Patent Application Titled “System For Finding And Enrolling Individuals In Programs Requiring Determination, Certification And Redetermination Chronically” Published Online (USPTO 20230245763): Patent Application

2023 AUG 18 (NewsRx) -- By a News Reporter-Staff News Editor at Health Policy and Law Daily -- According to news reporting originating from Washington, D.C., by NewsRx journalists, a patent application by the inventors Madigan, Andrew (Chicago, IL, US); Miller, Jacob A. (Chicago, IL, US), filed on January 12, 2023, was made available online on August 3, 2023.

No assignee for this patent application has been made.

Reporters obtained the following quote from the background information supplied by the inventors: “There is a real and existing critical challenge regarding the manner in which healthcare, and particularly medical benefits, patient wellness and access to crucial local, state and federal coverage are enrolled, administered, maintained and kept current. Particularly, healthcare has always been behind the curve from a technology standpoint, but this is even more acute in the Medicaid space, specifically in the determination, redetermination/recertification process involved with Medicaid benefits and identification and enrollment for Supplemental Security Income (SSI) and Social Security Disability (SSDI) benefits for Medicaid beneficiaries. The purpose behind the present invention is to utilize a system or method that employs technology as a component to improve and transform the determination process especially but not limited to the methodology within the Medicaid space. This invention is also aimed at facilitating Managed Care Organizations (MCO’s) ability to locate, engage with, recruit and simplify the determination process for individuals.

“What’s the difference between Medicare and Medicaid? According to the US Department of Health and Human Services (HHS), Medicare is federal health insurance for anyone age 65 and older, and some people under 65 with certain disabilities or conditions. Medicaid is a joint federal and state program that gives health coverage to some people with limited income and resources.

“One goal of the present invention is to increase the number of people that will go through and complete the redetermination process. This is accomplished by automating the overall data collection process and in the manner in which prospects are found, location and personal communication is updated in a database and updated in the forms needed to redetermine. Further means to accomplish the goal is to continually encourage applicants to complete the redetermination process, including, making it easier for applicants or members to use one of a number of data input means and then also to be able to seamlessly move from one input means to another while also facilitating the data collection by providing redetermination forms in a simple, more condensed format and by pre-populating the forms with the individual’s currently known information for easy confirmation or updating.

“Medicaid renewal, also called Medicaid redetermination or recertification, is a necessary part of continuing to be a Medicaid beneficiary (also referred to herein and in the industry as “members”), regardless of whether one receive benefits through the regular state plan, or long-term home and community-based services (HCBS) via a Medicaid waiver, or are on nursing home Medicaid. The Medicaid redetermination process ensures one is still eligible to receive Medicaid benefits, and in the case of many seniors and disabled persons, continue to receive Medicaid-funded long-term services and supports. Medicaid has income and asset (resource) limits for Medicaid beneficiaries and the Medicaid agency wants to ensure that the individual continues to fall under those financial limits.

“Medicaid beneficiaries must, continually, report any change in income or assets, even if it is not time for renewal of Medicaid benefits. This is because circumstances, such as an increase in income or an inheritance, can result in one being found ineligible to continue to receive Medicaid benefits. Most states allow between 10 and 30 days to report any such changes. Failure to do so can result in the loss of all Medicaid benefits and require the repayment of services and/or benefits which Medicaid has paid; failure to make such reports can result in fines and imprisonment as well.

“In Illinois for example, there are several different Medicaid programs for which residents may participate in and be eligible. Bach of these programs has slightly different eligibility requirements and benefits, which must be read and understood prior to enrollment therein. Additionally, there are complications regarding a participant’s eligibility for such programs, including (but not limited to) marital status and age and it is often found that the state offers different channels towards eligibility depending on eligibility; choosing the proper channel being problematic. Regardless of the program, Medicaid determination and/or recertification, is a necessary part of being a Medicaid beneficiary.

“Furthermore, Medicaid enrollment and renewal processes are not consistent across states and Medicaid groups. All of this is a recipe for complications and losses for any individual who does not recognize the programs for which it is eligible and to which it can be entitled; loss of which can result in missing benefits and having financial and health related consequences.

“The determination and redetermination processes are currently conducted in one of three ways: 1) by telephone interview, 2) by mail and 3) by in-person interview. Often members and prospective members are notified by mail regarding the need of and requirements for enrollment or redetermination; which, as can be imagined can be rife with problems, such as lost mail, undelivered mail, stolen mail, language issues and cognitive issues all related to the receipt of the Medicaid mailing. These issues are exasperated when the member or prospective member is elderly or mentally, physically or medically disabled or challenged. Often such eligibility and benefit redeterminations occur once annually. The specifics of the process vary state by state and even by provider/administrator. It has been found that a common weakness in the process is that members or prospective members cannot be located, and/or forget to follow through with the redetermination process and/or simply do not care enough to make the effort to proceed with the process and/or do not have the wherewithal or assistance to understand the process and thus fall out of the determination or fail to determine or redetermine.

