NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 3101

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CHANGES TO MEDICAID CASES

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EIS 3101 – CHANGES TO MEDICAID CASES

I. COMPLETING THE DSS-8125

II. SIGNATURES AND DATE

III. KEY THE DSS-8125.

IV. OUTPUTS

V. FOR ANY CHANGES NOT LISTED, SEE ”OTHER CHANGED DATA”.

VI. AUTOMATED NOTICES

CHANGE IN LIVING ARRANGEMENT INCLUDING SUSPENSION

REVISED 02/01/11 - CHANGE NO. 03-11

I. COMPLETING THE DSS-8125

A. Use the following instructions to change the living arrangement of any active Medicaid case. If a numeric field requires less digits than spaces available, precede with zeroes.

1. Enter CASEHEAD/PAYEE at the top of the form for filing purposes.

2. Enter the COUNTY NAME.

3. Enter the CASE ID from the current Case Profile.

4. Enter your assigned WORKER NUMBER.

5. Enter the COUNTY NUMBER from the current Case Profile.

6. Ensure the DISTRICT NUMBER on the Case Profile is correct. If incorrect, enter the appropriate DISTRICT NUMBER.

7. Enter the appropriate AID PROGRAM/CATEGORY.

8. Enter the new address, if appropriate.

a. If PLA to LTC and you want the automated DMA-5016 to go to an address other than the case address, enter the facility code. (FACILITY code is not required if same facility as case address.) See EIS 1063, Automated DMA-5016.

b. If LTC to PLA, delete the facility code, if present.

c. If the recipient is in the custody of the North Carolina Department of Corrections, enter the address as:

Medicaid Coordinator

Division of Prisons

831 W Morgan St

Raleigh NC 27603

9. Enter the appropriate CHANGE CODE if you are changing the DB/PML, DB/PML AMOUNT, MEDICAID CLASSIFICATION to or from “Q”, changing the living arrangement related to suspension/non-suspension of Medicaid due to incarceration/release or admission/discharge from an institution for Mental Disease (IMD), and/or the MEDICAID STATUS. See the Codes Appendix to determine the appropriate code.

It is very important to enter the correct code. Unless overridden, an automated notice is produced based on the change code entered on the DSS-8125. The change code not only determines the text of the notice but also whether the notice is adequate or timely. See AUTOMATED NOTICES at the end of this section for more information regarding the automated notice.

REVISED 02/01/11 - CHANGE NO. 03-11

I. A. (CONT'D) (CHANGE IN LIVING ARRANGEMENT INCLUDING SUSPENSION)

10. Enter “Y” in NOTICE OVERRIDE if you wish to override the automated notice when:

a. The change code used from the Codes Appendix is “other”.

b. The change code listed in the Codes Appendix is marked with an asterisk (*).

c. You use the DB/PML screen to issue benefits.

NOTE: FOR CAP CASES, DO NOT ENTER NOTICE OVERRIDE OF “Y”. COMPLETE A MANUAL NOTICE.

11. Enter the MEDICAID EFFECTIVE DATE if:

a. The MEDICAID CLASSIFICATION CODE changes.

b. The DB/PML and DB/PML AMOUNT changes.

c. The MEDICAID STATUS changes.

d. The individual’s Medicaid is being changed to or from suspension due to incarceration/release or placement in/discharge from an Institution for Mental Disease (IMD). Enter the Medicaid Effective Date as the first day of the ongoing processing month.

12. Enter the new MEDICAID CLASSIFICATION CODE if appropriate. If entered, MEDICAID EFFECTIVE DATE is required.

13. Enter the MEDICAID STATUS if changed. If entered, MEDICAID EFFECTIVE DATE is required. (Medicaid Status not allowed for I-AS, or M-QB cases.) Refer to Deductible to Authorized and Authorized to Deductible for further instructions.

14. Enter the DB/PML CODE and AMOUNT if appropriate. If this is a long-term care (LTC) case, PML CODE and AMOUNT are required. If DB/PML code and amount are entered, MEDICAID EFFECTIVE DATE is required.

15. SUPPLEMENTAL NOTICE INFORMATION

The following three data elements have been added to the DSS-8125 Data Entry screen. A recommended form in which to enter the information can be found at the end of this section. This form should be attached the DSS-8125 when submitting to Data Entry for keying.

REVISED 02/01/11 - CHANGE NO. 03-11

I. A. 15. (CONT'D) (CHANGE IN LIVING ARRANGEMENT INCLUDING SUSPENSION)

a. AUTHORIZED REPRESENTATIVE NAME AND ADDRESS

If an applicant had an authorized representative/CAP Manager or PACE Agency acting in his behalf, the authorized representative's name and address may be entered for the purpose of mailing an automated notice to the authorized representative in addition to the applicant. See EIS-2250.

b. SECONDARY NOTICE CODE

Do not enter for changes.

c. NOTICE TEXT

This section may be used if no code exists for your situation and/or to provide additional information to the recipient if a change code of “02” or “50” is entered. You may not use Notice Text if a change code is not required. If you use Notice Text, you must include a manual citation.

16. Enter the NEW LIVING ARRANGEMENT CODE. If LTC, PML TYPE and AMOUNT are required if different from what is on current Case Profile. See the Codes Appendix to determine the appropriate living arrangement code.

B. DO NOT ENTER the following fields on the DSS-8125:

1. Application Data

2. Case Termination Data

3. Payment Data

4. Retro MA Data

5. Work Experience

6. Educational Level

7. Issue CRD

NOTE: ALL OTHER FIELDS ARE OPTIONAL. A DETAILED EXPLANATION OF EACH FIELD IS INCLUDED IN ”OTHER CHANGED DATA”.

