![Page 1: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/1.jpg)
Children’s Health Insurance
Program (CHIP)
Advisory Council Meeting
October 2, 2019
![Page 2: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/2.jpg)
Agenda
• Welcome and Introductions
• New Council Member Introduction
• Provider Enrollment
• CHIP by the Numbers
• Marketing Updates
• Policy Update
• Quality Assurance Updates
• Closing and Wrap-Up
2
![Page 3: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/3.jpg)
Welcome and Introductions
3
![Page 4: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/4.jpg)
New Council Member
Introduction:
Representative Sara Innamorato
![Page 5: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/5.jpg)
Provider Enrollment
5
• Federal regulations require that all providers for CHIP
are enrolled with the commonwealth.
• CHIP MCOs have been focused on ensuring PCPs
are enrolled with the commonwealth.
• For the total PCP network across all MCOs, there are
about 6.7% that are not enrolled, as of August.
• MCOs have been working with families to ensure that
PCPs that children see are enrolled.
• MCOs are now focusing on non-PCPs and ensuring
that all service locations for all providers are enrolled.
![Page 6: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/6.jpg)
CHIP by the Numbers
![Page 7: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/7.jpg)
CHIP Enrollment
7
175,000
176,000
177,000
178,000
179,000
180,000
181,000
182,000
183,000
184,000
185,000
Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19
178,594 178,523
179,981180,260
179,241
180,902 180,970
181,385
182,971
183,564 183,431
184,333
184,812
CHIP Enrollment
![Page 8: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/8.jpg)
MG18C Children
CHIP Enrollment
Ages 0 to 4 TOTAL
January 2019 27,547
February 2019 27,682
March 2019 27,683
April 2019 27,755
May 2019 27,977
June 2019 28,016
July 2019 27,957
August 2019 28,121
8
MG18C Children TOTAL
January 2019 1,171
February 2019 1,077
March 2019 1,142
April 2019 487
May 2019 1,095
June 2019 1,279
July 2019 1,430
August 2019 1,558
• MG18C refers to MA Children age 0-4 that remain in MA until their renewal date when
their family is over the MA income limits.
![Page 9: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/9.jpg)
CHIP Successful Renewals
9
54%
74% 75%
80%
87%
54%
76%
81%76%
85%
54%
77% 79%
72%
86%
54%
75% 76%79%
85%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Free Sub1 Sub2 Sub3 At Cost
CHIP Successful Renewals
May 2019 June 2019 July 2019 August 2019
![Page 10: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/10.jpg)
Processing Times for CHIP Applications
10
9,185
7,430
7,929
9,074
8,243
7,629
8,594
1,999
1,047 1,193 1,2901,464 1,422
1,213
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
10,000
Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19
Processing Times for CHIP Applications
30 Days or Less Over 30 Days
![Page 11: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/11.jpg)
Customer Calls to the CHIP Call Center
11
1-800-986-KIDS Calls Received
4,065
3,788
3,511 3,591
4,511 4,464
0
1000
2000
3000
4000
5000
6000
7000
March 2019 April 2019 May 2019 June 2019 July 2019 August 2019
![Page 12: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/12.jpg)
12
CHIP Call Center Metrics (continued)
12
Apply Over the Phone:
Completed Applications
454
391372
388
516
020406080
100120140160180200220240260280300320340360380400420440460480500520
March 2019 April 2019 May 2019 June 2019 July 2019
![Page 13: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/13.jpg)
Marketing Updates
![Page 14: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/14.jpg)
Mendoza Group, Inc.
Focus Effort Event Speaker
14
![Page 15: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/15.jpg)
Focus Effort – Target Areas
15
![Page 16: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/16.jpg)
Outreach
16
![Page 17: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/17.jpg)
Enrollment/ Renewal Events
17
![Page 18: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/18.jpg)
Creatives
18
![Page 19: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/19.jpg)
Event Speaker
19
![Page 20: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/20.jpg)
• PA Act 84 of 2015 requires that
DHS, in conjunction with PDE,
provide notice of the existence of
CHIP to public and nonpublic
schools annually.
• Must be provided electronically
each year by August 15th.
• In addition to working with PDE,
CHIP also works with the PA
Association of Intermediate Units
to ensure all schools are informed.