“In the case of telephonic and in-person interviews, participants are typically sent a letter, in the mail, telling them to expect a call at a certain date and time. Many, who need assistance with the process, are often at a severe cognitive disadvantage and can and do miss appointments, with the consequence of loss of benefits. Typically, the Managed Care Organization (MCO) is aware of the process at least 60 to 90 days prior to the annual deadline; but there may be circumstances wherein participants can wind up having as few as 30 days to respond to an appointment letter, complete and return the form, or advise why they either cannot keep the appointment or are having trouble filling out the form. If they do not satisfy the process requirements, then they could lose Medicaid eligibility at that time and would need to reapply to determine eligibility, which is time-consuming and tedious and laden with hurdles for many possible participants.

“Oftentimes, a Medicaid recipient may be in tolerably good health, at the time of the process, and may ignore the need to determiner or redetermine, or the determinant feels that it does do not need any medical or healthcare coverage and therefore falls out of the program. This is often an error and can cause delays in coverage when a need does suddenly occur.

“Some purposes behind the present invention then, and as described in the preferred embodiment, is to serve the public medical insurance space and related commercial functioning behind this space in a convenience, efficient, secure, and optimal manner so Medicaid benefits are secured and/or continue from certification period to certification period. The invention is also applicable to other areas where chronic enrollment or re-enrollment is required.

“Another critical characteristic of the present invention is found in its ability to simplify and greatly facilitate the ability of members to engage in the redetermination process and easily enter, update and transmit their required information and data by being able to go from using a virtual agent or voice chat to an online web form with a virtual text chat feature and even back to a human assistant seamlessly and without losing any data input. A particular unique feature of this invention is that it allows the member to start the process through one of the means available, stop at some point and then reconvene using the same means or transferring the process to another means available through the system without missing a beat. Unique to this system is that the member can switch between a virtual agent (using artificial intelligence) on the telephone, to an online web form with a virtual text chat assistant to an old-school human assistant. Another useful feature of this inventive system is that in many cases the redetermination form is pre-populated with the member’s then known information; which can be uploaded during the redetermination process as the member is walked through the data fields so as to confirm or update the member’s information.

“Another aspect of the present invention’s redetermination processing is that the various data collection means are designed to be compliant with the Americans with Disabilities Act (ADA). ADA compliance, by aspects of the present invention, is found regardless of which of the different means to enter data provided by the invention are being used by the member, and then, any of the other means to which the member can switch, continues to be ADA compliant regardless of the stage of the redetermination process that user is in and regardless of the number of transitions from one data entry means to another.

“In another aspect of the invention, the scouring systems will be utilized to review any changes to the Medicaid program and institute those changes in the questionnaires and forms utilized to assess the candidate and enroll the applicant.”

There is additional background information. Please visit full patent to read further.”

In addition to obtaining background information on this patent application, NewsRx editors also obtained the inventors’ summary information for this patent application: “In accordance with the present invention, a method of finding and enrolling or re-enrolling a person in a specific desirable program, using telephonic, computer and electronic communications means, is provided. The method comprises the steps of providing means for communication with a candidate or person assumed to meet requirements for admission to the desirable program and if communication is not made, automatically using a search program and computer to find personal contact information of the candidate to then reattempt communication therewith. Storing the personal contact information of the candidate in a secured rewritable and searchable computer database having a calendar for use now and for finding the candidate again after a preset time for the next timely period and then utilizing the personal contact information to communicate with the candidate. Determining, through the interrogation of the candidate, if the candidate is eligible for the desirable program, and if so, renaming the candidate an applicant. Directing the applicant to an appropriate enrollment means for providing information for enrollment in the desirable program and securing enrollment data, through the enrollment means, from the applicant. Then storing the enrollment data in the secured rewritable and searchable database, and associating the data with the personal contact information for the applicant as applicant data for use in enrollment and for later contact. Automatically, by allowing the computer to use the applicant data, merging the applicant data to a precise computer chosen application form to create an application for enrollment in the specific desirable program and submitting the application form for enrollment. Then updating the applicant data within the data storage device or a cloud storage service, and associating the data with the calendar to automatically contact the applicant, using the updated applicant data, within a specified time period for re-enrollment.

