January 2021 |  Vol. 6   No. 7

Deputy Director's Corner

Happy New Year everyone!  And here’s to a great 2021.  We know the first half will remain challenging as we come out of the public health emergency.  And it will remain challenging for the MHD team as we implement Medicaid expansion.  But I am looking to the spring, and then the summer and knowing we will be able to get together again and celebrate the holidays very differently next year than this year!

I want to highlight a couple MHD areas in this month’s newsletter.  Here is a segment on TPL Recoveries (thank you, Lois, for this!)

The TPL Recoveries section consists of two different groups: Estate Recovery which includes Personal Funds, Burial Plans and TEFRA, and Tort (Casualty) Recoveries.

In Estate Recovery there are 7.5 FTE who recovered $14,700,000.00 in FY 20. Estate Recovery is just that, if a Medicaid participant has any remaining assets in their estate, at the time of their death, the estate group will try to recover any money up to the amount expended on that participant.  There are some allowed expenses that can be paid out of the estate before Medicaid can recover. Our team must review and approve these expenditures. 

TEFRA is The Tax Equity and Fiscal Responsibility Act which says if a Medicaid participant owns their home and goes into a nursing home permanently, Medicaid can place a lien on their home.  However, when the participant dies Medicaid will not force the family to sell the home so Medicaid can collect.  But if and when the home does sell, Medicaid’s lien is recorded and Medicaid will typically receive money if there is any left after qualifying expenses. 

Personal Funds is a program where the Medicaid participant, who is in a nursing home, has personal money set aside in an account for such things as haircuts or manicures. If there is money left in that account when the participant dies the money is sent to Medicaid. Again, this can be used by the family for some approved expenses.

With a burial plan, if there is money left at the funeral home after all approved funeral expenses have been paid the remaining money is sent to Medicaid.

Tort (Casualty) Recoveries include Malpractice, workers comp, product liability claims, automobile accidents, and slip and falls.  In FY 20 there were eight team members who recovered $8,678,000.00. Recoveries are made from liable third parties and can take years to settle. Every case, in which Medicaid is notified, must be reviewed for applicable claims that are related to the injury/accident.  Reviewing the billing statements can be very time consuming. The billing statements may have many lines that must be reviewed with only a few remaining related to the injury/accident. 

FY20 was the BEST year TPL recoveries has ever had, recovering $23,379,000.00.  A lot of hard work and dedication went into FY20, even with working remotely half of the year. 

Here’s a little bit about the Medicare Buy-in Unit (Thanks Robin!)

The Medicare Buy-In Unit is responsible for ensuring that Medicare is reflected in the MMIS, for cost avoidance purposes, Fee-For-Service claims. By doing this step, we cost avoided over $2 billion in FY2020. FY2021 is on track to reach those same figures or potentially more.

Our team is responsible for reviewing all dual-eligible cases to determine if we should pay for the participant’s Medicare Part A and/or B premiums. This process ensures that Medicare is the primary payer and helps participants out financially. For some participants this is literally a life saver. It puts income back into their household to help with bills and necessities.

All of the team members have worked really hard to ensure that we could work remotely during these unsure times. They are a great bunch and are full of ideas on how to streamline processes.

Fun facts from a few Medicare team members:

Karen Tappel likes to draw and paint.

Tammy Tice was selected to sing with the Missouri state high school choir out of thousands of kids.

Robin Beeler has met Ross Perot, Troy Aikman and Chuck Norris all while living in Dallas. She lived 3 miles from the South Fork Ranch as well.  

Barb Hart was once chosen to be on Who Wants to Be A Millionaire but missed the call.

Kathy Schroer says she’s an awesome Nana.

Renee Clardy came to MHD in 2010 from DLS/Investigations and had already worked through her 5-year backdrop; BUT loves her job so much she’s stayed 10+ years with MHD. Oh, and she is a big Elvis fan.

Awesome job and thanks for the fun facts!

Did you know?

What’s PERM?  Well, it’s a hair thing, but it’s also payment error rate measurement.  The PERM program is run by CMS and it’s a process where they audit state Medicaid agencies once every three years.  Missouri is a “Cycle 1 State” along with 16 other states.  PERM auditors review Fee-For-Service and managed care claims, and review eligibility segments for our Medicaid participants, too.  They do a medical review of FFS claims, as well as a data processing review on FFS and managed care claims.  Then they look at caseworker actions on Medicaid and CHIP eligibility samples and look at where cases were denied or terminated.  It takes around 26 months from start to finish!

So, while once every three years doesn’t seem too long, it’s barely over before we start again.  It’s a big deal because if the PERM auditors have findings, they might put us on a corrective action plan, or they might take money back from us.

Diversity fact:

I read an article that said ethnically diverse companies are 35% more likely to outperform their respective national industry medians.  Despite this, studies show that resumes submitted by those with non-white sounding names are less likely to get a callback.  Why do you think that is?  Where do you bump up against bias?

