June 2018 CBMS Build

Transcription

1 June 2018 CBMS Build

2 Before We Get Started Let us know how we are doing! Your questions are not being ignored. Attendance tracking is not immediate. We are recording. The Build Guide and PPT are available!

3 HCPF Projects

4 Reasonable Compatibility is required by Federal regulation. The Verification Plan outlines how it is used for both MAGI and Non-MAGI categories. CBMS MA Updates to IEVS & Reasonable Compatibility Project #11206

5 What is Reasonable Compatibility? A method of verification used for Medical Assistance Programs that compares a clients' self-attested income against income provided by electronic data sources.

6 The Change

7 Changes Applying RC to Non-MAGI categories Verifying income for Continuous Eligibility/Guaranteed Programs Members will be allowed to reapply if they were previously terminated due to IEVS hit CBMS Pages

8 Reasonable Compatibility Threshold of 10% Income Standard Check and Reasonable compatibility threshold of 10%: If the reported income and interface income are less than a 10% variance, income is considered to be reasonably compatible If the reported income and the interface income are greater than a 10% variance, but still under the FPL, income is considered reasonably compatible.

9 Income Trust Patient Payments Exceptions

10 Knowledge Check Which categories of Medical Assistance will be checking for Reasonable Compatibility: MAGI Non-MAGI Both MAGI and Non-MAGI

11 CBMS

12 Reasonable Explanation The opportunity is given to an applicant to explain a discrepancy of more than 10% between self-declared income and income as reported by CDOLE.

13 Case Individual Page

14 Display on Individual Countable Income Eligibility Results

15 CBMS Reasonable Compatibility Page

16 . Case Wrap Up - Additional Information

17 Display Medical Eligibility Results Page

18 PEAK

19 PEAK All members including Non-MAGI will now be able to update the Reasonable Compatibility in PEAK.

20 PEAK Closed Cases

21 Warning Message

22 Client Correspondence

23 Client Correspondence

24 Interfaces

25 IEVS & CDLE Changes Monthly request process will be changed to include all members on the case whose income would be used to determine eligibility. Post the income received for each quarter even if the income is the same as prior quarter End date the prior quarters income

26 Examples

27 Non-MAGI Self-attested Income = $1,010 monthly Below QMB Income Standard ($1,025) IVES Report: $3,405 quarterly ($3,405/3 = $1,132) Above QMB Income Standard ($1,025) Below SLMB Income Standard ($1,226) Results Client is not reasonably compatible Given an ROP IEVS discrepancy letter sent Stays in QMB during ROP No reasonable explanation provided? Client rolls into SLMB (with 10 day noticing) Individual Individual MBU s WAGE Budget s net income Individual MBU s CDLE Budget s net income IEVS amount over or under Income standard? Difference in FPL% Under to 10% threshold? Reasonably Compatible? OAP recipient $1,010 99% $1, % Over 11% No No

28 $1,300 MAGI $800 IVES Report: 07/07/2017 Dad = $1,500 monthly Mom = $1,000 monthly Total Countable Income = $2,500 Results CBMS use IEVS reported income (determine reasonable compatibility) Compare Mom & Dad s income to the income standard and FPL% for each individual Based on aid code and MBU size In this scenario the household selfreported amount and the total income using the IEVS reported amount are under the income standard for each member Income is Reasonably Compatible even though the threshold is greater than 10% No ROPs created Total Countable Income: $2,100 * Eligible for Medical Assistance * Mom & Dad = MAGI Adult (133%; $2,726.60) Children = MAGI Children (142%; $2,911.00) Individual Individual MBU s WAGE Budget s net income Mom $2, % Dad $2, % Child 1 $2, % Child 2 $2, % Individual MBU s CDLE Budget s net income $2, % $2, % $2, % $2, % IEVS amount over or under Income standard? Difference in FPL% Under to 10% threshold? Under 19% No Yes Under 19% No Yes Under 19% No Yes Under 19% No Yes Reasonably Compatible?

29 WAwd Self-attested Income = $1,010 monthly Employer s CDLE = $1,500 monthly Discrepancy Letter sent to Member: Requesting explanation Member expected to: Work out discrepancy with employer Provide verification Results Because a person on the Working Adults with Disabilities (WAwD) is considered a household of one, no other household member will be considered for the WAwD calculation. If a discrepancy that is unresolved is over 450% of FPL, the member will receive a termination notice for being over income for the program and will be reviewed for every other Medicaid program as required by federal law.