“It will be understood, by persons having ordinary skill in the art, that enrollment data can be secured via a telephone conversation, a questionnaire on a mobile device or a questionnaire on a personal computer. Further, securing enrollment data can be started on any one of a telephone conversation, a questionnaire on a mobile device or a questionnaire on a personal computer and completed, later, on any one or more of a telephone conversation, a questionnaire on a mobile device or a questionnaire on a personal computer.

“The primary focus of the method is enrollment into Medicaid; however, it will be understood that the method is applicable to other programs necessitating that a person re-enroll or apply on a chronological basis. Such programs as general medical insurance, licensure recertification (including, but not limited to professional licenses, driver’s licenses, firearm licenses), memberships, annual donations and tax reporting, can be facilitated using the system of the present invention.

“Use of the method can proceed, where the computer noted can include any electronic data entry and manipulation devices including one or more of a personal mobile device, a mobile telephone, an electronic pad, an electronic tablet, a personal computer, a laptop computer or any other data entry device and components thereof, including software and peripherals.

“Enrollment data, for eligibility, is created by the applicant answering a series of questions, the answers being automatically recorded in the secure database.

“The method includes means wherein when an attempt to communicate with a candidate is unsuccessful, the process automatically uses means to search public and private databases to find updated contact information and then uses the updated contact information to again attempt to communicate with the candidate; this process continuing until communication is made.

“As some programs are limited to certain jurisdictional bodies, such as individual states, in some embodiment the process includes means to notify a provider in a second jurisdiction of a candidate who has moved to the second jurisdiction from the particular jurisdiction for enrollment of the member therein.

“The questionnaire used to make assessments can, in preferred embodiments, include a Health Risk Screening to help assess the candidate’s present health and needs during enrollment.

“The method provided includes the step of utilizing the means for communication and storage to periodically scour the regulations of the specific desirable program to allow for automated changes in one or more of the questionnaire, forms and enrollment data as required for enrollment relative to any changes in laws or regulations.

“In a preferred embodiment, then, the present invention, is a method of finding and enrolling or re-enrolling persons into Medicaid. The method uses telephonic, computer and electronic communications means, and comprises the steps of communicating with a candidate or person assumed to meet requirements for admission to Medicaid via a telephone conversation, a questionnaire on a mobile device or a questionnaire on a personal computer and if communication is not made, automatically using a search program and computer to find personal contact information of the candidate to then reattempt communication therewith. Storing the personal contact information of the candidate in a secured rewritable and searchable computer database having a calendar. Utilizing the personal contact information to communicate with the candidate and determining if the candidate is eligible for Medicaid, and if so, renaming the candidate an applicant.

“The method then directs the applicant to an appropriate enrollment means for providing information for enrollment in Medicaid and securing enrollment data, wherein securing enrollment data can be started on any one of a telephone conversation, a questionnaire on a mobile device or a questionnaire on a personal computer and completed, later, on any one or more of a telephone conversation, a questionnaire on a mobile device or a questionnaire on a personal computer, from the applicant, and storing the enrollment data in the secured rewritable and searchable database, and associating the data with the personal contact information for the applicant as applicant data. Automatically, by allowing the computer to use the applicant data, merging the applicant data to a precise computer chosen application form to create an application for enrollment in the specific desirable program and submitting the application form for enrollment. Then updating the applicant data and associating the data with the calendar to automatically contact the applicant, using the updated applicant data, within a specified time period for re-enrollment.

“The method includes using any electronic data entry and manipulation devices including one or more of a personal mobile device, a mobile telephone, an electronic pad, an electronic tablet, a personal computer, a laptop computer or any other data entry device and components thereof, including software and peripherals. Enrollment data is created by the applicant answering a series of questions, the answers being automatically recorded in the secure database.

“In a preferred embodiment, when an attempt to communicate with a candidate is unsuccessful, the process automatically uses means to search public and private databases to find updated contact information and then uses the updated contact information to again attempt to communicate with the candidate; this process continuing until communication is made.”

The claims supplied by the inventors are:

“1. A method of finding and enrolling or re-enrolling a person in a specific desirable program, using telephonic, computer and electronic communications means, comprising the steps of: providing means for communication with a candidate or person assumed to meet requirements for admission to the desirable program and if communication is not made, automatically using a search program and computer to find personal contact information of the candidate to then reattempt communication therewith; storing the personal contact information of the candidate in a secured rewritable and searchable computer database having a calendar; utilizing the personal contact information to communicate with the candidate; determining if the candidate is eligible for the desirable program, and if so, renaming the candidate an applicant; directing the applicant to an appropriate enrollment means for providing information for enrollment in the desirable program; securing enrollment data, through the enrollment means, from the applicant, and storing the enrollment data in the secured rewritable and searchable database, and associating the data with the personal contact information for the applicant as applicant data; automatically, by allowing the computer to use the applicant data, merging the applicant data to a precise computer chosen application form to create an application for enrollment in the specific desirable program and submitting the application form for enrollment; and updating the applicant data and associating the data with the calendar to automatically contact the applicant, using the updated applicant data, within a specified time period for re-enrollment.

