a username and password, and we'll help you take it from there! Not a member? Click here to join HealthWatch Wisconsin!

REGISTER TODAY: Building Blocks of Health Coverage

Open Enrollment is only one month away. Are you ready? Do you know how to troubleshoot Marketplace and BadgerCare Plus questions? Do you know where to refer families for more help? We can help! Register today for our half-day workshop:

  • November 3, 2015, 12:30-4:30pm
  • Medical College of WI, Milwaukee
  • Draft Workshop Agenda Now Available!

Draft Workshop Agenda Now Available! Speakers include: HHS Region V Director Kathleen Falk, ABC for Health Attorneys and Bilingual Health Benefits Counselors, and policy experts.

Join us in Milwaukee on Tuesday, November 3 for an afternoon of Medicaid & Marketplace workshops! In this "intermediate-level" training, we'll start the afternoon with a session called "Open Enrollment 3.0."

We'll explore issues like taxes, family size, and ways to direct consumers to the correct coverage program. We'll then focus our attention on "Coverage Transitions" for both children and adults. We'll then turn our attention to "BadgerCare Plus Hot Topics and Troubleshooting," as we look at BadgerCare Plus eligibility tips for parents and children--but also childless adults.

The workshop will examine appeals in both Medicaid and the Marketplace, taking a look at the independent review process. We'll conclude the day with a detailed look at "Immigrant Health Coverage Considerations," answering your top questions in eligibility, verification and enrollment.

Click HERE or on the picture below to view a draft agenda for this workshop!

This workshop will provide the latest details for the next Marketplace Open Enrollment Period.  There are substantial discounts for HealthWatch members!

Attendees who register early earn an additional entry in the next Packers Ticket Prize Drawing!

WHAT: The Building Blocks of Health Coverage Workshop
WHEN: Tuesday, November 3, 2015
TIME: 12:30pm - 4:30pm
WHERE: Medical College of Wisconsin (Milwaukee)
PRICE: $20 for HWW members! Join and Register at the same time!
REGISTER: Click the big red button below!
QUESTIONS: Call 608-261-6939 ext. 218

In the Training Portal: Newsletter Table of Contents:

Some of the news and analysis features added to the Training Portal as of October 1 includes:

  • Building Blocks Workshop Registration!
  • Packer Ticket Prize Drawing
  • Access Trainings Announced
  • Open Enrollment in 1 month!
  • ICD-10 is Here!
  • BadgerCare Plus Changes for Some Pregnant Women and Children
  • FoodShare FSET Program
  • WI Hospital Association Releases 2014 Uncompensated Care Report
  • Health Care Costs: A Closer Look
  • The Impact of Expansion on Rural Hospitals
  • Mergers and Mental Health
  • Medicaid Expansion: South Dakota
  • Coalition Corner: Information and Resources from Local HW Coalitions
  • Ask a Good Question...Refugee Benefits is this week's question!
  • Et Cetera: New Handbook links, Ops Memos & Updates
  • Headlines, and much more!

Members and paid subscribers, click here to login and view the Update online!

Not a member yet? No problem! Click here to register online and pay for your membership or subscription with a credit card. Or, you can print a registration form to mail or fax back to us (instructions provided on the form). If you would like to register over the phone or have questions about the registration process, please call 608-261-6939 ext. 218.

Other Events:  Enhancements Made to ACCESS:

According to the Department of Health Services website (updated on Sept. 28):

"The Department of Health Services will be hosting trainings in October for community partners regarding enhancements being made to ACCESS on October 24, 2015. ACCESS will be updated with new features that will expedite application processing for applicants.  For some applicants, these new features will allow additional online data matching to minimize the need for additional verification and for a small number of applicants, it could mean they are able to get an immediate eligibility determination. This new, immediate eligibility determination is referred to as real-time eligibility. The MyACCESS tool is also being enhanced to allow existing members to apply for additional programs through a streamlined process – Add a Program." Read more by CLICKING HERE
Marketplace Open Enrollment: Only ONE Month Away!

