NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 2400

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BENEFIT ISSUANCE FOR REOPENED APPLICATIONS

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EIS 2400 – BENEFIT ISSUANCE FOR REOPENED APPLICATIONS

V. BENEFIT ISSUANCE FOR REOPENED APPLICATIONS (APPLICATIONS WITH DATE SCREENS)

EIS 2400 – BENEFIT ISSUANCE FOR REOPENED APPLICATIONS

ISSUED 10/01/02 - CHANGE NO. 02-03

V. BENEFIT ISSUANCE FOR REOPENED APPLICATIONS (APPLICATIONS WITH DATE SCREENS)

A. BACKGROUND

1. EIS issues benefits back to the original date of application or date of improper discouragement based on the dates entered on the Date Screen. EIS allows benefits to begin up to 3 months prior to the original date of application or date of discouragement. Enter all eligibility on the DSS-8125.

Remember: Always enter a current date of application on the DSS-8124 to reopen a case. Enter the original date of application or original date of discouragement on the Date Screen.

2. EIS does not allow a DB/PML transaction to authorize benefits for appeal reversals, incorrect denials, or improper discouragements, denials, and withdrawals for a period of time prior to the month of application on the current DSS-8124.

B. THERE ARE TWO TYPES OF ONGOING APPROVALS FOR REOPENED CASES:

1. Ongoing from the original date of application or original date of discouragement entered on the Date Screen and including the month of application on the current DSS-8124; (See C.1.below)

AND

2. Ongoing from the original date of application or original date of discouragement entered on the Date Screen but not including the month of application on the current DSS-8124. (See C.2.below)

C. APPROVING REOPENED MEDICAID BENEFITS

EIS issues benefits beginning with the Medicaid Effective Date entered on the DSS-8125. The Date Screen for appeal reversals, incorrect denials, discouragement, improper denials, or improper withdrawals, allows EIS to issue benefits based on the original date of application or original date of discouragement.

Example: The original date of application is 02/01/02 on the Date Screen. The date of application entered on the current DSS-8124 is 06/03/02. The Medicaid Effective Date can be up to three months prior to 02/01/02, if the application includes retroactive benefits. The certification period must start with 06/01/02.

ISSUED 10/01/02 - CHANGE NO. 02-03

V.C. (CONT'D)

Complete the 8125 in one of the two ways listed below to issue MEDICAID benefits:

1. Approval Including the Month of Application on the Current DSS-8124

a. The Medicaid Effective Date may go all the way back to the first day of the original application month entered on the Date Screen, or up to three months prior if the application is for retroactive coverage.

(1) Determine the certification period or periods from the original date of application or discouragement entered on the Date Screen through the current ongoing period based on policy.

(2) Determine the eligible dates prior to the original date of application entered on the Date Screen, if the application is two-part.

(3) If there are no breaks in eligibility, the Medicaid Effective date can be either:

(a) The first day of eligibility in the ongoing period (based on the original date of application). Or,

(b) The first day of eligibility in the retro period.

EXAMPLE: The date of application on the two-part DSS-8124 is 10/02/2002. The original date of application entered on the Date Screen is 04/01/2002. Applicant is eligible from 02/01/2002 with no breaks in eligibility. The Medicaid Effective date is 02/01/2002. The Certification begin date is 10/01/2002.

(4) If there are breaks in eligibility, determine the date the applicant has a continuous authorized period that includes the current date of application. This is referred to as the ‘Stable Date’ and may include more than one policy certification period.

ISSUED 10/01/02 - CHANGE NO. 02-03

V.C.1.a.(4) (CONT'D)

The Medicaid Effective date is the first day of the continuous eligibility.

EXAMPLE: The date of application on the one-part DSS-8124 is 10/02/2002. The original date of application entered on the Date Screen is 11/27/2001. The applicant is eligible from 12/19/2001 thru 04/30/2002. For some reason they are not eligible again until 06/01/2002 and remain eligible thru the current application certification period. The “Stable Date” is 06/01/2002, therefore the Medicaid Effective Date is 06/01/2002. The Certification Begin date is 10/01/2002.

An administrative application must be done for 12/19/2001 thru 04/30/2002.

b. The Certification Period begins with the month of application on the current 8124 and ends not more than 6 or 12 months after the “From Date”, depending on the aid program/category and the Medicaid Classification.

The Through Date may be less than 6 or 12 months.

