Transcript Redetermination - SOM

Redetermination
Module
Updated 12/02/2013
Redetermination
Objectives
• Locate and Monitor cases due for Redetermination
• Schedule an early Redetermination
• Log in a Redetermination packet
• Perform the Redetermination
• Process Overdue and Not Logged Redeterminations
7/16/2015
2
Redetermination
How to Take this Training
In order to access the hyperlinks in this PowerPoint, you will need to view it in Slide Show
mode. If it opens from within PowerPoint (in Edit mode), please follow these steps to play the
slide show:
• On the bottom status bar, click the Slide Show icon.
• If you cannot see the bottom status bar, click Slide Show
on the top menu, and then click From Current Slide or
From Beginning.
• If you cannot see the PowerPoint interface, you may be
viewing the presentation in Slide Show mode already.
7/16/2015
3
Redetermination
The Redetermination
The Department of Human Services must
periodically redetermine an individual’s
eligibility for active programs. The
redetermination process includes a
thorough review of all eligibility factors.
An ex parte review is required before
Medicaid closures when there is an
actual or anticipated change, unless the
change would result in closure due to
ineligibility for all Medicaid. When
possible, an ex parte review should
begin at least 90 calendar days before
the anticipated change is expected to
result in case closure. The review
includes consideration of all MA
categories; see BAM 115 and BAM 220.
7/16/2015
A complete redetermination is
required at least every 12 months.
Bridges sets the redetermination
date according to benefit periods;
see Eligibility Decisions in
BAM 115.
4
Redetermination
Redetermination Periods
3 - month
6 - month
FAP groups
FAP semiwith unstable annual contact
circumstances for FAP groups
that are
Simplified
Reports
24 - month
12 - month
MA, see exceptions on FAP groups in
the next slide
which all group
members are
* CDC
senior and/or
disabled and the
FAP groups that are
group's only source
not 3 or 24 month
of income is SSI
and/or RSDI
FAP mid-certification
contact for FAP groups benefits.
that qualify for a 24
month benefit period
No Redetermination
** Special N/Support
** Title IV-E Recipients
** Special needs
adoption assistance
recipients
** Department wards
** SSI recipients
* If a CDC group is active for other programs, Bridges will set the CDC redetermination date to
be the same redetermination date as the other program if 12 months or less.
** A ex parte review must be completed before closing an individual in one of these categories
if the closure is for any reason other than total ineligibility for any MA (such as moved out of
state or death). The ex parte review must consider eligibility in all other FIP and SSI related MA
categories.
7/16/2015
5
Redetermination
Redetermination Period Exceptions
Newborn MA - Newborn cases must be
scheduled for redetermination no later than
the month of the child’s first birthday; see
BEM 145.
Group 2 Persons Under 21 - If a member will reach age 21 before the
month the case is scheduled for redetermination, an ex parte review
should begin at least 90 days prior to the date the member turns 21; see
BAM 210.
7/16/2015
6
Redetermination
Scheduling
Bridges generates a redetermination packet to the client three business
days prior to the negative action cut-off date in the month before the
redetermination is due. Bridges schedules required redetermination
appointments in the first 10 business days of the redetermination month.
The packet includes the following as
determined by the TOA to be redetermined:
•
•
•
•
•
•
•
•
Redetermination/review form.
Notice of review as determined by policy.
Interview date.
Interview type.
Place and time.
Required verifications.
Due date.
Return envelope.
7/16/2015
7
Redetermination
Redetermination Forms
Redetermination forms may include:
DHS-574, Redetermination Telephone Interview (FIP and FAP Bridges only form)
DHS-1010, Redetermination (all TOA).
DHS-1046, Semi-Annual Contact Report (FAP).
DHS-1171, Assistance Application (all TOA).
DHS-2240-A, Mid-Certification Contact Notice (MA and FAP).
DHS-2063-B, Continuing Your Food Assistance Benefits (FAP).
DHS-4574, Medicaid Application for Long-Term Care.
DCH-0373-D, MI Child and Healthy Kids Application.
7/16/2015
8
Redetermination
Scheduling Early
Redetermination of an active program may be scheduled up to three
months before the review date. Redetermination of active programs may
be necessary for one of the following reasons:
• A case is found to be error-prone as a result of
supervisory case reading, quality assurance
data or quality enhancement data.
• Specialist’s schedule requires early
redetermination of active program.
• Align dates to simultaneously process
redeterminations for multiple programs.
Bridges does this automatically for all
programs except certain MA programs such
as TMA.
7/16/2015
9
Redetermination
Scheduling Early
Step-by-Step Instructions to Schedule an Early Redetermination:
1.
2.
3.
4.
5.
On Left Navigation, select Redetermination.
Select Initiate Redetermination.
The Redetermination Ready page displays.
Enter the case number.
Click Search.
The Redetermination Details displays at the bottom.
