NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 3451

------------------------------------------------------------------------------

AID PROGRAM/CATEGORY TRANSFERS TO MEDICAID PROGRAMS

------------------------------------------------------------------------------

EIS 3451 – AID PROGRAM/CATEGORY TRANSFERS TO MEDICAID PROGRAMS

I. COMPLETING THE DSS-8125

II. KEY THE DSS-8125.

III. OUTPUTS

IV. AUTOMATED NOTICES

TRANSFERRING FROM M-AA OR M-AD TO M-AB

REVISED 02/01/11 – CHANGE NO. 03-11

I. COMPLETING THE DSS-8125

A. Use the following instructions to complete the DSS-8125. Use the current Case Profile to determine what case and/or individual data must be changed to support the transfer to M-AB. A transfer from M-AA or
M-AD to M-AB may be retroactive if the individual is in deductible status in the M-AA or M-AD program and will be authorized in the M-AB program.

B. Enter the following required information to perform the aid program/category transfer. If a numeric field requires less digits than spaces available, precede with zeroes.

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

2. Enter the COUNTY NAME.

3. Enter the CASE ID from the Case Profile.

4. Enter your WORKER NUMBER.

5. Enter the COUNTY NUMBER from the Case Profile.

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

7. Enter “M” “AB” for AID PROGRAM/CATEGORY.

8. Enter the appropriate TRANSFER CODE for the transfer in the CHANGE CODE field. See the Codes Appendix to determine the appropriate code.

NOTE: FOR CAP CASES, DO NOT ENTER A TRANSFER CODE. SEND A MANUAL NOTICE.

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.

9. Enter “Y” in NOTICE OVERRIDE if you wish to override the automated notice. Always 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 (*).

REISSUED 02/01/11 – CHANGE NO. 03-11

I. B. 9. (CONT'D) (TRANSFERRING FROM M-AA OR M-AD TO M-AB)

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

NOTE: FOR CAP CASES, DO NOT ENTER A TRANSFER CODE. SEND A MANUAL NOTICE.

10. Enter “A” or “D” for MEDICAID STATUS. “A” must be entered if the MEDICAID CLASS is “Q” or “B”.

11. If MEDICAID STATUS is entered as “D”, enter the DEDUCTIBLE AMOUNT in the “DED AMT” field. This DEDUCTIBLE AMOUNT will print on the automated notice. Do not enter DEDUCTIBLE AMOUNT if you enter “Y” in the Notice Override field. DO NOT enter DEDUCTIBLE amount for CAP cases.

12. Enter the MEDICAID EFFECTIVE DATE.

a. If the MEDICAID CERTIFICATION FROM DATE entered is not equal to the CERTIFICATION FROM DATE on the existing case and:

(1) The MEDICAID STATUS entered is “D”, the MEDICAID EFFECTIVE DATE must be the same as the CERTIFICATION FROM DATE entered.

(2) The MEDICAID STATUS entered is “A”, the MEDICAID EFFECTIVE DATE must be after or the same as the CERTIFICATION FROM DATE entered and before or the same as the ongoing month.

b. If the MEDICAID CERTIFICATION FROM DATE entered is the same as the CERTIFICATION FROM DATE on the existing case and:

(1) The existing case has a MEDICAID STATUS of “D” and the MEDICAID STATUS entered is “A”, the MEDICAID EFFECTIVE DATE must be before or the same as the ongoing month and after or the same as the CERTIFICATION FROM DATE.

(2) The MEDICAID STATUS entered is “D”, the MEDICAID EFFECTIVE DATE must be the first day of the ongoing month.

13. Enter the CERTIFICATION PERIOD from the Case Profile if it has not expired. If the CERTIFICATION PERIOD has expired, enter a new CERTIFICATION PERIOD.

REISSUED 04/01/93 – CHANGE NO. 02-93

I. B. 13. (CONT'D)

a. The CERTIFICATION PERIOD must be no longer than twelve months if the MEDICAID STATUS entered is “A”, and no longer than six months if the MEDICAID STATUS entered is “D”.

b. The FROM DATE must:

(1) Be the same as the CERTIFICATION FROM DATE on the existing case; or

(2) Be the first day of the month following the CERTIFICATION THRU MONTH on the existing case; and

(3) Be before or the same as the ongoing month.

c. The THRU DATE must:

(1) Represent a period no longer than twelve months from the CERTIFICATION FROM DATE entered if the CERTIFICATION FROM DATE entered is not the same as the CERTIFICATION FROM DATE on the existing case.

(2) Be before or the same as the CERTIFICATION THRU DATE on the existing case. If the certification period has expired and the CERTIFICATION THRU DATE is before the ongoing month, a new certification period must be entered.

14. Enter the MEDICAID CLASS even if it is the same. Refer to the Codes Appendix to determine the appropriate code.

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 to your DSS-8125 when submitting to Data Entry for keying.

a. AUTHORIZED REPRESENTATIVE NAME AND ADDRESS

If the recipient had an authorized representative 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 recipient.