Example: The policy certification period established for a reopened case is May thru October. Date of application on the current 8124 is August. The Certification From Date is tied to the current 8124, so it is August 1. The Certification Thru Date is based on the original date of application and redetermination requirements (in this case, 6 months). Therefore October 31 would be the certification thru date in this example.

c. If the application is two-part and there is retro eligibility, it can be entered in the Retro 1 and 2 fields.

d. If there is a break in eligibility and benefits need to be issued prior to the ‘Stable Date’ determined in C.1.a.(4), above, enter additional new (Type 1) applications for each continuous period of eligibility and approve them open/shut. Enter any additional “Admin” applications the day after the first application approval processes in EIS.

Key each DSS-8124 as “Administrative”.

ISSUED 10/01/02 - CHANGE NO. 02-03

V.C.1. (CONT'D)

e. The Date of Application on the “Administrative” DSS-8124 must be the first month(s) for which benefits are needed.

(1) Since there is no Date Screen associated with an “Administrative” application, the certification period can be no longer than 6 or 12 months, depending on the aid program/category.

(2) EIS allows a DB/PML transaction.

REMINDER: FOR ONGOING APPROVALS, ENTER ONGOING DISPOSITION REASON AND DATE.

FOR RETROACTIVE APPROVALS, ENTER RETROACTIVE DISPOSITION REASON AND DATE.

FOR ONGOING AND RETROACTIVE APPROVALS, ENTER ONGOING AND RETROACTIVE DISPOSITION REASON AND DATE.

2. Approval Not Including the Month of Application on the Current DSS-8124

a. The Medicaid Effective Date may go all the way back to the first day of the original application month entered on the Date Screen or up to 3 months prior if the application is for retroactive coverage.

(1) Determine the certification period or periods from the original date of application or discouragement entered on the Date Screen through the end of eligibility, not including the month of application on the current DSS-8124, based on policy.

(2) Determine the eligible dates prior to the original date of application or date of discouragement entered on the Date Screen, if the application is two-part.

(3) If there is no break in eligibility, the Medicaid Effective date can be either:

(a) The first day of eligibility in the ongoing period (based on the original date of application). Or,

ISSUED 10/01/02 - CHANGE NO. 02-03

V.C.2.a.(3) (CONT'D)

(b) The first day of eligibility in the retro period.

(4) If there are breaks in eligibility, determine the continuous authorized period that ends just prior to the current date of application. This is referred to as the ‘Stable Date’ and may include more than one policy certification period.

The Medicaid Effective date is the first day of continuous eligibility.

b. The Certification Period begins with the first month of continuous eligibility and ends with the last month for which eligibility has been determined - but cannot include the month of application on the current DSS-8124.

(1) This period can be more than 12 months because of the Date Screen.

(2) The Medicaid Effective Date and the Certification “FROM Date” must be the same month.

c. If the application is two-part and there is retro eligibility, it can be entered in the Retro 1 and 2 fields.

d. Case termination date is required and must be the same as the Certification Period “Through Date”. This is an open/shut.

e. If there is a break in eligibility and benefits need to be issued prior to the ‘Stable Date’ determined in C.2.a.(4) above, enter additional new (Type 1) applications for each continuous period of eligibility and approve them open/shut. Enter any additional “Admin” applications the day after the first application approval processes in EIS.

Key each DSS-8124 as “Administrative”.

ISSUED 10/01/02 - CHANGE NO. 02-03

V.C.2. (CONT'D)

f. The Date of Application on the “Administrative” DSS-8124 must be the first month(s) for which benefits are needed.

(1) Since there is no Date Screen associated with an “Administrative” application, the certification period can be no longer than 6 or 12 months, depending on the aid program/category.

(2) EIS allows a DB/PML transaction.

REMINDER: FOR ONGOING APPROVALS, ENTER ONGOING DISPOSITION REASON AND DATE.

FOR RETROACTIVE APPROVALS, ENTER RETROACTIVE DISPOSITION REASON AND DATE.

FOR ONGOING AND RETROACTIVE APPROVALS, ENTER ONGOING AND RETROACTIVE DISPOSITION REASON AND DATE.

If you have any situation that you cannot fit into either of the explanations given, please call EIS staff.

D. APPROVING REOPENED WORK FIRST BENEFITS

EIS issues benefits beginning with the Payment Effective Date, and if entered, Prior Month 1 and Prior Month 2 Dates entered on the DSS-8125. The Date Screen for appeal reversals, incorrect denials, discouragements, improper denials, and improper withdrawals, allows EIS to issue benefits based on the original date of application or original date of discouragement. However, the Payment Review Period can never be prior to the month of application on the current DSS-8124.