6. Review the redetermination details to make sure you
have retrieved correct case.
7. Click the Schedule Early box for each TOA you want to
schedule early.
8. Click Submit.
Submitted Successfully message displays at the top.
You must complete the above steps at least 4 business days prior to the Negative
Action Cut-Off Day the month prior to the month of the early redetermination.
7/16/2015
10
Redetermination
Scheduling Early
Here is the
Bridges page
where you can
select the EDG
you wish to
schedule early.
Notice that only
one of the boxes
is not “grayed
out”. That is the
box for the FAP
EDG, and in this
example, it is the
only program that
meets the criteria
for scheduling
early.
7/16/2015
11
Redetermination
Scheduling Early
Select
“Schedule
Early” for the
FAP EDG.
7/16/2015
12
Redetermination
Scheduling Early
CLICK
on the
“Submit” button
7/16/2015
13
Redetermination
Scheduling Early
You“Revert”
will see a
The
greenin the
button
message
next
column
under
will
allowthe
you
title
topage
change
thatmind
states:
your
“Submitted
about
Successfully”
rescheduling
and
the
the
review
“Schedule
early,
until the
Early”
date
thebox for
the FAP
EDG
packets
have
will now
been
sent.be
grayed out.
7/16/2015
14
Redetermination
Redetermination Statuses
• As your case moves through the various stages of a
Redetermination, Bridges will assign it a status.
•
You can check the status of your Redeterminations by
going to
Left Navigation>Redetermination>Initiate
Redetermination.
• This is the same path you would take to schedule an
Early Redetermination.
7/16/2015
15
Redetermination
Redetermination Statuses
Once Bridges has sent the
packet and/or scheduled the
appointment, Bridges will
update the redetermination
status to Redetermination
Packet and/or Appointment
Sent.
Bridges
will update
to
This indicates
that the
Redetermination
Completed
redetermination process
has
once
data has been
been the
started.
updated,
EDBC
has been
If this status
remains
and the
run,
and the programs
redetermination
packethave
been
and/orcertified.
appointment are never
updated to being received
and/or shown, Bridges will
automatically close the
program based on policy.
7/16/2015
16
Redetermination
Redetermination Statuses
Send
Redetermination
Packet and/or
Appointment
Redetermination
Packet and/or
Appointment Sent
Redetermination
Initiated
Redetermination
Complete
Bridges will set this
status when the
redetermination due
date is approaching.
Once the Redet
packet has been
sent and/or the
appointment has
been scheduled,
Bridges will update
to this status. This
indicates the review
process has been
started.
After you log in the
redetermination
packet and/or the
appointment has
been marked as
“Show”, Bridges will
update to this
status. This status
will keep Bridges
from automatically
taking negative
action against the
client.
This status will
appear after the
data in Bridges has
been updated,
EDBC has been run,
and the programs
have been certified.
7/16/2015
17
Redetermination
Scheduling Early Example
Mrs. Imma Worker checks her future redeterminations in Bridges and
notices she has 83 redeterminations in August 2013. Mrs. Worker decides
to send some of her August redeterminations out early to balance her
caseload. She decides to schedule15 August redeterminations in May and
20 August redeterminations in June.
Negative Action Cut Off Days:
March = 03/18/2013
April = 04/19/2013
May = 05/20/2013
June = 06/17/2013
To schedule 15 of Mrs. Worker’s August
redeterminations in May, by what day
will she have to schedule them early?
04/15/2013 is correct!
To schedule 20 of Mrs. Worker’s August
redeterminations in June, by what day
will she have to schedule them early?
05/14/2013 is correct!
7/16/2015
18
Redetermination
Impact of Scheduling Early
If the client is found eligible, a new redetermination date for the EDG
is set based on the month you processed the redetermination. The
client’s new benefit period begins the month following the month you
processed the redetermination.
Healthy Kids Exception:
• If the client is found to be ineligible, the
Redetermination Due Date will revert to the original
date.
• You will have to perform the review again at the
regularly scheduled time.
FAP Exception:
• When a redetermination is scheduled early, FAP
benefits cannot be terminated prior to the end of the
benefit period for failure to complete the
redetermination process.
7/16/2015
19
Redetermination
Redetermination Interview Requirements
No Interview Required
Medicaid (MA)
Adult Medical
Program (AMP)
Child Development
and Care (CDC)
Interview Required
Telephone
In-Person
Family Independence
Program (FIP)
Yes
Yes
State Disability
Assistance (SDA)
No
Yes
Refugee Cash
Assistance (RCA)
No
Yes
Food Assistance
Program (FAP)
Yes
Yes
If both a telephone and in-person interview are acceptable choose the
method that is more convenient for the client. Conduct an in-person
interview if the client requests one or fraudulent information is
suspected. For more information on who can be interviewed for each
program see BAM 210.