REVISED 04/01/93 – CHANGE NO. 02-93

I. B. 15. (CONT'D)

b. SECONDARY NOTICE CODE

Do not enter for transfers.

c. NOTICE TEXT

This section may be used if there is no transfer code for your situation and/or to provide additional information to the recipient. If this text is used, you must enter a Change Code of “02” or “50”. If you use NOTICE TEXT, you must enter a manual citation.

16. Enter the DATE the form is completed.

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

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

C. DO NOT ENTER the following information on the DSS-8125 when completing a transfer to M-AB.

1. Case Data

a. VERIFICATION INDICATOR

b. APPLICATION NUMBER

c. ONGOING DISPOSITION REASON and DATE

d. RETRO DISPOSITION REASON and DATE

e. CASE TERMINATION REASON and DATE

f. OLD CASE TERMINATION REASON and DATE

g. PAYMENT DATA

h. RETRO MA 1 and RETRO MA 2 fields

i. GRANT RECOUPMENT DATA

j. AMBULATION CAPACITY

k. DOMICILIARY RATE

REISSUED 02/01/11 – CHANGE NO. 03-11

I. C. 1. (CONT'D) (TRANSFERRING FROM M-AA or M-AD TO M-AB)

l. STEPPARENT INDICATOR

m. JOBS/WORK REQUIREMENT SAVINGS DATA

n. SPECIAL COVERAGE GROUP DATA

o. SPECIAL NEEDS DATA

2. Individual Data

a. INDIVIDUAL TERMINATION DATE

b. DATE OF DEATH

c. JOBS/WORK REGISTRATION/EXEMPTION

d. JOBS/WORK REQUIREMENT SAVINGS DATA

e. WORK EXPERIENCE

f. GROSS EARNED INCOME

g. CHILD/ADULT CARE

h. WORK EXPENSES

i. NET EARNED INCOME

j. EDUCATIONAL LEVEL

k. ISSUE CRD (See EIS 3105 for how to request replacement cards.)

D. Update other information using the DSS-8125 or Name Change function if necessary. Refer to Making Changes to Active Cases, EIS 3101, for instructions.

II. KEY THE DSS-8125.

III. OUTPUTS

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

A. A Case Profile is produced the night the transfer processes and is mailed to the county the following workday.

B. The aid program/category transfer is reported on the Caseworker Supervisor Report. The number of aid program/category transfers completed is determined from the WORKER NUMBER.

REVISED 02/01/11 – CHANGE NO. 03-11

IV. AUTOMATED NOTICES

A. General Information

1. An automated notice (DSS-8110A) is produced for all M-AA, or
M-AD to M-AB transfers 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.

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 from authorized to deductible status with an effective date of March 1992 and a timely reason code is keyed February 12, 1992.

REISSUED 02/01/11 – CHANGE NO. 03-11

IV. C. 4. (CONT'D)

The eleventh workday is February 27, 1992. The keying deadline is February 25, 1992.

EIS changes the Medicaid effective date to April 1992.

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, you must have your Data Entry Operator 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.

Notify Data Entry to 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

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.

NOTE: FORM ID NUMBERS ARE LISTED ON THE NOTICE REGISTERS AND ARE AVAILABLE THROUGH INQUIRY IN RMDS 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.

REVISED 02/01/11 – CHANGE NO. 03-11

IV. C. 8. (CONT'D) (TRANSFERRING FROM M-AA or M-AD TO M-AB)

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. The following data may be keyed up until the day before a timely action is to process without rescinding the pending action:

(1) County Number

(2) County Case Number

(3) District Number

(4) Address

(5) RSDI Claim Number

NOTE: See EIS 3210 for information regarding reopening a MQB-E case into MAABD prior to January 1 when EIS has terminated MQB-E automatically effective December 31.

EIS 3451 – AID PROGRAM/CATEGORY TRANSFERS TO MEDICAID PROGRAMS

I. COMPLETING THE DSS-8125

B. Enter the following required information to perform the aid program/category transfer. If a numeric field requires less digits than spaces available, precede with zeroes.

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

2. Enter the COUNTY NAME.

3. Enter the CASE ID from the Case Profile.

4. Enter your WORKER NUMBER.

5. Enter the COUNTY NUMBER from the Case Profile.

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

7. Enter “M” “AB” for AID PROGRAM/CATEGORY.

8. Enter the appropriate TRANSFER CODE for the transfer in the CHANGE CODE field. See the Codes Appendix to determine the appropriate code.

9. Enter “Y” in NOTICE OVERRIDE if you wish to override the automated notice. Always 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.