Example: The original date of application is 02/01/02 on the Date Screen. The date of application entered on the DSS-8124 is 06/03/02. The Ongoing Payment Effective Date can be 02/02 and the Medicaid Effective Date can be up to three months before 02/01/02. The Payment Review Period begins 06/02.

ISSUED 10/01/02 - CHANGE NO. 02-03

V.D. (CONT'D)

Complete the 8125 in one of the two ways listed below to issue WORK FIRST benefits:

1. Ongoing Including the Month of Application on the Current DSS-8124

a. The Medicaid Effective Date may go back to the first day of the original application month entered on the Date Screen, or up to 3 months prior if retroactive benefits are requested.

b. The Payment Effective Date and Prior Month Payment Dates 1 and 2 and Amounts may go back to the original month of application indicated on the Date Screen.

(1) Determine the payment review period or periods from the original date of application or discouragement entered on the Date Screen through the current ongoing period based on policy.

(2) Determine the Medicaid eligible dates retro to the original date of application entered on the Date Screen, if retro Medicaid benefits were requested.

(3) If there is no break in eligibility, the Medicaid Effective date can be either:

(a) The first day of eligibility in the ongoing period (based on the original date of application). Or,

(b) Up to 3 months prior to the original date of application entered on the Date Screen, if retro Medicaid is requested. AND

(c) The Payment Effective date is the first month of eligibility (based on the original date of application).

(4) If there is a break in eligibility, determine the continuous authorized period that includes the current date of application. This is referred to as the ‘Stable Date’ and may include more than one policy payment review period.

(a) The Medicaid Effective date and the Payment Effective date is the first month of continuous eligibility.

ISSUED 10/01/02 - CHANGE NO. 02-03

V.D.1.b.(4) (CONT'D)

(b) The Payment Review Period begins with the month of application on the current 8124 and may be from one to 12 months, depending on the case.

(c) The “Through Date” should be the end of the Payment Review Period determined in D.1.b.(1), above.

c. If there is a break in eligibility and benefits need to be issued prior to the ‘Stable Date’ determined in D.1.b.(4) above, enter additional new (Type 1) applications for each continuous period of eligibility and approve them open/shut. Enter any additional “Admin” applications the day after the first application approval processes in EIS.

Key each DSS-8124 as “Administrative”.

d. The Date of Application on the “Administrative” DSS-8124 must be the first month(s) for which benefits are needed.

(1) Since there is no Date Screen associated with an “Administrative” application, the certification period can be no longer than 6 or 12 months, depending on the case.

(2) EIS allows a DB/PML transaction.

2. Ongoing Not Including the Month of Application on the Current DSS-8124

a. The Medicaid Effective Date may go back to the first day of the original application month entered on the Date Screen, or up to 3 months prior if retroactive benefits are requested.

b. The Payment Effective Date and Prior Month Payment Dates 1 and 2 and Amounts may go back to the original month of application as indicated on the Date Screen.

(1) Determine the continuous eligible period from the original date of application or discouragement entered on the Date Screen through the end of eligibility, but not including the month of application on the current DSS-8124, based on policy.

ISSUED 10/01/02 - CHANGE NO. 02-03

V.D.2.b. (CONT'D)

(2) Determine the Medicaid eligible dates retro to the original date of application entered on the Date Screen, if retro Medicaid benefits are requested.

(3) If there are no breaks in eligibility, the Medicaid Effective date can be either:

(a) The first day of the first eligible month, which can be as far back as the original date of application entered on the Date Screen. Or,

(b) Up to 3 months prior to the original date of application, if retro Medicaid is requested. AND

(c) The Payment Effective date is the first month of eligibility (based on the original date of application).

c. If there is a break in eligibility, determine the continuous authorized ongoing period that ends prior to the date of application on the current DSS-8124. This is referred to as the ‘Stable Date’ and may include more than one policy payment review period.

(1) The Medicaid Effective date and the Payment Effective date is the first month of the stable eligibility.

(2) Do not enter the Payment Review Period, as this situation would require a case termination date. This is an Open/Shut.

d. If benefits need to be issued prior to the stable period established in D.2.c above, enter additional new (Type 1) applications for each continuous period of eligibility and approve them open/shut. Enter any additional “Admin” applications the day after the first application approval processes in EIS.

Key each DSS-8124 as “Administrative”.

e. The Date of Application on the “Administrative” DSS-8124 needs to be the first month(s) for which benefits are needed.