To ensure you have health insurance for 2016, mark your calendars for November 1st, the first day of this year's open enrollment period! Enrollment is open for a 3 month period and closes on January 31, 2016. Only a Special Enrollment Period will allow you to enroll in the Marketplace after January 31! To qualify for a Special Enrollment Period, individuals must meet a listed "qualifying life event," such as getting married, having a baby, or losing coverage. Here are a few dates to keep in mind:

  • October 12: Plans and prices are available to preview the third week of October
  • November 1: Open Enrollment begins for January 1 coverage
  • December 15: Last day to enroll in or change plans for new coverage to start January 1st and AVOID a coverage gap!
  • January 15: Last day to enroll for coverage starting February 1st
  • January 31: Last day of Open Enrollment for coverage starting March 1st

CLICK HERE to watch this month's "Featured Video Case Tip" on Open Enrollment 3.0!

Wisconsin Navigators:

  • Forest County Potawatomi Community: 715-478-7200
  • Northwest WI Concentrated Employment Program: 715-682-9141
  • Covering Wisconsin (formerly known as Covering Kids and Families): 608-261-1455
Changes to BadgerCare Plus

The rules relating to "dropping health insurance" for non-qualified immigrant pregnant women and for children have been changed. In an Operations Memo dated September 17, the Department of Health Services notified Income Maintenace supervisors and staff of the policy change, with a backdated effective date of July 14, 2015. Why the change? A provision to end this 3-month waiting period was included in the WI Budget, 2015 Wis Act 55. The law became effective July 14, 2015. (Login to continue reading.)

WHA Releases Uncompensated Care Report

The Wisconsin Hospital Association recently released the 2014 Uncompensated Care Report. Notable figures include a total of $1.3 billion in uncompensated care in Wisconsin including $736 million in charity care. The ACA appears to have an impact on reducing uncompensated care since total uncompensated care reduced by 10% from $1.45 billion in 2013.  That still seems like a lot of uncompensated care and a lot of expenses that some effective health benefits counseling services could greatly reduce! See how your local hospital compares.

Video Case Tip: Medicaid Purchase Plan (MAPP)

The Medicaid Purchase Plan offers people with disabilities who are working or interested in working the opportunity to buy health care coverage through the Wisconsin Medicaid Program. Depending on an individual’s income, a premium payment may be required for this health care coverage.

To qualify for the Medicaid Purchase Plan, the following rules must be met. The applicant must:

  • Be at least 18 years old.
  • Reside in Wisconsin.
  • Have individual countable assets of less than $15,000. (Countable assets include savings, life insurance policies, stocks or bonds. A home or one vehicle is not considered a countable asset.)
  • Be determined to have a disability by the Department of Health Services’ Disability Determination Bureau.
  • Be employed in a paid position or be enrolled in a certified Health and Employment Counseling program.
  • Have an adjusted family income of less than 250% of the federal poverty level, based on your family size. Contact your local agency for additional information.

Click here to view a free video case tip featuring the Wisconsin Medicaid Purchase Plan (MAPP)

Ask a Good Question...

I am working with a family who was just granted status as "refugees" and are now in the United States permanently. Are they eligible for BadgerCare Plus?

...Get a Good Answer: Login to the Training Portal to see the answer to this question!

Coalition Roundup

Help us complete our new listing of 2015 upcoming HealthWatch local coalition meetings! Email us! As always, contact the coalition directly for more information.

Coalition Next Meeting Contact
Chippewa County Nov. 10 Rose Marsh
Dane County Oct. 5 Anna Kaminski
Eau Claire Nov. 5 Lou Kelsey
Milwaukee Oct. 14 Danielle Coterel
Pierce County TBD Kelsi Winter
Polk County TBD Mike Rust
Tri-County Oct. 27 Connie Raether

Et Cetera: Memos & Updates


NEW: BadgerCare Plus Handbook, published September 2, 2015 in Release 15-02

Marketplace Handbook: On October 3, CMS's Center for Consumer Information and Insurance Oversight released the first edition of a "Federally Facilitated Marketplace Enrollment Operational Policy & Guidance" Handbook, effective October 1.

