Harbage: Erroneous Cal MediConnect Notices to Medicare Plan Members
From our colleagues at Harbage Consulting:
Approximately 10,000 beneficiaries in Medicare plan products erroneously received 90-day CMC notices due to a data timing issue for the January enrollment phase. This issue only applied to beneficiaries in Medicare products operated by a plan that is also a Cal MediConnect (CMC) plan. Beneficiaries who received the 90-day CMC notices did not receive further CMC notices (for example, they did not receive Part D or DSNP disenrollment notices) and were not enrolled in CMC. Instead, these beneficiaries have begun to receive MLTSS notices. Beneficiaries who would have enrolled in MLTSS in January will instead enroll in February (birth months from the beginning of passive enrollment in the county through January plus the regular February birth month enrollment), and enrollment will continue by birth month.
January 2015 DSNP Cross Walk
Beneficiaries who are Cal MediConnect eligible and currently enrolled in a DSNP operated by a CMC plan (known as a CMC DSNP) will be passively enrolled in Cal MediConnect in January 2015 – these are the DSNP cross walk beneficiaries.
For this set of beneficiaries, DHCS needed to use a two step data sorting process to determine which beneficiaries were in a CMC DSNP and eligible to cross walk, and not in a different non-cross walk plan product.
When DHCS created the beneficiary data file for this 90-day mailing, the DSNP contract number was used to identify the DSNP beneficiary cross walk. In typical months, the DSNP and MA contract numbers are used to hold all beneficiaries out of the Cal MediConnect mailings. However, the contract numbers can include multiple plan products, which are identified in a second level of data called the plan benefit package (PBP) number. DHCS did not have enough time in the 90-day mailing process to pull an accurate data file of potential eligible beneficiaries and fully screen them against the PBP. DHCS would have had to use an older data file of potential eligible beneficiaries to screen against the PBP, which would have introduced additional risk of erroneous mailings to beneficiaries.
As DHCS moved forward with the passive assignment process, the state was able to refine the beneficiary data file for the 60-day mailing to only include those in the DSNP cross walk products. When conducting this second screening, DHCS identified approximately 10,000 beneficiaries who received 90-day notices in error (the end of September mailings) and who are not eligible for passive enrollment into Cal MediConnect.
All of the erroneously notices beneficiaries were flagged as excluded from the 1/1/15 passive and can voluntarily enroll. Additionally, call center systems were marked to ensure the Health Care Options CSRs can identify these members and explain they can disregard the notice.
There should not be subsequent errors due to this problem, as the DSNP cross walk only occurs once per county. Additionally, the only subsequent DSNP cross walk is in Orange County, and the CalOptima DSNP contract number only covers the one PBP with cross walk eligible beneficiaries.
Health Plan A:
- Is an Cal MediConnect plan
- Has a D-SNP and a Medicare Advantage Plan under contract H1234
- D-SNP = H1234-PBP1
- MA = H1234-PBP2
Member is enrolled in the contract number H1234 and sent 90 day notice
Day 80, member is identified as contract and PBP H1234-PBP2, they no longer qualify for the transition.