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NC DEPARTMENT OF HEALTH & HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 3800

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TRANSITIONAL BENEFITS REPORTS TRACKING

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EIS 3800 – TRANSITIONAL BENEFITS REPORTS TRACKING

I. TRANSITIONAL BENEFIT REPORTING

II. TRANSITIONAL BENEFITS REPORTS TRACKING

III. UPDATING THE TRANSITIONAL BENEFITS REPORTS TRACKING SCREEN

IV. EIS REVIEWS THE TBR TRACKING SCREEN - FIRST QR DEADLINE

V. EIS REVIEWS THE TBR TRACKING SCREEN - SECOND QR DEADLINE

EIS 3800 – TRANSITIONAL BENEFITS REPORTS TRACKING

REVISED 10/01/01 - CHANGE NO. 04-02

I. TRANSITIONAL BENEFIT REPORTING

A. Case Selection

1. Transitional Benefit Reports (TBR's) are generated automatically by EIS and are mailed according to the designated dates on the Work First/Transitional Quarterly Reporting Schedule.

2. EIS selects a transitional case to receive a TBR when the case contains a payment type of 5.

3. The transfer to transitional benefits is effective the first day of the ongoing month. The case is selected for reporting at the end of the first quarter of transitional benefits.

àFOR EXAMPLE:

ON OCTOBER 15, 2001, YOU TRANSFER A WORK FIRST CASE TO TRANSITIONAL BENEFITS. THE EFFECTIVE DATE OF THE TRANSFER IS 11/01/01. THEREFORE, NOVEMBER IS THE FIRST MONTH OF TRANSITIONAL BENEFITS. EIS GENERATES THE FIRST TBR ON 01/28/2002 FOR THE REPORT MONTHS OF NOVEMBER, DECEMBER, AND JANUARY.

B. Second Reports

1. If the first TBR is not returned by the first Work First/Transitional Quarterly Reporting deadline, EIS generates a second TBR.

2. EIS uses the Work First/Transitional Quarterly Reporting screens to determine if a second TBR should be generated.

3. County staff are responsible for the update of the Work First/Transitional Quarterly Reporting screens. These screens must be updated according to the Work First/Transitional Quarterly Reporting Schedule to ensure the automated monthly reporting process operates correctly.

4. EIS 3600 describes the processing requirements for a TBR completed for the CURRENT report month.

5. The information in the remainder of this section describes the processing requirements for a TBR completed for a historical report month.

REVISED 10/01/01 - CHANGE NO. 04-02

II. TRANSITIONAL BENEFITS REPORTS TRACKING

A. EIS requires an automated mechanism with which to track the 4th, 7th, and 10th month Medicaid requirements. This mechanism is the Transitional Benefits Reports (TBR) tracking screen.

B. The Eligibility Information System (EIS) creates a Transitional Benefits Reports (TBR) tracking screen for each case that is transferred to transitional Medicaid (Payment Type 5).

C. The tracking screen is retained by the system throughout the history of the case. However, a tracking screen created when a case is first transferred to transitional benefits will be replaced by a new tracking screen with each subsequent occurrence of transitional coverage. The new tracking screen will contain the REPORT MONTHS for the new transitional benefit period.

III. UPDATING THE TRANSITIONAL BENEFITS REPORTS TRACKING SCREEN

A. County staff are responsible for the update of the TBR tracking screen. These screens must be updated according to the quarterly reporting deadlines indicated on the Work First/Transitional Quarterly Reporting Schedule.

B. Updating this screen is important because EIS uses the report tracking information to determine if the recipient has complied with the 4th, 7th, and 10th month Medicaid reporting requirements. When the requirements are not met, EIS uses the information on this screen to generate an automated notice and transfer the transitional Medicaid benefits case to MAF-C for 2 months.

C. Use the TBR tracking screen to indicate that a transitional benefit report for a HISTORICAL REPORT QUARTER is returned (complete or incomplete) or to indicate that the payee has good cause for not returning the report.

D. Use the following instructions to access the Transitional Benefits Reports Tracking screen:

1. Refer to EIS 4900, Appendix A, for instructions to access IMS.

REVISED 10/01/01 - CHANGE NO. 04-02

III. D. (CONT'D)

2. From the Update Menu, enter "TR" in the SELECTION field and the Case ID in the KEY field. Press ENTER. The Transitional Benefits Reports Tracking Screen is displayed.