Medicaid Eligibility Handbook (MEH), published July 30, 2015 in Release 15-02

Administrator's Memo 14-04, 2015 IM Consortia Administrative Allocation, has been published to the DHS web

Release 15-01 of the Electronic Case File (ECF) Handbook was published on January 16th

Release 15-01 of the FoodShare Handbook was published 

Ops Memos

Ops Memo 15-29 Federal Fiscal Year 2016 FoodShare Mass Change

Ops Memo 15-30 End to BadgerCare Plus Restrictions Related to Dropping Health Insurance

Ops Memo 15-31 Applying Discounts to Wisconsin Shares Reimbursements

Ops Memo 15-32 Real Time Eligibility Determinations

Ops Memo 15-33 Policy Changes for Documents Stored in Electronic Case File

Ops Memo 15-34 Wisconsin Shares Policy Manual Chapters 1-4

Ops Memo 15-J8 Collection Centralization and Changes to the Benefit Recovery Repayment Agreement

Provider Memos

2015-41 New Policy Regarding Coverage and Prior Authorization Criteria for Hyperbaric Oxygen Therapy

2015-42 Revised Prior Authorization Criteria and Documentation Requirements for Periodontal Scaling and Root Planing

2015-43 New Prior Authorization Guidelines for Pectus Carinatum Surgery

2015-44 Hospital Access Payments Discontinued for Fiscal Year 2015

2015-45 New Coverage and Prior Authorization Policy for Cranial Remolding Orthosis

2015-46 Changes to Therapies Spell of Illness Prior Authorization Policy and Form

2015-47 ForwardHealth Will Not Issue Interim Payments for Claims Delayed Due to Lack of ICD-10 Readiness

2015-48 ForwardHealth Introduces Real-Time Eligibility Determinations for Qualified Applicants

Other Provider Announcements:

Changes have been made to the Pharmacy Resources page on the ForwardHealth Portal including the Diagnosis Restricted Drugs table effective 10/1/2015 with International Classification of Diseases, 10th Revision (ICD-10) codes. The September 2015 changes include the following:

Diabetic Supply List Quick ReferenceDiagnosis Restricted DrugsExpanded Maximum Allowed Cost List (EMAC)Numeric Listing of Manufacturers That Have Signed Rebate AgreementsPreferred Drug List Quick ReferenceQuantity Limit Drugs and Diabetic SuppliesState Maximum Allowed Cost Limit (SMAC) Refer to the Pharmacy Resources page for the most current information.

ICD-10 Codes Published in the ForwardHealth Online Handbook:

As a reminder, effective for dates of service on and after October 1, 2015, ICD-10 diagnosis codes must be indicated, when applicable, on claim submissions to ForwardHealth. Continue to refer to the ICD-10 Code Set Transition home page for current ICD-10 information. The ICD-10 diagnosis codes are labeled as "Information for dates of service on and after October 1, 2015." Other ICD-10-related revisions to the Online Handbook will be made in October 2015. Other ICD-10 related revisions to the Online Handbook will be made in October 2015.



33 Million Americans Still Don't Have Health Insurance: Here's Who They Are, Five Thirty Eight

Dane County, Distric to Expand Mental Health Resources in Schools, Channel3000

Patients File Lawsuit Against Two D.C. Hospitals Alleging Excessive Fees to Obtain Medical Records, Washington Business Journal

Prisons and Jails Forcing Inmates to Cover Some Medical Care Costs, Kaiser Health News

Why Big Pharma's Patient-Assistance Programs Are a Sham, Los Angeles Times

Tell Us What You Think!

HealthWatch Wisconsin Update readers, we want to hear from you! What do you think of the format? How do you find the material on the HealthWatch Wisconsin Training Site? Do you have any topics you'd like to see or questions you want answered. Please email HealthWatch and let us know!

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