And what about New Year’s Day? New Year’s celebrations have been around for a really long time, and in about 46 B.C. Julius Caesar made it January 1.  It’s celebrated in a variety of ways around the world.  I read that in Colombia people wear brand-new yellow underwear! In Spain there is a practice of eating 12 grapes at or before midnight.  I hope that for each and every one of you, it is peaceful and happy and I look forward to working alongside you in 2021.   Jessie

Unit Spotlights

Money Follows the Person (MFP)

Our very own Shawn Brice heads up this small unit along with Elise Davenport. It may be small but it does BIG things. 

The Centers for Medicare and Medicaid Services (CMS) awarded a Money Follows the Person (MFP) Demonstration grant to Missouri in January, 2007.

The Money Follows the Person (MFP) demonstration program was designed for states to reduce reliance on institutional care, while providing resources for individuals wishing to transition from an institutional setting to a quality community-based long-term care setting. The objectives of Missouri’s MFP program are:

• to move people from a facility to the community;
• identify and eliminate barriers that prevent people from being able to move to the community;
• improve the ability of MO HealthNet to provide in-home services;
• and to ensure that there is continuous quality improvement of in-home services provided. 

The 125 transitions was 89% of Missouri’s 2020 projection even with the challenges of COVID-19. None of this success would be possible without our partners at DHSS, nursing homes allowing us to continue our work with their residents, and the great MFP Contractors that transition our participants.

MFP has successfully transitioned 2106 individuals from an institutional setting to the community since its’s inception in Missouri, but 2020 has added challenges to this process. However, while other states have struggled to transition participants for a number of reason, Missouri MFP has been able to transition 125 individuals from nursing homes to the community through the challenges of COVID-19.

DYK...

DYK that our MHD intranet page can be found at https://dssintranet.mo.gov/dss-mhd/?   There are all types of interesting information that can be found including:

• Check out the RESOURCES tab, where you can find information such as our MHD Playbook, Policy and Procedures, EOQ information and more.

MHD is seeking individuals to form a subcommittee under MHD Connections for team members that have a desire to increase and promote inclusion, diversity and leadership at MO HealthNet. This group of people will meet monthly (1-2 hours a month) to work together to find ways to celebrate diversity, engage in team building experiences and provide education/training opportunities around inclusion, diversity and leadership.  If you would like to be a part of this committee, simply submit your name and unit you work in via email to MHD Connections.   If you don't want to be part of the committee but have suggestions on ways to increase diversity and encourage inclusivity in our workplace, please submit your suggestion, submit those to MHD Suggestions email or  drop in one the suggestion box located in Center Court.

DYK:

• January 4: World Braille Day, observed in order to raise awareness of the importance of braille as a means of communication in the full realization of the human rights for blind and partially sighted people. Celebrated on Louis Braille’s birthday, the inventor of braille.
• January 18: Martin Luther King Jr. Day commemorates the birth of Martin Luther King Jr., the recipient of the 1964 Nobel Peace Prize and an activist for nonviolent social change until his assassination in 1968.

• January 27: The International Day of Commemoration to remember the victims of the Holocaust. The anniversary of the liberation of the Auschwitz death camp in 1945 and U.N. Holocaust Memorial Day.

Staff News

Welcome to MHD

Welcome Aboard Jeff Terry.   Jess jointed the TPL Unit at MHD as the new Benefit Program Supervisor, replacing Mandy Fulks.  Jeff formerly worked at the Division of Legal Services. Jeff attended Missouri Southern State University where he earned a Bachelor of Science degree in Biology. Jeff currently resides in Jefferson City with husband and best friend Gary.  Jeff said "We have been married six years but have known each other over thirty years. We have a new fur baby named Dolly. She is a Shih Tzu and may be just the slightest bit spoiled. Dolly is very special to us and we enjoy spending time with her and pampering her. I grew up in Joplin, MO and I visit there frequently as my parents still live there." Jeff enjoys music, gardening and spending time with his family.  One little known fact about him that is first car was a 1977 Ford Maverick.  Jeff and Gary had a drip planned to Jamaica in December but like a lot of folks, Mr. Covid cancelled those plans.  However, they ae hoping to get to go this year.  They so plan to celebrate one milestone in February, when their little Dolly will be 6 months old.

Here a few New Year's resolutions from our MHD family.    Let's see how long they last....

• Dana Bernier: Soda sober!!
• Kathy Simmons: As always losing weight is once again on my list. LOL   We are building a house so patience is something I’m working on, and budgeting! And I want to continue to be grateful every day for what I have!
• Nanci Nikodym:  Mine is to never take things for granted.  I found this poem on Facebook and I love it! 

May we never again take for granted:

Friday nights with friends, birthday celebrations,

the roar of a stadium, mornings at the gym,

packed dance floors, coffee with a friend,

crowded concerts, happy hours, or life itself.