10. Enter “A” or “D” for MEDICAID STATUS. “A” must be entered if the MEDICAID CLASS is “Q” or “B”.

11. If MEDICAID STATUS is entered as “D”, enter the DEDUCTIBLE AMOUNT in the “DED AMT” field. This DEDUCTIBLE AMOUNT will print on the automated notice. Do not enter DEDUCTIBLE AMOUNT if you enter “Y” in the Notice Override field. DO NOT enter DEDUCTIBLE amount for CAP cases.

12. Enter the MEDICAID EFFECTIVE DATE.

a. If the MEDICAID CERTIFICATION FROM DATE entered is not equal to the CERTIFICATION FROM DATE on the existing case and:

(1) The MEDICAID STATUS entered is “D”, the MEDICAID EFFECTIVE DATE must be the same as the CERTIFICATION FROM DATE entered.

(2) The MEDICAID STATUS entered is “A”, the MEDICAID EFFECTIVE DATE must be after or the same as the CERTIFICATION FROM DATE entered and before or the same as the ongoing month.

b. If the MEDICAID CERTIFICATION FROM DATE entered is the same as the CERTIFICATION FROM DATE on the existing case and:

(1) The existing case has a MEDICAID STATUS of “D” and the MEDICAID STATUS entered is “A”, the MEDICAID EFFECTIVE DATE must be before or the same as the ongoing month and after or the same as the CERTIFICATION FROM DATE.

(2) The MEDICAID STATUS entered is “D”, the MEDICAID EFFECTIVE DATE must be the first day of the ongoing month.

13. Enter the CERTIFICATION PERIOD from the Case Profile if it has not expired. If the CERTIFICATION PERIOD has expired, enter a new CERTIFICATION PERIOD.

a. The CERTIFICATION PERIOD must be no longer than twelve months if the MEDICAID STATUS entered is “A”, and no longer than six months if the MEDICAID STATUS entered is “D”.

b. The FROM DATE must:

(1) Be the same as the CERTIFICATION FROM DATE on the existing case; or

(2) Be the first day of the month following the CERTIFICATION THRU MONTH on the existing case; and

(3) Be before or the same as the ongoing month.

c. The THRU DATE must:

(1) Represent a period no longer than twelve months from the CERTIFICATION FROM DATE entered if the CERTIFICATION FROM DATE entered is not the same as the CERTIFICATION FROM DATE on the existing case.

(2) Be before or the same as the CERTIFICATION THRU DATE on the existing case. If the certification period has expired and the CERTIFICATION THRU DATE is before the ongoing month, a new certification period must be entered.

14. Enter the MEDICAID CLASS even if it is the same. Refer to the Codes Appendix to determine the appropriate code.

15. SUPPLEMENTAL NOTICE INFORMATION

a. AUTHORIZED REPRESENTATIVE NAME AND ADDRESS

b. SECONDARY NOTICE CODE

c. NOTICE TEXT

16. Enter the DATE the form is completed.

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

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

C. DO NOT ENTER the following information on the DSS-8125 when completing a transfer to M-AB.

1. Case Data

a. VERIFICATION INDICATOR

b. APPLICATION NUMBER

c. ONGOING DISPOSITION REASON and DATE

d. RETRO DISPOSITION REASON and DATE

e. CASE TERMINATION REASON and DATE

f. OLD CASE TERMINATION REASON and DATE

g. PAYMENT DATA

h. RETRO MA 1 and RETRO MA 2 fields

i. GRANT RECOUPMENT DATA

j. AMBULATION CAPACITY

k. DOMICILIARY RATE

l. STEPPARENT INDICATOR

m. JOBS/WORK REQUIREMENT SAVINGS DATA

n. SPECIAL COVERAGE GROUP DATA

o. SPECIAL NEEDS DATA

2. Individual Data

a. INDIVIDUAL TERMINATION DATE

b. DATE OF DEATH

c. JOBS/WORK REGISTRATION/EXEMPTION

d. JOBS/WORK REQUIREMENT SAVINGS DATA

e. WORK EXPERIENCE

f. GROSS EARNED INCOME

g. CHILD/ADULT CARE

h. WORK EXPENSES

i. NET EARNED INCOME

j. EDUCATIONAL LEVEL

k. ISSUE CRD (See EIS 3105 for how to request replacement cards.)

D. Update other information using the DSS-8125 or Name Change function if necessary. Refer to Making Changes to Active Cases, EIS 3101, for instructions.

II. KEY THE DSS-8125.

III. OUTPUTS

A. A Case Profile is produced the night the transfer processes and is mailed to the county the following workday.

B. The aid program/category transfer is reported on the Caseworker Supervisor Report. The number of aid program/category transfers completed is determined from the WORKER NUMBER.

IV. AUTOMATED NOTICES

A. General Information

1. An automated notice (DSS-8110A) is produced for all M-AA, or M-AD to M-AB transfers 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.

1. An automated notice (DSS-8110A) is produced for all M-AA, or
M-AD to M-AB transfers 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.