Adult Medicaid Change Notices

A. DHREJA TRANS ASSET EVAL NEEDED

B. DHREJA TRANS ASSET EVAL SUMM

A. MA-2240, Transfer of Resources

B. MA-1100, SSI Medicaid-County DSS Responsibility

A. Who received in-home health services and supplies on or after February 1, 2003, and

B. Who were authorized under the MAA, MAB, MAD, or MQB-Q aid program/category as of the date of service, and

C. Who do not have a CAP code in EIS as of the date of service, and

D. Who do not have a transfer of assets indicator in EIS, and

E. For whom a claim for in-home health services and supplies has been paid by Medicaid.

A. Remove: MA-1100, SSI Medicaid-County DSS Responsibility, pgs 1-18.

B. Remove: MA-2240, Transfer of Resources, pgs 31-32.

CHANGE NOTICE FOR MANUAL NO. 22-03, Transfer of Resources Tracking

DATE: APRIL 15, 2003

Manual: Aged, Blind, and Disabled Medicaid

Change No: 22-03

To: County Directors of Social Services

Effective: May 1, 2003

I. BACKGROUND

In February 2003, transfer of resources policy was revised to include individuals in a private living arrangement requesting or receiving assistance with in-home health services and supplies. The North Carolina General Assembly mandated this change in order to reduce Medicaid expenditures.

This change in policy is applicable only to individuals receiving or who have received Medicaid under the MAA, MAB, MAD, and MQB-Q aid program/categories since February 1, 2003. At application, redetermination and applicable change in situation, a transfer of resources evaluation must be completed by the caseworker and the results entered on the EIS Assets Transfer Tracking Screen.

In an effort to assist counties in identifying MAABD and MQB-Q individuals who do not have a transfer of resources evaluation indicator in EIS and for whom a claim for in-home health services and supplies has been paid, two weekly reports will be generated by the Medicaid claims contractor and posted in NCXPTR.

II. REPORTS

A. DHREJA TRANS ASSET EVAL NEEDED

1. This report is for county use and is sorted by county number, district number, date first appeared on the report, and recipient name.

2. When a claim for in-home health services and supplies is submitted to the Medicaid claims contractor for payment, the contractor will search for the transfer of assets indicator.

a. If the Assets Transfer Tracking Screen has been updated with an evaluation indicator and/or a sanction period, the Medicaid claims contractor will either pay or deny the claim based on the date of service, evaluation indicator, and/or sanction period.

b. If the Assets Transfer Tracking Screen has not been updated with an evaluation indicator and/or a sanction period, the Medicaid claims contractor will pay the claim and produce the report entitled DHREJA TRANS ASSET EVAL NEEDED. The report will be generated weekly in NCXPTR and will be available on Wednesday.

Individuals on this report received Medicaid under an MAABD or MQB-Q aid program/category on the date the in-home health services and supplies were received. However, these individuals may currently be receiving Medicaid under another aid program/category or may be terminated.

(1) The county must review the report, and

(2) Contact the recipient regarding transfers during the lookback period.

(a) For PLA applications dated prior to 02/01/03, the starting point for the lookback period is the date of service.

Use the date of service on the report as the starting point for determining the lookback period, unless you learn from any other source that the recipient received assistance with in-home health services and supplies prior to the date of service on the report.

(b) For PLA applications dated 02/01/03 or later, the starting point for the lookback period is the date of application.

And

(3) Document the results of the transfer of resources evaluation in the case record, and

(4) Update the Assets Transfer Tracking Screen. An individual will remain on the report until the transfer of assets indicator is updated.

B. DHREJA TRANS ASSET EVAL SUMM

This report is for county and DMA use. It provides a summary of the number of pending and overdue evaluations and is sorted by county and district number. The report will be generated weekly in NCXPTR and will be available on Wednesday.

III. CONTENT OF CHANGE

A. MA-2240, Transfer of Resources

MA-2240, Transfer of Resources, has been revised to include the policy and procedures for evaluating for transfer of resources when a claim for in-home health services and supplies is paid for a recipient with a blank transfer of resources indicator in EIS.

B. MA-1100, SSI Medicaid-County DSS Responsibility

1. MA-1100, SSI Medicaid-County DSS Responsibility, has been revised to include procedures when determining county responsibility for completing a transfer of resources evaluation when the SSI recipient is not a resident of the county listed on the DHREJA TRANS ASSET EVAL NEEDED report.

2. Deleted references to forms and XPTR reports that have been revised, renumbered, or renamed.

IV. EFFECTIVE DATE

This change in policy is effective May 1, 2003.

V. IMPLEMENTATION PROCEDURES

The first report will be available in NCXPTR on April 30, 2003. The report will include all PLA individuals:

A. Who received in-home health services and supplies on or after February 1, 2003, and

B. Who were authorized under the MAA, MAB, MAD, or MQB-Q aid program/category as of the date of service, and

C. Who do not have a CAP code in EIS as of the date of service, and

D. Who do not have a transfer of assets indicator in EIS, and

E. For whom a claim for in-home health services and supplies has been paid by Medicaid.

Review the report weekly to determine who needs a transfer of resources evaluation.

Vi. Maintenance of Manual

A. Remove: MA-1100, SSI Medicaid-County DSS Responsibility, pgs 1-18.

Insert: MA-1100, SSI Medicaid-County DSS Responsibility, pgs 1-18.

B. Remove: MA-2240, Transfer of Resources, pgs 31-32.

Insert: MA-2240, Transfer of Resources, pgs 31-35.

If you have any questions regarding this material, please contact your Medicaid Program Representative.

Nina Yeager

Director

(This policy was researched and written by Vanessa Broadhurst, Policy Consultant, Medicaid Eligibility Unit.)