School Flyer
20
![Page 21: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/21.jpg)
Policy Updates
![Page 22: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/22.jpg)
Policy Updates
22
New Employee Role• Congratulations to Heather Williams, Member Services
Supervisor.
CHIP Procedures Handbook and MCO Review• On August 14th, CHIP held a one-day workshop to review the
current CHIP Procedures Handbook
• CHIP received over 200 comments on the Handbook.
• Comments included sustentative and format issues.
• CHIP focused on the top 31 topics during the workshop.
• CHIP also conducted an email survey in early September to learn
more about program initiatives within the MCOs.
![Page 23: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/23.jpg)
Policy Updates
23
CHIP Procedures Handbook and MCO Review
• During this afternoon’s MCO meeting, DHS staff will provide a
presentation on potential program initiatives including Pay For
Performance and Value Based Purchasing.
• CHIP is currently working with executive leadership on
appropriate revisions to the CHIP Procedures Handbook and
release timing.
![Page 24: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/24.jpg)
Policy Updates
24
Public Charge Rule: INA Section 212(a)(4); 8 U.S.C. § 1601. • On August 14, 2019, The Department of Homeland Security
published a new rule which interprets a provision of the
Immigration and Nationality Act (INA) stating that a person is
inadmissible to the United States as a immigrant if the person is
likely to become a public charge. INA Section 212(a)(4).
• The new rule, which goes into effect October 15, 2019, will
consider the use of publicly funded health care, nutrition and
housing programs as negative factors in determining if a person is
likely to be or is a public charge.
• The Children’s Health Insurance Program is exempt from the new
rule.
![Page 25: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/25.jpg)
Quality Assurance Updates
![Page 26: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/26.jpg)
• New Staff Assignments
• CPOP SMART Tool Demonstration
• Onsite Monitoring Visitso Combined with Quarterly Quality Review Meetings
• External Quality Review Reports
26
Quality Assurance (QA) Updates
![Page 27: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/27.jpg)
New Staff
Tracey Cox
– Aetna Better Health
– Geisinger Health Plan
– Overall compliance
David Hetrick
– Capital Blue Cross
– United Health Care
– Programmatic Change Requests
– Overall compliance
27
![Page 28: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/28.jpg)
What is the CHIP
Program Oversight
Portal (CPOP)?
CHIP Program Oversight Portal (CPOP)
CPOP Home Page
CPOP Applications
![Page 29: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/29.jpg)
Systematic Monitoring
Access Retrieval
Technology (SMART)
CHIP SMART Screen Examples
CHIP Program Oversight Portal (CPOP)
![Page 30: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/30.jpg)
Healthcare Effectiveness
Data and Information Set
(HEDIS)
CHIP HEDIS Data Repository
and Dashboard
CHIP Program Oversight Portal (CPOP)
![Page 31: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/31.jpg)
Consumer Assessment of
Healthcare Providers and
Systems (CAHPS)
CHIP CAHPS Data Repository
and Dashboard
CHIP Program Oversight Portal (CPOP)
![Page 32: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/32.jpg)
Key Performance
Measures (KPMs)
KPM Data Repository
and Dashboard
CHIP Program Oversight Portal (CPOP)
![Page 33: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/33.jpg)
Onsite Monitoring Visits
• Determination of Compliance/requirement to meet
federal mandate
• Serves as a means to populate the External
Quality Review Reports
• Conducted Annually
33
![Page 34: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/34.jpg)
External Quality Review Report
• Purpose and Background
• Eight documents posted annually to the CHIP
Website
• Contains aggregated information on quality,
timeliness and access to health care services
34
![Page 35: CHIP Advisory Council Ad… · Tracey Cox –Aetna Better Health –Geisinger Health Plan –Overall compliance David Hetrick –Capital Blue Cross –United Health Care –Programmatic](https://reader035.vdocuments.us/reader035/viewer/2022081408/605be41fddf4302bbb2cd550/html5/thumbnails/35.jpg)
Closing and Wrap Up
• Topics of discussion for next meeting?
• Proposed 2020 Advisory Council meetings:
• Wednesday, April 15, 2020
• Wednesday, October 14, 2020
35