II. SIGNATURES AND DATE

A. Enter the DATE COMPLETED.

B. Sign the DSS-8125 in the WORKER'S SIGNATURE field.

C. The county director or his designee must sign the form in the DIRECTOR'S SIGNATURE field.

REISSUED 02/01/11 - CHANGE NO. 03-11

III. KEY THE DSS-8125.

IV. OUTPUTS

When the DSS-8125 processes successfully, the following are received:

A. Case Profile

An updated Case Profile is produced the night the DSS-8125 processes and is mailed to the county the following workday.

B. Automated DMA-5016

If long term care, an automated DMA-5016 is produced the night the change processes and is mailed to the facility the next workday.

C. Caseworker Supervisor Report

All changes completed by an IMC are reported on the Caseworker Supervisor Report. The number of actions completed is determined from the WORKER NUMBER.

V. FOR ANY CHANGES NOT LISTED, SEE ”OTHER CHANGED DATA”.

VI. AUTOMATED NOTICES

A. General Information

1. An automated notice (DSS-8110A) is produced for all changes the night the DSS-8125 processes in the system unless “Y” is entered for “NOTICE OVERRIDE”. A sample of the DSS-8110A is located at the end of this section.

2. The CHANGE CODE entered on the DSS-8125 determines the text of the notice and whether the notice is adequate or timely.

3. The system calculates the 60th calendar day for the notice.

4. The date of the automated notice is the next state workday after the DSS-8125 processes. This is the date the notice is mailed to the recipient. A copy of the notice is not mailed to the county.

5. A Notice Register Report is produced each night and is mailed to the county the following workday. This report lists vital information related to all automated notices produced for that day. See EIS 3556 for more information regarding the Notice Register Report.

B. Adequate Notice

1. “Adequate” is indicated at the top of the notice.

2. The system calculates the 60th calendar day for the notice.

3. The action indicated on the DSS-8125 takes place in EIS the same night the adequate notice is produced.

REISSUED 02/01/11 - CHANGE NO. 03-11

VI. (CONT'D) (CHANGE IN LIVING ARRANGEMENT INCLUDING SUSPENSION)

C. Timely Notice

1. “Timely” is indicated at the top of the notice.

2. To produce an automated timely notice, you must complete the DSS-8125 and have it keyed into EIS at the same time you would have completed the manual DSS-8110.

3. The system calculates the tenth county workday and the 60th calendar day for the notice.

4. The action takes place in EIS eleven county workdays from the date of the notice. If the eleventh county workday falls after the 4th workday from the end of the month, EIS adjusts the month of change to the next benefit month.

For example: A DSS-8125 indicating a change with an effective date of July 1, 1996 and a timely reason code for an automated notice is keyed June 12, 1996. The eleventh workday is June 28, 1996. The keying deadline is June 25, 1996. EIS changes the Medicaid Effective Date to August 1, 1996.

This action is reported on the Notice Register for that day. The information related to the automated notice is displayed with an asterisk (*) entered in the “CHANGE/TERMINATION DATE” column of the report.

5. No further action is required by you for the action to occur.

6. An updated Case Profile is produced the night the action takes place in EIS.

7. Deleting the Action

Because the action does not actually process in EIS until the eleventh county workday, it is possible to stop the action. To do so, delete the action that is on hold in EIS. The deletion must occur no later than the eleventh county workday from the date of the notice.

Delete the pending action using one of the following methods.

a. Submit a copy of the DSS-8125 you sent originally to request the change. Write “DELETE” in red across the top of the form; or

REISSUED 02/01/11 - CHANGE NO. 03-11

VI. C. 7. (CONT'D) (CHANGE IN LIVING ARRANGEMENT INCLUDING SUSPENSION)

b. Submit a county form developed for this purpose. This form must contain the form ID number of the original DSS-8125 and a message to Data Entry to delete the form.

c. See EIS 4900, DATA ENTRY APPENDIX E.

NOTE: FORM ID NUMBERS ARE LISTED ON THE NOTICE REGISTERS AND ARE AVAILABLE THROUGH INQUIRY IN XPTR FOR THREE DAYS AFTER THE DSS-8125 IS KEYED.

This action is reported on the Notice Register for that day. The information related to the automated notice is displayed with “DELETED” noted in the “COMMENTS” column of the register.

8. Rescinding the Action

There is another situation where an action pending in EIS is stopped.

If a subsequent DSS-8125 is keyed by the eleventh county workday from the date of the notice and the subsequent DSS-8125 causes a new notice to be produced, the pending action is stopped. In this situation, EIS “rescinds” the pending action and produces an automated notice for the new action.

Both actions are reported on the Notice Register for that day. The information related to the first automated notice is displayed with “RESCINDED” noted in the “COMMENTS” column of the register. The information related to the subsequent automated notice is also displayed with no entry in the “COMMENTS” column.

9. DSS-8125 and Timely Pending Action

a. A DSS-8125 may not be placed on hold when there is a timely action pending.

b. A DSS-8125 may be keyed, but if a change code or termination code is present, it will rescind the pending action.

c. Demographic data may be keyed up until the day before a timely action is to process without rescinding the pending action.

REISSUED 02/01/11 - CHANGE NO. 03-11

IV. C. 9. c. (CONT'D) (CHANGE IN LIVING ARRANGEMENT INCLUDING SUSPENSION)

Following are examples of demographic data:

(1) County Number

(2) County Case Number

(3) District Number

(4) Address

(5) RSDI Claim Number