MMIS WebEx Training

1. Department of Medical Assistance Services MMIS WebEx Training Department of Medical Assistance Services – Eligibility and Enrollment Unit June 2014 http://www.dmas.virginia.gov 1

2. Agenda • Spenddown Processing • Aid Category (AC) 058 Project II • Spenddown Enrollment • Spenddown Processing & Enrollment Resources • MMIS Review Dates • Delay in LTC Determination • Release 60 • Commonwealth Coordinated Care (CCC) Updates • Foster Care/Adoption Assistance Members Data Entry in VaCMS & MMIS • Retro Cancel Reinstate – Tip • Enrollment of Certain Newborns in the MMIS • Enrollment of Hospital Presumptive Eligibility (HPE) AC 064 & Certain Newborns • Coverage Correction Requests • Medicaid Handbook

3. Spenddown Processing M0320.000.B Determine an individual’s eligibility first in a CN covered group. If the individual is not eligible in a full-benefit CN covered group, determine the individual’s eligibility as MN (on a spenddown). *If the individual meets all the requirements, other than income, for coverage in a full benefit Medicaid group, evaluate as MN. 

4. Spenddown Processing (cont.) M0320.701.D • The following ACs are used when the individual is ABD MN and QMB or SLMB: • 028 for an aged individual also QMB; • 048 for a blind individual also QMB; • 068 for a disabled individual also QMB; • 024 for an aged MN individual also SLMB; • 044 for a blind or disabled MN individual also SLMB. • The following ACs are used when the individual is ABD MN and not QMB or SLMB: • 018 for an aged individual NOT QMB or SLMB; • 038 for a blind individual NOT QMB or SLMB; • 058 for a disabled individual NOT QMB or SLMB.

5. AC 058 Project II Updates • Open ended AC 058 eligibility segments • Responses were due back to DMAS EEU by 5/16/2014. • The deadline has been extended to 6/20/2014. • DMAS will end eligibility for members where there is no response • Notices will be mailed from DMAS • The Comment screen will updated with DMAS action

6. Spenddown Enrollment Reminder: The only time a member should be enrolled in open ended MN AC is when the member is long-term care residing in a nursing facility. All other eligibility in AC 058 should have an end date.

7. Spenddown Processing & Entry Resources • Training/References Available • AGENDA - Spenddown Policy & Processing & MMIS Spenddown Enrollment (08/2012) • Spenddown Desk Tool • SSA Title II Disability Desk Tool • Spenddown Bill Evaluation Desk Tool • Eligibility and Enrollment Unit Webpage http://dmasva.dmas.virginia.gov/content_pgs/ss-elgb_enrl.aspx

8. MMIS Review Dates • Broadcast #8520-MMIS will now accept a review date up to one year plus three months in advance to allow for early processing of renewals Example: The edit allows for a change 1-year plus 2 months in advance. Current/Action Date is 5/16/2014; existing MMIS review date is 7/30/2014. The renewal is being processed 2-mos. early on 05/16/2014. The new renewal date may be less than, but cannot exceed 07/30/2015, otherwise the renewal period would exceed 12 months.

9. MMIS Release 60 Changes • Effective for dates of service on or after July 1, 2014 • DMAS will offset claim payments for LTC services by the patient pay amounts in the MMIS. • Patient pay will not necessarily be collected by one provider. • Processing and data entry that is completed by the local agencies will be unchanged.

10. CCC Mailings • Phase I mailing resulted in 2,000 letters returned due to incorrect or insufficient addresses in the MMIS. • Currently, returned mail will be sent to the LDSS by DMAS for address correction. • Effective June 2014 mail will be automatically routed by USPS to the appropriate LDSS for address correction.