• Nate Percy: My New Year’s resolution is more books and less phone!
• Michelle Kohrmann:  Growing in my personal journey with faith and being better about spreading the word of Jesus Christ to others.
• Gail Luecke:    I won't promise to loose a certain amount of weight BUT I'm sure gonna try to lose something!  Also, get back to my exercising.
• Renee Clardy: I would like to spend more time reading God’s Word.

Congratulations...

• Sheri Johnston accepted the Senior Program Benefits  position in MMIS previously held by Racheal Matheny.  In her new position, Sheri will serve as the HIPAA Standards Compliance Officer and a project manager. 

• Amanda Fahrendorf developed and presented a power point instruction for Oral Health Network of Missouri for the Missouri Primary Care Association dental providers December 7^th, assisting them in understanding the new 2019 ADA claim form and the requirement for including the diagnosis code(s).   The training was well attended with 50+ providers/billers in attendance.  Dr. John Dane also provided answers to many questions.  Thank you Amanda for a valuable training and your commitment to preserving the relationship with MO HealthNet dental providers. 

• Anna Dmuchovsky with Home State Health had this to say about Lori Reed.  "I would like to take a moment to let you know how much we value Lori’s guidance as we work through issues. She has a wealth of information and experience that she is willing to share. We are grateful she responds so timely.  We are a better health plan because of her support."
• Legetto Webster recently assisted a participant with an  issue they were having with a pharmacy reimbursement.  According to Ambra Stotler, "The  participants mother had nothing but nice things to ay about Legetto and how helpful she was."  Jeanette Book and Melody Webb both thanked Legetto as well for providing great customer service and for being a great representative of the agency!

• Nanci Nikodym gave a big shout out to Jamie Purnell and Melissa Hesemann. "We have approved the systems work for the OSFS!!!  This was quite an undertaking and Jamie and Melissa have been awesome throughout this process. I wanted to give a them a HUGE SHOUT OUT!  Thank you so much, Jamie and Melissa! "

• Rebecca Logan and Bobbi Jo Garber sang Tameka Whitney's praises for her work on the CHIP HSI SPA.  Rebecca said, "Just one of the several projects that Tameka has been juggling. Way to go, Tameka!!!!"  Bobbi Jo added "Tameka has been a great addition to the team."

Employment Opportunities

Do you have a friend or family member looking for a career change or job opportunity?   Are you looking for a career development/promotional opportunity?    Visit  MO Careers to view & apply for  current job openings.   Below are a  few positions currently open:

• Administrative & Legislative Planner at DNR.   Closes January 4, 2021.
• Program Coordinator at FSD.  Closes January 5, 2021.
• Client Support Tech at OA.   No closing date listed.
• Associate Customer Service Rep (call center) at DOR.  Closes January 10.
• Program Specialist at DESE.  Closes January 15.

MHD  Connection News

They say "Out with the old, in with the new."  So, Goodbye 2020 and Hello 2021!   Here's hoping you had time to relax and catch up with family and friends over the holidays. 

There is nothing on our MHD Calendar for Staff Forums or other activities due to COVID;  however, we'd love to hear from you.    We'd welcome your ideas for upcoming Staff Forums.  If you have a particular subject or idea that would be of interest to you and others, please let us know.   You can email MHD Connection at MHD.Connection@dss.mo.gov or to me.

Although we don't have anything currently planned , please feel free to share your ideas with any committee member: Gail Luecke (Chairman),  Nanci Nikodym (Treasurer), Pam Burris, Nici Smith, Karen Pendleton, Stephanie Hunt, Bridgette Hicks, Stacie Gibson, Sheana Wilcox, and Carolyn Twardowski (secretary). 

What's Cooking at MHD?

Send me a note if you've tried any of the recipes and what you thought.  Keep those recipes coming and enjoy these delicious treats!!  Here are a couple of those recipes featured on The Recipe Corner.  

MHD Calendar

Visit our Calendar of Events page for WEBEX Meeting Info

1-01  HAPPY NEW YEAR!!

1-06  2021 Legislative Session begins

1-18  Martin Luther King Holiday Observed

REMINDERS CONFERENCE ROOMS:  Please remove meetings from the conference room calendars if you know that staff will be attending your meeting remotely and you will not need the conference room.   TO THOSE WORKING REMOTELY:  Please ensure you have turned off desk lights, monitors, and other electronic devices not in use.  Also, if you have any plants, please remove them or arrange to have them watered. KEEP YOUR OUTLOOK CALENDARS UPDATED PLEASE!   Since the majority of our staff is now working remotely, PLEASE remember to keep your Outlook calendars updated.   This includes scheduled days offs, meeting, training, regularly scheduled days off due to working a compressed work schedule, etc.   By doing this it will help immensely to ensure meetings are scheduled within your work hours and help staff working deadlines to be able to plan around planned absences or if they need to reach you.  Thank you.