Eligibility
Name the three criteria that make an individual eligible for the NH CARE Program.
What are....
HIV+
NH Resident
Household Income at or Below 500% FPL
The ADAP acronym stands for this.
AIDS Drug Assistance Program.
Identify four types of insurance that the NH CARE Program will pay premiums for.
What are...
Medicare Part D
ACA Marketplace plan
Off-marketplace plan (under certain circumstances)
Medicare Supplemental Plan F/G
COBRA
This data element is recorded under the screening tab.
What is medication adherence?
FPL stands for this.
What is Federal Poverty Level?
This application is required annually when a client has an income at or below 200% FPL.
What is a Medicaid application?
This is where case managers should refer pharmacies to resolve problems processing claims.
What is the Magellan Help Desk.
Both QMB and SLMB plans pay for this premium.
What is Medicare Part B.
Clients living in this area require a Part A ID to be entered in CAREWare.
What is the EMA?
This is what SLMB stands for.
Specified Low - Income Medicare Beneficiary
List four acceptable forms of proof of residence.
What are
State of NH Photo ID
Government issued document
Bank statement
Lease or mortgage statement
Utility bill
Paystub w/ address
True or false: ADAP can cover compounded medications.
What is false?
Clients have this many days to enroll in ACA Marketplace insurance if they qualify for special enrollment.
What is 60 days?
These two labs are entered on the encounters tab in CAREWare.
What are CD4 count and viral load?
This is what PBM stands for.
What is Pharmacy Benefit Manager?
This form may be submitted in lieu of a complete application once a year, provided that the client has not had a lapse in enrollment.
What is a 6-month attestation?
NH ADAP cannot cover copays for this type of insurance.
What is Medicaid?
Name two examples of a "special enrollment period" for insurance eligibility through the Affordable Care Act.
What are
Loss of health coverage
Changes in household composition
Changes in residence (different county or zip code)
Leaving incarceration
True or false: When entering enrollment services, the services should be back dated to the day the case manager met with the client.
What is false.
This acronym is used for the "Extra Help" program offered by the Social Security Administration to help clients pay their Medicare Part D costs.
What is LIS? (Low income subsidy)
A client's unmarried partner counts as a household member when applying for the NH CARE Program only if one or both of these two things apply.
They are the client's dependent for tax purposes
They are the parent of the client's child.
This is required by the PBM when a client would like ADAP to cover an over the counter item.
What is a prescription?
True or false: if a client has their own private dental insurance, they can still use the NH CARE Program to cover their copays and deductibles for dental services.
What is false?
This field should be filled in by the case manager using all capital letters and no punctuation.
What is common notes?
In order for the NH CARE Program to pay a medical bill for a client, the program needs a copy of this form that shows what portion was paid by the client's primary insurance. This form is commonly referred to by this acronym.
What is an EOB. (Explanation of benefits)