BPRO Medicaid ag committee meeting Friday, May 17, 2019 The DMAS Enrollment Unit reports to the Eligibility and Enrollment Services Division of the Department of Medical Assistance Services under the leadership of Cindy Olson, Division Director. We are located at 600 East Broad Street, Downtown Richmond.

What Does the DMAS Enrollment Unit Do? Ensure member enrollment accuracy Conduct Inquiries to make corrections Add coverage Adjust Aid Categories Edit/update Member and Case Information in MMIS Reports The Enrollment Unit makes edits and/or corrections to member and cases with effective beginning and ending dates as well as ensure the appropriate Aid Category is being utilized. Monthly reports received from our Data Analytics department must be processed in an effort to correct member enrollment information; Some of the reports include RSO 485. This report is the SSN Discrepancy report and must be in compliance with CMS.

MEMBER DEMOGRAPHICS – Updates Member Demographics – Updates can be performed to Member and Case information by the LDSS worker. Individuals known to MMIS are identified by a unique Member/Enrollee ID#. Searches can also be performed by entering the full name, SSN and gender.

ELIGIBILITY DATA - INQUIRY The Eligibility Data Inquiry screen allows the worker to view the member’s eligibility/enrollment to determine the Aid category; the Begin/End date; and, the status of the line of coverage (i.e., A – active). Further inquiry can be viewed by selecting the radio button to view the Benefit Plan and Plan Description along with Provider information. Due to bridge closure, workers are unable to modify enrollment data at this time.

REPORTS

MA Application - SSN Requirements MA Policy M0210.150.B A social security number verified by the Social Security Administration is necessary accurate Medicaid application evaluation Medicaid Policy M0210.150.B indicates that a valid social security number verified by the Social Security Administration is necessary for the accurate evaluation of a Medicaid application.

Citizenship & Identity Procedures M0220.100D During the eligibility determination process through VaCMS, the social security data match takes place when the individual’s information is sent through the HUB.

MMIS Data Matches SSA Cases not processed in VaCMS, the SSA data match will take place after the individual has been enrolled in MMIS. If the information in the MMIS matches the information contained in the SSA files, the MMIS will be updated to reflect the verification of C&I. No further action is needed on the part of the eligibility worker, and the enrollee will not be required to provide any additional documentation, if the SSA match code in MMIS shows that SSA verified the individual’s C&I. M0220.100 Cases not processed in VaCMS, the SSA data match will take place after the individual has been enrolled in MMIS. If the information in the MMIS matches the information contained in the SSA files, the MMIS will be updated to reflect the verification of C&I. No further action is needed on the part of the eligibility worker, and the enrollee will not be required to provide any additional documentation, if the SSA match code in MMIS shows that SSA verified the individual’s C&I.

MMIS Data Does Not Match SSA If the information in the MMIS does not match the information in the SSA files, a discrepancy report generates monthly listing the inconsistent information. Eligibility staff is expected to review the report to see if the report lists any enrollees who were rejected because SSA could not verify the enrollee’s citizenship and identity.

RSO 485 Discrepancy Reports Generated monthly Sent to Regional Consultants by FIPS Sent to the LDSS staff LDSS Staff makes corrections in VaCMS and MMIS LDSS gives the RC results Regional Consultant notifies EU Supervisor

Duplicate Member Medicaid Policy

Duplicate Enrollee/Member LDSS staff initiate the duplicate member enrollment process either through VaCMS or MMIS; Twice daily, the Enrollment Unit staff reviews and monitors the duplicate review process in the override screen of MMIS.

If a possible duplicate is identified in the LDSS worker believes that the possible duplicate is not their member, then a DMAS duplicate review should be requested by taking the following steps: Log into MMIS From the Enrollment Menu enter the member ID# that received the possible duplicate error message and click “duplicate member”; In the duplicate member review inquiry screen enter “Y” in the “Req Review Y/N” box; Press enter and update.

New Member Data Section The information on the top half of the page is the new information the LDSS is attempting to add or change; Possible Duplicates Section The information on the bottom half of the page is the existing enrollment. The information is compared by Enrollment Unit staff to determine if the members are duplicates or not. Duplicate match criteria includes SSN; Full/partial name; DOB TDO members; assessments; Newborns are generally already in MMIS with a 975# and that number is the member’s enrollee ID# and should be used in VaCMS for processing.

When both member ID#s have active enrollment, a determination must be made by the LDSS as to which ID# should be used. The active member ID# will be the permanent ID# and the cancelled member ID# eill become the associate ID#. A MMIS Coverage Correction Request Form should be submitted to enrollment@dmas.virginia.gov mailbox to identify which is the permanent and the associate ID#s.

MMIS Coverage Correction Request Form Duplicate Member ID Link Section provides the LDSS worker the opportunity to identify which member ID# is permanent and which becomes the associate. This form should be sent via email to enrollment@dmas.virginia.gov.

PATIENT PAY Patient Pay

Patient pay corrections are managed by the DMAS Enrollment Unit by submitting completed Patient Pay Request Forms to patientpay@dmas.virginia.gov.

PATIENT PAY Patient Pay cannot be increased in the past Patient Pay does not apply to Medicaid expansion Medicaid Policy M1510.303 – Patient Pay Information After an individual in long-term care is found eligible for Medicaid, the recipient’s patient pay must be determined. When the patient pay amount is initially established or when it is changed, the worker enters the information in VaCMS. VaCMS sends the “Notice of Obligation for Long-Term Care Costs” to the enrollee or the enrollee’s authorized representative. When patient pay increases, the “Notice of Obligation for Long-Term Care Costs” is sent in advance of the date the new amount is effective. Patient Pay cannot be increased in the past Patient Pay does not apply to Medicaid Expansion

Where to Send Forms? Enrollment Unit Patient Pay Unit enrollment@dmas.virginia.gov Patient Pay Unit patientpay@dmas.virginia.gov Enrollment Unit Mailbox: submit completed MMIS Coverage Correction Request Forms only Patient Pay Unit Mailbox: submit Patient Pay Request Forms only