IHCP issued a bulletin on 8/9/16 which revised the process and time frame for conditional status and full enrollment for a PE member.

Effective 8/5/2016 individuals that are enrolled as a PE member will transition from the PE # to a RID # the month following the month that the full HIP application is approved.

The newly approved individual will not stay in a conditional status as they did previously awaiting for their contribution for HIP Plus.  Once FSSA determines they are eligible based on the full application they are considered enrolled and will be issued a traditional RID #. Members will then be given notice that they can enroll in HIP Plus in the 60 day time frame. See the scenarios below:

  • Adult PE members who make a Fast Track Payment are enrolled in HIP Plus effective the first day of the month following approval of their full IHCP application. (Example #1 below)
  • Adult PE members who do not make a Fast Track Payment are enrolled in HIP Basic effective the first day of the month following approval of their full IHCP application. These members continue to have the potential to buy in to HIP Plus benefits by making a POWER Account contribution within 60 days of HIP enrollment.
  • – Members transitioned from Adult PE who make a POWER Account payment in the 60-day time frame will be enrolled in HIP Plus effective the first day of the month after payment is received. (Example #2 below)
  • – Members transitioned from Adult PE who do not make a POWER Account payment in the 60-day time frame who have household income equal to or less than 100% of the federal poverty level (FPL), will stay enrolled in HIP Basic. These members are not eligible to buy in to HIP Plus until eligibility re-determination.
  • – Members transitioned from Adult PE who do not make a POWER Account payment in the 60-day time frame and who have household incomes greater than 100% FPL will be terminated from HIP and not eligible to re-enroll for six months. (Example #3 below)
  • As members transition from enrollment under the conditional Adult PE status to full enrollment in HIP Basic or HIP Plus, they will be issued a traditional member identification number (RID). Providers should use the traditional RID for billing, rather than the PE RID, as soon as it is effective.

 

Please note that these changes are for PE members only. The lock out period will be for those members that are approved subsequent to the PE with income between 100% and 138% of FPL if they do not make their POWER account payment.  This is because they are now considered enrolled once determined by FSSA to be eligible based on the full application.   Previously they were not considered enrolled until they made their initial contribution. It is VERY important that you educate the patient that if they do not make the POWER account contribution they will be locked out of participation for 6 months (for transitioned adult HIP PE category members only with income between 100- 138%)

PE change 8 2016