E. When you have accessed the TBR Tracking Screen, use the following instructions to update the REPORT RESPONSE fields.

1. The REPORT RESPONSE is the only field on the TBR Tracking Screen that you may update. You may only update the field for the 3rd, 6th, or 9th month. This will automatically up date the prior 2 months with the same code.

a. Update Only Historical REPORT MONTHS.

à You must use the Work First/Transitional Quarterly Reporting Screen to update the REPORT RESPONSE for the current REPORT MONTH of the quarter.

à When a STATUS CODE of C, G, or I is entered on the Work First/Transitional Quarterly Reporting screen, EIS automatically updates the REPORT RESPONSE field for the corresponding current report month and the 2 prior months of the quarter on the TBR tracking screen.

à Refer to EIS 3600 for additional information regarding the Work First/Transitional Quarterly Reporting screen.

b. Update only active transitional cases. You may not update the TBR tracking screen for a terminated case.

REVISED 10/01/01 - CHANGE NO. 04-02

III. E. (CONT'D)

2. Before you enter a REPORT RESPONSE, verify that you have accessed the correct transitional case by checking the PAYEE NAME and CASE ID NUMBER at the top of the screen.

3. Select the appropriate REPORT RESPONSE from the list below.

àC = COMPLETE

The payee returns a complete TBR.

àG = GOOD CAUSE

The payee has good cause for not submitting the TBR on a timely basis.

àI = INCOMPLETE

The payee returns an incomplete TBR.

4. You can update the REPORT RESPONSE field for the 3rd month only as a historical period. Press ENTER. EIS updates the code for the 1st, 2nd, and 3rd months online and displays the message UPDATE COMPLETE at the bottom of the screen.

5. To quit processing without updating the tracking record, press PF2.

6. If a response is keyed incorrectly, you may delete the REPORT RESPONSE code by using the DELETE key or by spacing over the code and pressing ENTER.

7. ERROR MESSAGES

àNO UPDATE APPLIED

You have pressed the ENTER key without entering a RESPONSE CODE.

àRESPONSE MUST BE C, I, OR G

You have keyed an invalid REPORT RESPONSE. The invalid responses will be highlighted on the screen. The valid codes are C, G, and I. Select one of these codes and press ENTER, or delete the invalid code.

IV. EIS REVIEWS THE TBR TRACKING SCREEN - FIRST QR DEADLINE

On the night of the first Work First/Transitional Quarterly Reporting keying deadline, EIS reviews the TBR tracking screen for each transitional reporting Medicaid case (payment type 5) in the 4^th, 7^th, or 10^th month of transitional coverage. EIS uses the tracking screen to determine if TBR's were submitted for the appropriate quarters of transitional coverage.

REVISED 10/01/01 - CHANGE NO. 04-02

IV. (CONT'D)

A. For transitional cases in the 4th month of coverage, EIS determines if the TBR was submitted for the first quarter (1st, 2nd, and 3rd months).

B. For transitional cases in the 7th month of coverage, EIS determines if the TBR was submitted for the second quarter (4th, 5th, and 6th months).

C. For transitional cases in the 10th month of coverage, EIS determines if the TBR was submitted for the third quarter (7th, 8th, and 9th months).

If the recipient did not complete the required TBR or did not establish good cause, as indicated by the tracking screen, EIS generates and mails a second quarterly report along with an insert explaining good cause.

V. EIS REVIEWS THE TBR TRACKING SCREEN - SECOND QR DEADLINE

A. On the night that the Work First/Transitional Quarterly Reporting transfers are executed, EIS reviews the TBR tracking screen for each transitional reporting Medicaid case (payment type 5) in the 4th, 6th, 7th, 10th, or 12th month of transitional coverage. EIS uses the tracking screen to determine if TBR's were submitted for the appropriate quarters of transitional coverage.

B. TRANSITIONAL MEDICAID CASES (PAYMENT TYPE 5)

1. For transitional Medicaid cases in the 4th month of coverage, EIS determines if the TBR was submitted or if good cause was established for the first quarter (1st, 2nd, and 3rd months).

