We have seen very little movement on our core issues since we last sent an update, though we have gained some clarity into the area that is causing the greatest delay.

1. Document View On-Line: The IBM-Coalition has recently added a Document View option which has been long promised and is helpful to some extent. Documents are only accessible for us to see after a case number has been assigned which only occurs after an interview has been completed which is usually several weeks after the application date.

2. Medical Review Team: Where we have gained headway with the initial processing of the applications and seen some (I don't want to overstate here) progress in the consistency of information, we are finding that extreme cases that fall way out of the acceptable processing times are held up in MRT and we cannot get any information on what is causing the delays. When it reaches the MRT, all the call-center or side door e-mails will tell us is that the case is pending MRT decision and that's as far as we can go. Case in point: Patient application date is 10/19/2008 was submitted to MRT on 12/17/08, we have sent 3 side-door e-mails requesting an update and each time they have replied that the case is pending MRT and that they have all the information they need to process his application. As of 5/19/09 he is still pending a decision which by my count is 240 days since application. Other similar cases are available upon request. The MRT reports to the office of Medicaid Office of Planning and Policy and is outside of the IBM-Coalition’s realm of influence. We have had no contact with MRT directly, nor would we ask for that if their decisions were timelier. Another question we have for them is a procedural one. Often, they request additional documents or tests or communication from physicians in order to make their decision. Our question is what happens to that case when all documents are returned? Do they go back in the stack, or are they handled first? It appears they go back into the queue and have to wait for review.

3. Blank forms: We have received several letters recently from the Document Center which are completely blank other than the applicant's name and case number. Concerning and not exceptionally helpful. Examples are available upon request.

4. Retro months are not being added without prompting. In some cases, the eligibility is not even going back to the application date. Example: Patient application date was 12/3/08 and his eligibility began 2/1/09. We were able to get the retro by sending a side-door e-mail on this case. I have details if needed.

5. Appeal Process: This may be related to the MRT issues, but we have heard that the Call-center reps are suggesting to clients that they should just re-apply instead of appeal denials because it will be "Faster and easier." This is not an acceptable approach because even though it may be true, clients that take this route lose months of coverage that they could have normally had. Considering that we are still seeing denials for "failure to return documents" that when we call the right people we find were there the whole time, appeals will be frequent. From our understanding, appeals are handled by the same office that runs the MRT and we fear that this problem will snowball if the number of appeals continues to increase.

6. Authorized Representatives not receiving correspondence: I hear continuous complaints of the inconsistency in which we receive the documents that we should. This is hard to pin down to examples because we don't know what we are not receiving often times until after denials. Overall our rating for the modernization process remains 4 out of 10. If you need additional examples or clarifications, please let me know.