11. Foster Care/Adoption Assistance Members Data Entry in VaCMS & MMIS • IV-E cases are not entered into VaCMS at this time as the system cannot evaluate eligibility for these groups.  VaCMS Release for June 2015 or later will allow for entry into VaCMS. • New Non IV-E Foster Care and Adoption Assistance cases have been evaluated in VaCMS since October 2013. • Effective with April 2014 renewals all Non IV-E FC and AA will be completed in VaCMS using Medicaid MAGI rules.

12. Retro Cancel Reinstate - Tips • Used to move members from limited to ongoing full-coverage eligibility. • The start date of the new eligibility line cannot be prior to the start date of the line being replaced. • Coverage prior to the start date should be entered in update mode as a separate closed eligibility segment.

13. Retro Cancel Reinstate –Tips (cont.) Example: • Member is currently enrolled in Plan First AC 080 effective 4/1/2014 – ongoing. • Member is found eligible for full-coverage AC 091 effective 3/1/2014. (There is currently not any coverage in the MMIS during the month of March.) • Use the Retro Cancel Reinstate function to input the full coverage from 4/1/2014 – ongoing. • Next, enter the coverage for the month of March in update mode from 3/1/2014-3/31/2014.

14. Enrollment of Certain Newborns in the MMIS • Child born to a woman who was eligible for Medicaid orFAMIS • Includes children born to alien mothers who are Emergency Services eligible • Eligible as certain newborn, child under age 1 and enrolled beginning with the newborn’s date of birth. (Medicaid Manual: M0330.400)

15. Enrollment of Certain Newborns in the MMIS (cont.) • No other nonfinancial or financial eligibility requirements • No resource test • The ACs for certain newborns is always Medicaid AC “093” or FAMIS AC “010” (Medicaid Manual: M0330.400)

16. Enrollment of Certain Newborns in the MMIS (cont.) • Income changes do NOT affect certain newborn eligibility for the first year of the child’s enrollment. • The mother’s failure to complete a renewal for her own eligibility and/or the eligibility of other children in the household does NOT affect the eligibility of the certain newborn. (M0330.400)

17. Enrollment of HPE AC 064 & Certain Newborns • Newborns born to Medicaid/FAMIS mothers are enrolled in Medicaid AC 093 or FAMIS AC 010. • Certain newborns – should not be enrolled in HPE. A newborn is only enrolled in HPE when the mother was not active Medicaid/FAMIS on the date of birth or alien emergency services approval is pending. • If a local agency finds that a certain newborn has been enrolled in AC 064 report the finding to the Enrollment Inbox (enrollment@dmas.virginia.gov). DMAS staff will void the incorrect line of HPE eligibility to allow for the entry of the correct certain newborn AC.

18. Coverage Correction Requests • MMIS Enrollment Issues – DMAS Eligibility and Enrollment Unit • enrollment@dmas.virginia.gov • ADAPT and VaCMS – VDSS Help Desk • http://spark.dss.virginia.gov/divisions/dis/technical_support/ • Phone: 1-866-637 VITA (8482) • E-mail: vccc@vita.virginia.gov • For VaCMS issues it is recommended that staff email the Help Desk using the VaCMS template. 

19. Medicaid Handbook • Per Broadcast 8542, the Medicaid Handbook has been split into two versions; ABD and Families and Children. • See Broadcast 8531 for information regarding the FAMIS Handbook. • To order contact the DMAS Order Desk at Commonwealth-Martin by telephone, fax, e-mail or postal mail. • Phone: (804) 780-0076 Fax: (804) 780-0198 • Email: dmas@cms-mpc.com • Mail: Commonwealth-Martin 1700 Venable Street Richmond, Virginia 23223

20. Thank you… Thank you for viewing this presentation. Continue to send questions and comments about this training or ideas for future trainings to: mmiswebex@dmas.virginia.gov. Eligibility and Enrollment issues should be sent to the Enrollment Inbox at enrollment@dmas.virginia.gov Patient Pay enrollment questions or issues should be sent to the Patient Pay Inbox at patientpay@dmas.virginia.gov