“2. The method of claim 1, wherein enrollment data can be secured via a telephone conversation, a questionnaire on a mobile device or a questionnaire on a personal computer.

“3. The method of claim 2, wherein securing enrollment data can be started on any one of a telephone conversation, a questionnaire on a mobile device or a questionnaire on a personal computer and completed, later, on any one or more of a telephone conversation, a questionnaire on a mobile device or a questionnaire on a personal computer.

“4. The method of claim 1, wherein the specific desirable program is Medicaid.

“5. The method of claim 1, wherein a computer includes any electronic data entry and manipulation devices including one or more of a personal mobile device, a mobile telephone, an electronic pad, an electronic tablet, a personal computer, a laptop computer or any other data entry device and components thereof, including software and peripherals.

“6. The method of claim 1, wherein enrollment data is created by the applicant answering a series of questions, the answers being automatically recorded in the secure database.

“7. The method of claim 1, wherein when an attempt to communicate with a candidate is unsuccessful, the process automatically uses means to search public and private databases to find updated contact information and then uses the updated contact information to again attempt to communicate with the candidate; this process continuing until communication is made.

“8. The method of claim 1, including the step of utilizing the means for communication and storage to periodically scour the regulations of the specific desirable program to allow for automated changes in one or more of the questionnaire, forms and enrollment data as required for enrollment as a result of changes to laws and/or regulations associated therewith.

“9. The method of claim 7, where membership is limited to a particular jurisdiction and the process includes means to notify a provider in a second jurisdiction of a candidate who has moved to the second jurisdiction from the particular jurisdiction for enrollment of the member therein.

“10. The method of claim 2, wherein the questionnaire includes a Health Risk Screening to help assess the candidate’s present health and needs during enrollment.

“11. A method of finding and enrolling or re-enrolling a person into Medicaid, using telephonic, computer and electronic communications means, comprising the steps of: communicating with a candidate or person assumed to meet requirements for admission to Medicaid via a telephone conversation, a questionnaire on a mobile device or a questionnaire on a personal computer and if communication is not made, automatically using a search program and computer to find personal contact information of the candidate to then reattempt communication therewith; storing the personal contact information of the candidate in a secured rewritable and searchable computer database having a calendar; utilizing the personal contact information to communicate with the candidate; determining if the candidate is eligible for Medicaid, and if so, renaming the candidate an applicant; directing the applicant to an appropriate enrollment means for providing information for enrollment in Medicaid; securing enrollment data, wherein securing enrollment data can be started on any one of a telephone conversation, a questionnaire on a mobile device or a questionnaire on a personal computer and completed, later, on any one or more of a telephone conversation, a questionnaire on a mobile device or a questionnaire on a personal computer, from the applicant, and storing the enrollment data in the secured rewritable and searchable database, and associating the data with the personal contact information for the applicant as applicant data; automatically, by allowing the computer to use the applicant data, merging the applicant data to a precise computer chosen application form to create an application for enrollment in the specific desirable program and submitting the application form for enrollment; and updating the applicant data and associating the data with the calendar to automatically contact the applicant, using the updated applicant data, within a specified time period for re-enrollment.

“12. The method of claim 11, wherein a computer includes any electronic data entry and manipulation devices including one or more of a personal mobile device, a mobile telephone, an electronic pad, an electronic tablet, a personal computer, a laptop computer or any other data entry device and components thereof, including software and peripherals.

“13. The method of claim 11, wherein enrollment data is created by the applicant answering a series of questions, the answers being automatically recorded in the secure database.

“14. The method of claim 11, wherein when an attempt to communicate with a candidate is unsuccessful, the process automatically uses means to search public and private databases to find updated contact information and then uses the updated contact information to again attempt to communicate with the candidate; this process continuing until communication is made.”

For more information, see this patent application: Madigan, Andrew; Miller, Jacob A. System For Finding And Enrolling Individuals In Programs Requiring Determination, Certification And Redetermination Chronically. U.S. Patent Application Number 20230245763, filed January 12, 2023 and posted August 3, 2023. Patent URL (for desktop use only): https://ppubs.uspto.gov/pubwebapp/external.html?q=(20230245763)&db=US-PGPUB&type=ids

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