Adult Medicaid Admin. Letters

DMA ADMINISTRATIVE LETTER NO. 18-01, NC Health Choice Cases with EIS Cert. Periods That Do not Match the BCBS 12 Month Coverage Periods

DATE: DECEMBER 5, 2000

Subject: North Carolina Health Choice Cases With EIS

Certification Periods That Do Not Match The

BCBS 12 Month Coverage Periods

Distribution: County Directors of Social Services

Medicaid and NC Health Choice Supervisors

Medicaid and NC Health Choice Caseworkers

I. BACKGROUND

There are currently NCHC cases that have certification periods in EIS that do not match the 12- month coverage period in the BCBS system. When the 12-month periods are not in synch between the two systems, changes to the cases do not update.

The BCBS 12-month period is established by the first month of the EIS certification period for new approvals and reenrollments. Once established, a BCBS 12-month coverage period can not be changed. If a case closes and is later reopened within that 12-month period using the same case id, BCBS gives coverage from the point of reopen through the original 12th month.

The 12-month periods for the affected cases were established due to Floyd extensions, NCHC approvals and various other county actions. At some point, these cases were closed and later reopened within the established 12-month period. Then the recipients were reapproved for NCHC, a new 12-month period was entered in EIS but coverage at BCBS only extended through the 12th month of the already established BCBS period. If the EIS certification period ended prior to the BCBS period, the State manually sent reenrollments to BCBS.

It will be necessary for each county dss with affected cases to take the specific actions stated in this letter. The purpose of this letter is to identify affected counties and cases, provide instructions on how to handle these cases, and provide a standard form to be placed in these records for documentation. Read this letter in its entirety prior to taking action on any case.

These affected counties are: 02, 08, 10, 11, 16, 25, 26, 29, 32, 33, 34, 39, 40, 41, 42, 44, 45, 51, 54, 60, 64, 65, 66, 67, 68, 70, 74, 77, 78, 79, 80, 81, 82, 83, 84, 90, 92, 93, 94, 96, and 98.

II. PROCEDURES FOR CORRECTING CASES

When the EIS certification period ends at reenrollment, caseworkers must close the affected NCHC case. If the case continues to be eligible for NCHC, a new NCHC case must be opened with a new case id. Use the following instructions.

A. Reports

1. NCHC Cases With Incorrect Certification Periods

a. The counties listed in the letter will receive a report of all affected cases. Each county is responsible for their county’s cases. The report is attached to this letter. The report is not available in XPTR. The report will contain the following information:

(1) County No.

(2) Case ID

(3) Casehead Name

(4) EIS end date

(5) BCBS end date

b. Upon receipt of the report, each case listed must be “FLAGGED” to make certain the current NCHC case will be closed at the end of the EIS certification period.

2. The Case Management report will continue to list these cases when due for reenrollment based on the EIS certification through date.

B. Documentation

1. The attached form is to be used as documentation of the procedures in this letter. At this time this letter is received, the form must be copied, completed, and placed in each record.

2. Please retain this documentation in the record to not reopen the case using the original case id. If the recipient does not complete the reenrollment process and later reapplies, do not reapp against the closed NCHC case id.

C. Procedures When Cases Become Due for Reenrollment

Evaluate the case for continued eligibility.

1. Case remains eligible for NCHC.

a. Close the current NCHC case at the end of the EIS certification period. Override the termination notice. Do not reopen the closed case.

b. Register an 8124 application type “1” to open a “new” NCHC case in EIS. This will establish a new 12-month period of coverage in the BCBS system that will match the new EIS certification period.

c. Do NOT process this application. Call an EIS consultant at (919)857-4019 for assistance with the required processing procedures. Please reference this Administrative Letter when placing your call.

2. Case is eligible for MIC.

Follow regular policy regarding the transfer of the NCHC case to MIC.

NOTE: Do not overlap coverage periods. The MIC case is effective the first day of the month following the termination of the NCHC case.

For example: If the NCHC case ends 12-31-00, the MIC case will be effective 1-1-01 and the 12-month certification period will begin 1-1-01.

3. Case is eligible for the extended coverage group (class L).

Call an EIS consultant at (919) 854-4019 prior to taking any action on the case. Reference this Administrative Letter when placing your call.

4. Case is eligible for continued benefits.

Follow regular policy regarding sending a manual timely notice if the reenrollment form is not returned or if the case is found ineligible for other reasons. Ensure the case is flagged if the client reapplies.

If you have any questions regarding these instructions, please contact and EIS or Policy Consultant at (919) 857-4019.

Paul R. Perruzzi

Director

(This material was prepared by Jan McElroy and Trenita Dawkins, EIS Consultants.)