NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 3451

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AID PROGRAM/CATEGORY TRANSFERS TO MEDICAID PROGRAMS

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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, M-AB, OR M-AD TO M-QB)

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-QB. A transfer from M-AA, M-AD, or M-AB to M-QB is effective the ongoing month unless the individual is in deductible status in the M-AA, M-AD, or M-AB program. It may be retroactive if authorized in the
MQB-Q/B program. A transfer to MQB-E is effective the ongoing month.

B. A case cannot be transferred to MQB with a Medicaid classification of “E” if the funding for this classification is exhausted for the calendar year. The case must be terminated, changed to another aid program/category, or changed to another Medicaid classification.

When funding is exhausted, EIS stops accepting additional MQB-E cases, therefore pending timely forms that are waiting to process that are program transfers to MQB-E are put on hold. Pending timely forms that are MQB-E terminations are not put on hold. The following message appears on the Error and Attention Report for the forms put on hold: “FORMS ON HOLD - FUNDING FOR MQB-E EXHAUSTED”. Also, the following on-line message is displayed: “MQB-QI FUNDS EXHAUSTED. CAN ONLY DELETE/RESCIND FORM”, if you redisplay the form in Function 8 and press <ENTER>. You must either delete or rescind the forms that are put on hold. Since the case cannot be changed to MQB with a Medicaid classification of “E”, determine eligibility for another Medicaid classification or another aid program/category.

C. 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” “QB” 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.

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. C. (CONT'D) (TRANSFERRING FROM M-AA, M-AB, OR M-AD TO M-QB)

9. 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.

10. Enter the MEDICAID EFFECTIVE DATE.

a. The MEDICAID EFFECTIVE DATE must not be after the ongoing month.

b. MQB-B/Q - If transferring from M-AA, M-AD, or M-AB in deductible status, the MEDICAID EFFECTIVE DATE must not be before the CERTIFICATION FROM DATE on the current case and must be prior to or equal to the ongoing month. If the case was authorized under MAABD, the MEDICAID EFFECTIVE DATE must be the ongoing month.

c. MQB-E - The MEDICAID EFFECTIVE DATE must be the ongoing month.

11. Enter the CERTIFICATION PERIOD.

MQB-B/Q

a. Enter the CERTIFICATION PERIOD from the most recent case profile if it has not expired. If it has expired and the CERTIFICATION THRU DATE is before the ongoing month, enter a new certification period. The FROM DATE must:

(1) Be the same as the CERTIFICATION FROM DATE on the existing case, if it has not expired.

(2) Be the first day of the month following the CERTIFICATION THRU MONTH if it has expired.

b. The THRU DATE must represent a period no longer than twelve months from the CERTIFICATION FROM DATE.

REISSUED 02/01/11 – CHANGE NO. 03-11

I. C. 11. (CONT'D) (TRANSFERRING FROM M-AA, M-AB, OR M-AD TO M-QB)

MQB-E

c. The FROM DATE must be the ongoing month.

d. The THRU DATE must be:

1. December 31 of the CURRENT calendar year if the effective date is prior to 11/1.

2. December 31 of the NEXT calendar year if the effective date is 11/1 or after.

12. Enter “Q”, “B” or “E” for MEDICAID CLASS, even if it is the same as indicated on the current case profile.

13. Enter the new MAINTENANCE AMOUNT. The amount must be a whole dollar amount and have zeroes indicated in the cents column.

14. 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.

b. SECONDARY NOTICE CODE

Do not enter for transfers.

c. NOTICE TEXT

Do not enter for MQB transfers. Medicare indicators are required when transferring to MQB causing the Notice Override “Y” to be entered.