7/16/2015
20
Redetermination
Monitor Your Upcoming Redeterminations
1. Bridges Left Navigation > Inquiry > Case Load Search.
2. Change the Level to EDG and the Status to Approved.
3. You can choose Redetermination Due Date On or Before or
leave the date blank.
7/16/2015
21
Redetermination
Monitor Your Upcoming Redeterminations
1. Bridges Left Navigation > Inquiry > Case Load Search.
2. Change the Level to EDG and the Status to Approved.
3. You can choose Redetermination Due Date On or Before or
leave the date blank.
7/16/2015
22
Redetermination
Monitor Your Upcoming Redeterminations
1. Bridges Left Navigation > Inquiry > Case Load Search.
2. Change the Level to EDG and the Status to Approved.
3. You can choose Redetermination Due Date On or Before or
leave the date blank.
7/16/2015
23
Redetermination
Monitor Your Upcoming Redeterminations
1. Bridges Left Navigation > Inquiry > Case Load Search.
2. Change the Level to EDG and the Status to Approved.
3. You can enter a Redetermination Due Date On or Before
date or leave the date blank.
7/16/2015
24
Redetermination
Log Packets Received
DHS-1010/1171
Log in even if the
required verifications
are not received. If
the packet is not
logged in, the FAP
EDG will close
automatically through
the mass update
process. When you
process the
redetermination in
Data Collection,
select “Client
Statement” for
missing verifications.
DHS-2240-A
DHS-1046
Log in if all
verifications are
received. The EDG
with a DHS-2440-A
due and not returned
will shorten the FAP
benefit period to the
end of month 13.
Bridges will then send
a DHS-1010 and
schedule a telephone
interview during
month 13.
The client’s gross earned income from
their most current budget is pre-filled on
the DHS-1046. If the client’s gross
earned income has changed by more
than $100 from the pre-filled amount or
their gross unearned income has
change by more than $50 since they
last reported a change, they must
return verification of their past 30 days
income with their completed DHS-1046.
If they don’t return proof of income and
you can’t get proof through a DHS data
exchange (Consolidated Inquiry, SOLQ,
etc.) do not mark the form as received
in Bridges.
To log the redetermination packet in as received:
Bridges Left Navigation > Redetermination > Packet Received
7/16/2015
25
Redetermination
Failure to Log In Packet
Program
What happens in Bridges if the packet is received but
not logged in?
Cash,
CDC,
and FAP
The program will close automatically on the Negative Action Date
(Cash/CDC) or the Redetermination Due Date (FAP). You will have
to reinstate the program. You can use the Redetermination case
action to do this. First, mark the packet as received by going to
Left Navigation > Redetermination > Packet Received.
MA and
Medicare
Cost
Sharing
The programs will remain approved until you complete the
redetermination.
7/16/2015
26
Redetermination
Perform Reviews
After you have logged in the redetermination packet as received you
can proceed with the redetermination. Go to Bridges Left
Navigation > Data Collection > Initiate Interview.
What Case Action will you use?
For annual redeterminations, use the
Redetermination Case Action. You
must update all information that has
changed or requires re-verification at
Redetermination (income, assets,
and medical/support/ dependent care
expenses).
For semi-annual or mid-certification
contacts, use the Case Change
Case Action. You must update all
information that has changed or
requires re-verification (income,
child support expense, etc.).
Bridges will update the review dates for a program ONLY if the
redetermination has been initiated.
7/16/2015
27
Redetermination
New Redetermination Due Date Established
After you have certified the results of the review, you can
check to verify that a new Redetermination due date has
been established:
1. Go to Left Navigation>Inquiry>Case.
2. Click the EDG# hyperlink on the Case Search/Summary
page.
3. View the new Redetermination Date on the EDG
Search/Summary page..
7/16/2015
28
Redetermination
Overdue Redetermination
A redetermination is considered “overdue” when:
• The client returned the redetermination packet, and
• The client kept the interview (if required) and
• The specialist did not completed the redetermination in Bridges by
the end of the redetermination month.
Program
What happens in Bridges when the redetermination
is overdue?
FAP
The program will remain approved, but benefit issuance will
stop until the redetermination is completed.
Cash, CDC,
MA and
Medicare
Cost Sharing
The programs will remain approved and benefits will be issued
(if appropriate) until you complete the redetermination.
7/16/2015
29
Redetermination
Client fails to return Packet
Program
What happens in Bridges if the client didn’t return the
redetermination packet?
Cash
The program will close automatically on the Negative Action Date
in the month the review is due.
CDC
The program will close automatically on the Negative Action Date
in the month the review is due.
FAP
The program will close automatically after the Redetermination
Due Date passes.
MA and
Medicare
Cost
Sharing
Bridges will not close the program automatically. You must go to
Left Navigation > Redetermination > RD MA Redetermination
Packet Overdue to mark the program as ready for closure. The
program will automatically close on the next negative action date.
7/16/2015
30
Redetermination
Any
Questions?
7/16/2015
31