30 CBwD A child receiving the Children with Disabilities Buy-In (CBwD) program: The entire countable family income reviewed for reasonable compatibility through IEVS Example: Mom received a raise but has not reported it through PEAK CDLE record reports more than 10% reasonable compatibility discrepancy Discrepancy letter sent to the family: Requesting explanation Family expected to: Work out the discrepancy with the employer Provide verification Results If the discrepancy is not resolved, the member will receive a premium change notice due to an increase in income and may receive an increased premium in the following month. If a discrepancy that is unresolved is over 300% of FPL, the child will receive a termination notice for being over income for the program and will be reviewed for every other Medicaid program as required by federal law.

31 Questions?

32 This project is making updates to the logic for Psych <21, OAP Med Psych 65, and Incarceration to properly align with policy guidelines. Updates are needed to the living arrangement and housing situation logic, along with several preventative measures, to ensure that individuals are being placed into the appropriate category of Medical Assistance. MA Updates to Psych < 21 Psych 65 and Incarceration Updates Colorado Benefits Management System (CBMS) Project #11668

33 The Change

34 What the Change Is Updates to the Individual Attributes Page Modifications to the Field and Values for: Living Arrangement Housing Situation

35 Medical Assistance (MA) Modifications Psych < 21 OAP-A MED 65 Colorado Mental Health Inst Ft. Logan Colorado Mental Health Inst Pueblo Involuntary Treatment Act in CMHI Ft. Logan Involuntary Treatment Act in CMHI Pueblo Psychiatric Facility

36 Living Arrangements for Incarceration Division of Youth Corrections/Services City/County Jail State/Federal Prison Wilderness Camp under Gov. Control Work Release

37 Living Arrangements Living Arrangement Values Inter Care Facility Nursing Facility Division of Youth Corrections/Services Psychiatric Facility

38 Division of Youth Corrections/Services and Psychiatric Facility Adult Financial Colorado Works Food/Expedited Food Assistance

39 Knowledge Check What page in CBMS is being affected with this Build? A. Individual Demographics B. Medical Conditions C. Individual Attributes D. Individual Benefit

40 Knowledge Check What Field on the Individual Attributes Page will eligibility recognize as it relates to this training? A. Housing Situation B. Living Arrangements C. Source (Living Arrangements) D. Job Attached

41 Living Arrangements

42 Children under 10 The following living arrangements will no longer be selectable from the Living Arrangements field for a child under the age of 10 years old: Division of Youth Corrections/Services City/County Jail State/Federal Prison Wilderness Camp under Gov. Control Work Release

43 PEAK Change Where does this person live question Division of Youth Corrections/Services Psychiatric Facility Wilderness Camp under Gov. Control Work Release

44 Invalid Housing Situations Psychiatric Facility Work Release

45 Long-Term Care Value Update Long-Term Care-LC Long-Term Care-LT

46 Knowledge Check Psych categories will no longer be considered for clients that are incarcerated and they will only be eligible for limited benefits. 1. True 2. False

47 Knowledge Check Children under 10 may have a living arrangement of City/County Jail. 1. True 2. False

48 Questions?

49 This project addresses the termination of the Home and Community Based Services Children with Autism (HCBS CWA) Waiver effective June 30, CBMS HCBS CWA Sunset Project #11819

50 The Change

51 What is the Change HCBS CWA Sunset No New Enrollments Changes to Level of Care Page Notice of Action (NOA)

52 HCBS CWA Sunset HCBS CWA Waiver will terminate as of June 30, 2018 Eligibility requirements will need to be met The Waiver can be end dated in CBMS prior to the termination date

53 New Enrollments Enrollment is closed for HCBS CWA Ongoing HCBS CWA Additional information

54 Knowledge Check When will the HCBS CWA Waiver end? 1. July 1, January 31, June 30, January 2, 2018

55 Knowledge Check When will new enrollments for the HCBS CWA no longer be accepted? 1. July 1, January 31, June 30, January 2, 2018

56 CBMS Mass Update

57 CBMS Mass Update CBMS Mass Update is scheduled to run June 10, The Mass Update will affect any individual that has active HCBS CWA.

58 The Transition CBMS will attempt to transition individuals to MAGI Child Continuous Eligibility (CE) effective July 1, The individual will be evaluated for all other higher benefit categories before passing for MAGI Child CE. At redetermination the individual may remain on MAGI Child without CE, move to another benefit category or terminate services.