15. Enter the INDIVIDUAL ID.

16. Enter MEDICARE A & B indicators.

REISSUED 02/01/11 – CHANGE NO. 03-11

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

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

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. SPECIAL COVERAGE GROUP CODE or DATE

k. AMBULATION CAPACITY

l. STEPPARENT INDICATOR

m. JOBS/WORK REQUIREMENT SAVINGS DATA

n. SPECIAL NEEDS DATA

o. DOMICILIARY RATE

2. Individual Data

a. INDIVIDUAL TERMINATION DATE

b. DATE OF DEATH

c. JOBS/WORK REQUIREMENT SAVINGS DATA

d. WORK EXPERIENCE

e. JOBS/WORK REGISTRATION/EXEMPTION

f. GROSS EARNED INCOME

g. WORK EXPENSES

h. CHILD/ADULT CARE

i. NET EARNED INCOME

REVISED 02/01/11 – CHANGE NO. 03-11

I. D. 2. (CONT'D) (TRANSFERRING FROM M-AA, M-AB, OR M-AD TO M-QB)

j. EDUCATIONAL LEVEL

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

E. 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.

IV. AUTOMATED NOTICES

A. General Information

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

REISSUED 02/01/11 – CHANGE NO. 03-11

I. B. (TRANSFERRING FROM M-AA, M-AB, OR M-AD TO M-QB)

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. 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.

REISSUED 02/01/11 – CHANGE NO. 03-11

IV. C. 7. b. (CONT'D) (TRANSFERRING FROM M-AA, M-AB, OR M-AD TO M-QB)

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 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.

EIS 3451 – AID PROGRAM/CATEGORY TRANSFERS TO MEDICAID PROGRAMS

I. COMPLETING THE DSS-8125

B. A case cannot be transferred to MQB with a Medicaid classification of “E” if the funding for this classification is exhausted for the calendar year. The case must be terminated, changed to another aid program/category, or changed to another Medicaid classification.

C. 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” “QB” 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 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 the MEDICAID EFFECTIVE DATE.

a. The MEDICAID EFFECTIVE DATE must not be after the ongoing month.

c. MQB-E - The MEDICAID EFFECTIVE DATE must be the ongoing month.

11. Enter the CERTIFICATION PERIOD.

a. Enter the CERTIFICATION PERIOD from the most recent case profile if it has not expired. If it has expired and the CERTIFICATION THRU DATE is before the ongoing month, enter a new certification period. The FROM DATE must:

(1) Be the same as the CERTIFICATION FROM DATE on the existing case, if it has not expired.

(2) Be the first day of the month following the CERTIFICATION THRU MONTH if it has expired.

b. The THRU DATE must represent a period no longer than twelve months from the CERTIFICATION FROM DATE.

c. The FROM DATE must be the ongoing month.

d. The THRU DATE must be:

1. December 31 of the CURRENT calendar year if the effective date is prior to 11/1.

2. December 31 of the NEXT calendar year if the effective date is 11/1 or after.

12. Enter “Q”, “B” or “E” for MEDICAID CLASS, even if it is the same as indicated on the current case profile.

13. Enter the new MAINTENANCE AMOUNT. The amount must be a whole dollar amount and have zeroes indicated in the cents column.

14. SUPPLEMENTAL NOTICE INFORMATION

a. AUTHORIZED REPRESENTATIVE NAME AND ADDRESS

b. SECONDARY NOTICE CODE

c. NOTICE TEXT

15. Enter the INDIVIDUAL ID.

16. Enter MEDICARE A & B indicators.

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

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. SPECIAL COVERAGE GROUP CODE or DATE

k. AMBULATION CAPACITY

l. STEPPARENT INDICATOR

m. JOBS/WORK REQUIREMENT SAVINGS DATA

n. SPECIAL NEEDS DATA

o. DOMICILIARY RATE

2. Individual Data

a. INDIVIDUAL TERMINATION DATE

b. DATE OF DEATH

c. JOBS/WORK REQUIREMENT SAVINGS DATA

d. WORK EXPERIENCE

e. JOBS/WORK REGISTRATION/EXEMPTION

f. GROSS EARNED INCOME

g. WORK EXPENSES

h. CHILD/ADULT CARE

i. NET EARNED INCOME

j. EDUCATIONAL LEVEL

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

E. 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, M-AD, or M-AB to M-QB 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.

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