This information supplements handouts. 1. Welcome and Introductions Beth Giesting, executive director of the Hawaii Primary Care Association, opened the meeting at 10:00 AM and welcomed the 29 attendees. 2. Covering Kids & Families Update Six representatives attended the annual meeting in St. Louis in September. a. Developing a Systems Approach to Enrollment and Retention (Hii Campbell, Kahuku Local Project) Five main outreach approaches are: 1.) Distribute health insurance information, 2.) Direct families to application materials and application assistance, 3.) Create opportunities to apply, and 4.) Incorporate application and renewal assistance into agency routines, and 5.) Build systems for enrollment and renewal. A systems approach creates a simple and permanent path to health insurance application and renewal. It can sustain the effort to increase enrollment and improve retention, broaden the scope of participation, foster simplicity, ease, and consistency for application and renewal procedures, and incorporate health insurance enrollment and renewal activities in programs, organizations, and institutions that interact with families. b. Leveraging Medicaid Resources (Michelle Malufau, Kahuku Local Project) Medicaid can be a funding source for outreach and enrollment activities. Medicaid can reimburse schools for administration and direct services (e.g., Early and Periodic Screening, Diagnosis, and Treatment--EPSDT--services for Medicaid eligible students and services to special education students identified in Individualized Education Plans). Three steps Vermont uses to get funding are: 1.) Identify eligible school employees called coders, 2.) Coders fill out a time report with designated EPSDT activities that can be reimbursed, and 3.) A total is prorated based on the percent of children receiving Medicaid in the supervisory union. Vermont then spends the money for health promotion activities. c. Coalition-Building Principles (Uilani Nakagawa, Kauai Local Project) The workshop's objective was to analyze roles and responsibilities of coalition leaders, members, and staff during various stages of coalition development. One question that should be asked is how the coalition synchronizes its goals, roles, and resources. The coalition leader motivates members to participate, ensures fair and productive interactions, exhibits and maintains enthusiasm, commits to improving the circumstances based on values, beliefs, and a vision of change, and negotiates among diverse groups. Members take on leadership roles when they are committed to the process, willing to accept responsibility for the coalition goals and outcomes, and willing to take risks. During the life of the coalition, members assume different key roles at different stages and take responsibility of more than one role. d. "Why Should We Be Passionate About Reducing the Number of Uninsured, Low-Income Children and Adults? (Charlette Resinto, Kauai Local Project) Leonard Pitts is an author, columnist, and an inspirational speaker. He was a guest speaker and highlighted how one person can make a difference and although you can't reach them all, never give up. Love what you are doing, stick to the guidelines, and be stubborn at achieving your goals. "Stand in the gap for those in need and refuse to move." e. Self-Declaration of Pregnancy (Barbara Luksch, Hawaii Covering Kids Project Director) Effective September 2003, the Centers for Medicare and Medicaid Services allows states to accept self-declaration of pregnancy. We learned this information at a plenary session and immediately alerted the Application and Renewal Simplification Workgroup. The YES/NO question on Med-QUEST's updated application form will read: "Was the pregnancy confirmed by a home pregnancy test or health care provider (doctor, nurse midwife, nurse practitioner, or family nurse practitioner)?" 3. Presentations: QUEST Health Plans a. Kaiser Permanente (Kevin Imanaka and Carol Ganiron) They started in Hawaii in 1985 and the health plan, hospitals, and medical services make up its three areas. Hawaii Permanente Medical Group has over 350 physicians, 4,300 employees, and 233,000 members. The inpatient facilities include 250-bed acute care in Moanalua's Kaiser Foundation Hospital and 28-bed skilled-care facility adjacent to the hospital. Currently, there are 16 outpatient clinics in Oahu, 3 on Maui, and 3 on Hawaii. Additionally, Kaiser Permanente has a contract with the Kauai Medical Group to care for its members on Kauai. Two new clinics in Waipi'o and Maui Lani will open soon to serve more people. In Hawaii, Kaiser Permanente is the largest integrated group practice health maintenance organization (HMO). The National Committee for Quality Assurance (NCQA) accredited it three times and it earned NCQA's Excellent Accreditation status. The Joint Commission on Accreditation of Healthcare Organizations accredited