59 LTC Level of Care Page Level of Care Type field CWA 0-5 CWA in HCBS

60 Med Spans HCBS CWA benefit category Med Spans Transition to MAGI Child CE Med Spans will not be created for HCBS CWA

61 Notice of Action (NOA) Termination NOA will not be generated for HCBS CWA when a Client transitions to another Medical Assistance (MA) category. When a Client terminates MA completely a termination NOA will be generated. Effective July 1, 2018 an approval NOA will be generated in the new category.

62 Scenario 1 An MA application dated 12/04/2017 is processed on 02/01/2018. The applicant is approved by a Case Management Agency for the waiver type of CWA in HCBS as of 12/06/2017. The individual is approved for MA HCBS CWA on 12/06/2017. Additionally, the individual submits all required case verification.

63 Knowledge Check What is the last month the applicant will be eligible for HCBS CWA? A. February 1, 2018 B. December 4, 2017 C. July 2, 2018 D. June 30, 2018 MA Application date 12/4/2017 LOC Received 12/6/2017 Application Processed 2/1/2018

64 Knowledge Check Answer What date will HCBS CWA terminate? A. February 1, 2018 B. December 4, 2017 C. July 2, 2018 D. June 30, 2018

65 Scenario 2 An MA application dated 12/04/2017 is processed on 02/01/2018. The applicant is approved by a local Case Management Agency for the waiver type of CWA in HCBS as of 12/05/2017. In addition, the individual is approved for MA HCBS CWA on 12/05/2017. The individual also submits all required case verification. On June 10 th EDBC runs the case based on the mass update and will transition to an eligible category.

66 Knowledge Check What begin date will the new Med Span show after the mass update? A. January 2, 2018 B. June 1, 2018 C. July 1, 2018 D. August 1, 2018 MA Application date 12/4/2017 LOC Received 12/5/2017 Application Processed 2/1/2018 EDBC runs Mass Update 6/10/2018

67 Knowledge Check Answer What begin date will the new Med Span show after the mass update? A. January 2, 2018 B. June 1, 2018 C. July 1, 2018 D. August 1, 2018

68 Scenario 3 An MA application dated 12/04/2017 is processed on 07/02/2018. The applicant is approved by a local Case Management Agency for the waiver type of CWA in HCBS as of 12/06/2017. The individual is approved for MA HCBS CWA on 12/06/2017. Additionally, the individual submits all required case verification. On June 10 th EDBC runs the case based on the mass update. This time on June 24 th, a Long-Term Care LOC for CHCBS in HCBS with a Start Date of 7/1/2018 is entered into CBMS.

69 Knowledge Check What will be the effective date of the CHCBS in HCBS Waiver go into effect? A. August 1, 2018 B. December 4, 2017 C. July 1, 2018 D. June 24, 2018 MA Application date 12/4/2017 LOC Received 12/6/2017 Application Processed 2/1/2018 LOC w/start date 7/1/18 received 6/24/18

70 Knowledge Check Answer What will be the effective date of the CHCBS in HCBS Waiver go into effect? A. August 1, 2018 B. December 4, 2017 C. July 1, 2018 D. June 24, 2018

71 Post Implementation

72 Post Implementation Additional action is needed to process applications: Dated prior to 6/30/2018 and, Received and or processed at the eligibility site after 6/30/2018.

73 Post Implementation Actions An MA application dated 12/04/2017 is processed on 07/02/2018. The application has a Long-Term Care application is approved by a local Case Management Agency for the waiver type of CWA in HCBS as of 12/08/2017. The MA HCBS CWA application is approved on 12/08/2017. All required verifications are received. End-User action necessary

74 Post Implementation Process A Help Desk Ticket is processed and a data fix is completed in CBMS to add the Level Of Care (LOC) record of CWA in HCBS to the Long-Term Care (LTC) LOC page. EDBC is run Member is now CWA in HCBS eligible Med Span 12/8/2017 to 6/30/2018

75 Continuous Eligibility Results If they transition to MAGI Child, Med Spans will reflect: New Record: Begin Date 07/01/2018 Primary Category: MAGI Children CE Indicator = Yes

76 Knowledge Check An application dated 12/15/2017 was received 7/6/2018 approved for LTC with an approved LOC CWA in HCBS Waiver. What action will the Eligibility Technician need to take? A. Deny the case B. Request a new LOC C. Submit a HDT D. Nothing

77 Questions?

78 Thank You For all June 2018 Build projects and further training opportunities, visit TrainColorado.com for more information. Courses > CBMS Build Training > June 2018 CBMS Build Responses to questions that were unanswered during this session will be posted in a Q&A document at the same TrainColorado.com location on June 22, 2018.