If the TBR was not submitted and good cause has not been established, the case will go on the Transitional Cases Due Review Report. The case will display on this report until the 6^th month unles the TBR is received complete or good cause is established as indicated on the tracking screen.

2. For transitional Medicaid cases in the 6th month of coverage, EIS determines if the TBR was submitted for the first quarter (1st, 2nd, and 3rd months)or if the caseworker has taken action based on an ex parte review.

If the recipient did not complete the required TBR or did not establish good cause, as indicated by the tracking screen, or if the caseworker did not take action by the 6th month based on an ex parte review, EIS automatically transfers the case to MAF-C for two months, effective the ongoing month.

3. For transitional cases in the 7th month of coverage, EIS determines if the TBR was submitted for the second quarter (4th, 5th, and 6th months).

REVISED 10/01/01 - CHANGE NO. 04-02

V. B. 3. (CONT'D)

If the recipient did not complete the required TBR or did not establish good cause, as indicated by the tracking screen, EIS automatically transfers the case to MAF-C for two months, effective the ongoing month.

4. For transitional cases in the 10th month of coverage, EIS determines if the TBR was submitted for the third quarter (7th, 8th, and 9th months).

a. If the recipient did not complete the required TBR or did not establish good cause, as indicated by the tracking screen, EIS automatically transfers the case to MAF-C for two months, effective the ongoing month.

b. If the recipient did complete the required TBR, the case will now display on the Transitional Cases Due Review Report to alert the caseworker a redetermination is due by the end of the 12th month. The case will remain on this report until the 12th month.

5. For transitional cases in the 12th month of coverage, EIS determines if the caseworker has taken action on the case based on the redetermination. If the case is still in payment type 5, EIS will automatically transfer the case to MAF-C for two months effective the ongoing month.

6. On the night the transfer processes, EIS generates a case profile indicating the transfer to MAF-C. State staff mail the profiles the first workday following the transfer cycle.

VI. AUTOMATED NOTICES

A. EIS generates and mails an adequate notice when a transitional case is transferred to MAF-C.

The notice text reads:

You failed to meet transitional benefit quarterly reporting requirements. You are being evaluated for Medicaid.

EIS 3800 – TRANSITIONAL BENEFITS REPORTS TRACKING

EIS 3800 – TRANSITIONAL BENEFITS REPORTS TRACKING

I. TRANSITIONAL BENEFIT REPORTING

A. Case Selection

1. Transitional Benefit Reports (TBR's) are generated automatically by EIS and are mailed according to the designated dates on the Work First/Transitional Quarterly Reporting Schedule.

2. EIS selects a transitional case to receive a TBR when the case contains a payment type of 5.

3. The transfer to transitional benefits is effective the first day of the ongoing month. The case is selected for reporting at the end of the first quarter of transitional benefits.

B. Second Reports

1. If the first TBR is not returned by the first Work First/Transitional Quarterly Reporting deadline, EIS generates a second TBR.

2. EIS uses the Work First/Transitional Quarterly Reporting screens to determine if a second TBR should be generated.

3. County staff are responsible for the update of the Work First/Transitional Quarterly Reporting screens. These screens must be updated according to the Work First/Transitional Quarterly Reporting Schedule to ensure the automated monthly reporting process operates correctly.

4. EIS 3600 describes the processing requirements for a TBR completed for the CURRENT report month.

5. The information in the remainder of this section describes the processing requirements for a TBR completed for a historical report month.

II. TRANSITIONAL BENEFITS REPORTS TRACKING

A. EIS requires an automated mechanism with which to track the 4th, 7th, and 10th month Medicaid requirements. This mechanism is the Transitional Benefits Reports (TBR) tracking screen.

B. The Eligibility Information System (EIS) creates a Transitional Benefits Reports (TBR) tracking screen for each case that is transferred to transitional Medicaid (Payment Type 5).

III. UPDATING THE TRANSITIONAL BENEFITS REPORTS TRACKING SCREEN

A. County staff are responsible for the update of the TBR tracking screen. These screens must be updated according to the quarterly reporting deadlines indicated on the Work First/Transitional Quarterly Reporting Schedule.