Kaiser hospital and skilled-care facility. Kaiser Permanente QUEST members can chose to personal care physician (PCP) at any Kaiser clinic. Case managers remind members of appointments and coordinate care with social workers. b. Hawaii Medical Service Association (Jean Kohashi) HMSA is continuing to expand and improve health care delivery systems to meet the changing needs of the community. All HMSA plans feature managed care strategies to ensure members receive medically necessary and appropriate care. HMSA QUEST members must choose a participating physician and members will receive a handbook with detailed information. The member receives a card when he/she, should always carry the card, and show it when receiving care. The card contains the name of the primary care physician and other information the physician must know. Preventive and intervention health services are provided and HMSA care coordinators assist in making appointments. c. AlohaCare (Noe Foster) AlohaCare's philosophy is "We care about your health and the health of your family." They emphasize preventive care and truly believe that aloha is the difference. AlohaCare was formed in 1994 as a nonprofit QUEST health plan, has 43,000 members, and exclusively serves QUEST participants. It is available on Oahu, Hawaii, Kauai, and Maui and approximately 40% of AlohaCare's membership live on the Neighbor Islands. Members receive a list of AlohaCare physicians from which to choose. Note: All plans provide Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services for QUEST members under age 21. They encourage preventive check-ups and transportation services can be provided by Med-QUEST. 4. Presentation: Med-QUEST Identification Cards by Cheryl Kelly Note: The PowerPoint presentation can be downloaded in PDF form by clicking here: Med-QUEST's Identification Cards Monthly identification cards were discontinued in October 2002 and replaced by plastic health cards. However, these are not eligibility cards. There are three systems to verify eligibility: Automated Voice Response System (AVRS), DHS Medicaid Online, and Medicaid Eligibility Verification System (MEVS). AVRS and DHS Medicaid Online are free, real-time, 24-hour access to eligibility information and available to all Med-QUEST providers. The former is through touchtone telephone and the latter is via the internet. MEVS is similar and provides real-time access to key data. The health care provider must contract with a MEVS vendor and pay a service fee. The provider can gain access to the customer's eligibility and enrollment information. 5. Questions and Answers Q: Does a participant need to show a QUEST identification card to the health care provider when they receive medical treatment? A: Yes. For the participant to receive medical treatment, he/she must present their Med-QUEST card and health plan card. Q: How do physicians feel about the new plastic QUEST identification card? A: Most physicians agree with the new QUEST identification card. They can indicate the patient's health insurance, research the eligibility and enrollment status, and the new QUEST identification card can prevent Medicaid fraud. Q: Does your organization use EPSDT services and is it a high priority? Kaiser: We have a list of members and look at the data. Additionally, we use the list to schedule appointments. HMSA: We try to get adolescents and young children to participate in EPSDT services. The health care provider has a monthly listing of their patient, and if the child is due for a screening we schedule an appointment. AlohaCare: We often use a school-based approach to EPSDT and collaborate with school health aides and public health nurses. Q: If the member did not choose a PCP, how do you assign one to the member and how do you know which member can switch from QUEST to Medicaid Fee-for-Service for aged, blind, and disabled individuals? Kaiser: Because Kaiser case managers work closely with our physicians and members, they usually know who is eligible to switch from QUEST to Medicaid. HMSA: If the member did not choose a PCP, then we usually assign based on geographic region. AlohaCare: We also use geography to choose a PCP for the member. If the member does not wish to see the physician that we chose, then he/she has up to ten days to change. Q: Is there a time limit on the AVRS? A: Yes. Each call is limited to 2 minutes. Q: How does your organization feel about the web-based application? A: Some workers are technology savvy and some are not and access to internet service differs in each department. Q: If a pregnant woman submits her application to the Med-QUEST office and is eligible for QUEST, can she immediately see a doctor for check-ups even if she does not have a health insurance card? A: Yes. Temporary cards are issued to members until permanent cards are printed. Physicians can use AVRS to verify member's health insurance status.