Client Contact Forms

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Client Contact Forms
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Why Collect Data?

• Review SHINE Program Goal
• The objective of the SHINE Program is to provide
  Massachusetts Medicare beneficiaries with access
  to accurate, unbiased health insurance
  information, counseling and assistance
• SHINE is partially federally grant funded
• Requirement of grant that SHINE provide data to
  measure performance/achievement of program goal
• Performance compared nationally
• SHINE funding level based on performance

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Why Collect Data, cont.

• Requirement of grant that SHINE conduct targeted
  outreach to certain populations and collect data
• Targeted SHINE populations
• General Medicare population
• Populations considered hard to reach due to
• Race, culture background, and ethnicity
• Limited English proficiency
• Dual Eligibles with Mental Illnesses or
  Disabilities
• Beneficiaries with disabilities
• Individuals eligible for the low income subsidy
  for prescription drug coverage

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Client Contact Form (CCF)

• Data collected through Client Contact Forms
  (CCFs)
• Collected on paper then entered into computer
  system
• CCF must be completed for each contact between
  counselor and client
• Client contact All contacts between a counselor
  and a client
• Contacts may be conducted by phone or in person

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Completing a Client Contact Form

• Asterisk's Field MUST be filled out
• Grant requirement
• Check all appropriate boxes in each category,
  many accept multiple responses
• Review each CCF to ensure accuracy prior to
  submitting to Regional Director
• Must be submitted MONTHLY

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Section 1-3Client Identifying Information

• Zip code of Client Residence Most important
  information that MUST be collected
• Agency Where you are counseling
• Date of Contact Date of each contact with a
  client
• Fill out a separate CCF even if meeting with same
  client multiple times

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Section 4 5Information About the Contact
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Section 6 Race-Ethnicity Language
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Section 7 8Income and Disability Information

• Client Monthly Income
• If Below 150 FPL, eligible for LIS
• Receiving or Applying for SS Disability
• If under 65 and on Medicare, would always check
  YES

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Section 9Prescription Drug Assistance

• Check everything that you helped the client with
  in this section

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Section 10Time Spent and Status of Contact

• Total Time Spent
• Includes travel time, time spent preparing for
  the appointment, time spent researching before or
  after the session

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Section 11 CMS Special Use Fields Potential
Financial Assistance Provided

• State collects data from this section for state
  specific reports
• MIPPA (Medicare Improvements for Patients and
  Providers Act) Expectation is that every
  counselor screen clients for LIS and MSP
• One Care One Care data entry
• Potential Financial Assistance Provided Provides
  data showing how much money SHINE counselors
  saved beneficiaries by providing them with
  information and assistance
• Very important to fill out so accurate
  beneficiary savings can be determined

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How to Collect Data

• Preferred method self-report
• Self-reporting is the most consistent and valid
  source of information
• Client can choose from several categories to
  describe themselves
• Some clients may be concerned when asked certain
  questions they may feel are personal
• Be sensitive to concerns and explain why you are
  collecting the data and what is done with it
• Most often, once individuals understand the
  purpose of the question, they are happy to
  cooperate

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Race-Ethnicity

• Question Client Race-Ethnicity
• Categories should be read/shown to client for
  them to choose applicable category(s)
• Examples of how to ask this question
• Which of the following best represents your
  racial or ethnic heritage? Choose all that apply
  
• Which categories best describes your race or
  ethnicity? You can choose one or more categories
  

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Primary Language

• Question Client Primary Language Other Than
  English
• Primary language refers to the language that a
  person acquires in earliest childhood also, the
  primary language of a community
• Also referred to as native language or mother
  tongue
• Examples of how to ask this question
• Is English your primary language?
• Do you have a primary language other than
  English?

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Income

• Question Client Monthly Income
• This question asks whether a clients income is
  below 150 of the Federal Poverty Limit (FPL) or
  at or above 150 of the FPL
• To avoid making the client reveal their income
  which may make some clients uncomfortable, just
  ask whether income is below/at or above 150 FPL
  limit
• SHINE counselors do not need to know a clients
  exact income
• Counselors responsibility is only to SCREEN for
  potential benefit program eligibility
• Example of how to ask this question
• Is your income below (list the current 150
  FPL), or is it at or above that amount?

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SHIP NPR(State Health Insurance Assistance
Programs National Performance Reporting)

• Website where CCFs are entered and data
  collected
• All counselors entered into website
• Will receive an email asking to verify your email
  address, this will activate your account (must
  respond w/in 24 hrs)
• Another Important feature of SHIP NPR Used to
  obtain your CMS Unique ID
•  Unique ID allows you to call CMS Customer
  Service using the designated phone number for
  SHINE counselors
• To receive assistance, must provide your CMS
  Unique ID
• Will receive email with instructions on how to
  obtain your Unique ID