C. Use the TBR tracking screen to indicate that a transitional benefit report for a HISTORICAL REPORT QUARTER is returned (complete or incomplete) or to indicate that the payee has good cause for not returning the report.

D. Use the following instructions to access the Transitional Benefits Reports Tracking screen:

1. Refer to EIS 4900, Appendix A, for instructions to access IMS.

2. From the Update Menu, enter "TR" in the SELECTION field and the Case ID in the KEY field. Press ENTER. The Transitional Benefits Reports Tracking Screen is displayed.

E. When you have accessed the TBR Tracking Screen, use the following instructions to update the REPORT RESPONSE fields.

1. The REPORT RESPONSE is the only field on the TBR Tracking Screen that you may update. You may only update the field for the 3rd, 6th, or 9th month. This will automatically up date the prior 2 months with the same code.

a. Update Only Historical REPORT MONTHS.

b. Update only active transitional cases. You may not update the TBR tracking screen for a terminated case.

2. Before you enter a REPORT RESPONSE, verify that you have accessed the correct transitional case by checking the PAYEE NAME and CASE ID NUMBER at the top of the screen.

3. Select the appropriate REPORT RESPONSE from the list below.

4. You can update the REPORT RESPONSE field for the 3rd month only as a historical period. Press ENTER. EIS updates the code for the 1st, 2nd, and 3rd months online and displays the message UPDATE COMPLETE at the bottom of the screen.

5. To quit processing without updating the tracking record, press PF2.

6. If a response is keyed incorrectly, you may delete the REPORT RESPONSE code by using the DELETE key or by spacing over the code and pressing ENTER.

7. ERROR MESSAGES

IV. EIS REVIEWS THE TBR TRACKING SCREEN - FIRST QR DEADLINE

A. For transitional cases in the 4th month of coverage, EIS determines if the TBR was submitted for the first quarter (1st, 2nd, and 3rd months).

B. For transitional cases in the 7th month of coverage, EIS determines if the TBR was submitted for the second quarter (4th, 5th, and 6th months).

C. For transitional cases in the 10th month of coverage, EIS determines if the TBR was submitted for the third quarter (7th, 8th, and 9th months).

V. EIS REVIEWS THE TBR TRACKING SCREEN - SECOND QR DEADLINE

B. TRANSITIONAL MEDICAID CASES (PAYMENT TYPE 5)

1. For transitional Medicaid cases in the 4th month of coverage, EIS determines if the TBR was submitted or if good cause was established for the first quarter (1st, 2nd, and 3rd months).

2. For transitional Medicaid cases in the 6th month of coverage, EIS determines if the TBR was submitted for the first quarter (1st, 2nd, and 3rd months)or if the caseworker has taken action based on an ex parte review.

If the recipient did not complete the required TBR or did not establish good cause, as indicated by the tracking screen, or if the caseworker did not take action by the 6th month based on an ex parte review, EIS automatically transfers the case to MAF-C for two months, effective the ongoing month.

3. For transitional cases in the 7th month of coverage, EIS determines if the TBR was submitted for the second quarter (4th, 5th, and 6th months).

4. For transitional cases in the 10th month of coverage, EIS determines if the TBR was submitted for the third quarter (7th, 8th, and 9th months).

a. If the recipient did not complete the required TBR or did not establish good cause, as indicated by the tracking screen, EIS automatically transfers the case to MAF-C for two months, effective the ongoing month.

b. If the recipient did complete the required TBR, the case will now display on the Transitional Cases Due Review Report to alert the caseworker a redetermination is due by the end of the 12th month. The case will remain on this report until the 12th month.

5. For transitional cases in the 12th month of coverage, EIS determines if the caseworker has taken action on the case based on the redetermination. If the case is still in payment type 5, EIS will automatically transfer the case to MAF-C for two months effective the ongoing month.

6. On the night the transfer processes, EIS generates a case profile indicating the transfer to MAF-C. State staff mail the profiles the first workday following the transfer cycle.

A. EIS generates and mails an adequate notice when a transitional case is transferred to MAF-C.

B. Notices are recorded on the Transitional Notice Register. Refer to Figure 1 to review a sample of the printed register.

C. Refer to EIS 3561 for more information on this report.