1. LONG TERM CARE & SPENDDOWNS IN THE VACMS
SURFING THE WAVES OF VACMS
Presented By Debbie Miller
Medical Assistance Program Consultant

2. What Do You Do When Things Don’t Go As Expected?

3. Know Where Your Resources Are
Policy
Always include the policy you applied when submitting tickets
QRG’s, IBP’s, and Procedure Help
Readiness calls
The Calls, the Q&A’s and a Table of Contents can be found on SPARK under VaCMS, Readiness Calls, Tools
Releases
Check your Broadcasts daily
Desk Help Sheets
Created outside of VaCMS
Regional Consultant
Under Readiness Calls, mention the example of reasons to and not to separate cases.

4. Desk Tools Moving from CBC to NH in VaCMS
Moving from NH to CBC in VaCMS
Adding Non-Covered Medical Expenses to Patient Pay
Period of Ineligibility
Resource Transfer section in VaCMS
When to impose the POI
How to enter information in the VaCMS
Patient Pay
Effective Begin Dates
Burial Fund Exclusions & Burial Set Aside

5. Common Ticket Issues
VaCMS is using the wrong AC (aid category) code (M03)
The income chart found in SPARK has the correct AC codes on it.
Full coverage Medicaid covers long term care (LTC) services so the AC code won’t change.
Don’t override an AC code without discussing with your Regional Consultant & putting in a ticket.

7. Common Ticket Issues -continued-
VaCMS didn’t impose a penalty period
It wasn’t designed to
Know when to impose a penalty period (M )
Only when the customer is otherwise eligible for payment for LTC services if not for the penalty period (outside of the 300% SSI coverage)
Once it begins, it doesn’t stop until the period of ineligibility is completed, even if the customer’s case closes
Review how to impose a period of ineligibility in VaCMS
Follow the steps outlined in the desk help sheet ‘Period of Ineligibility’
Follow M1450.( ) regarding sending notices

8. Common Ticket Issues -continued-
The Resource Assessment won’t run (M )
Check your begin dates on all of the demographic screens – including residence & relationship screens
Review the two Procedure Helps and the QRG on Resource Assessments

9. The Known Issues

10. The Known Issues
Community Spouse Monthly Income Allowance (M D)
You must manually enter it as income for the community spouse
After initial eligibility, VaCMS incorrectly calculates patient pay
90 day intent to transfer (M )
Follow the IBP if the community spouse is not applying for Medicaid
If the community spouse is applying as well, you will need to enter the resources again, under the CS’s name and mark as available
Set an alert for the month the 90-day period ends (prior to cut off) to verify and update the resources that were transferred
Spousal Allowance- a change request has been requested.

11. The Known Issues -continued-
CBC coverage based on screening-(M )
M B.2-The institutionalization provisions may be applied when the individual is already in a medical facility at the time of the application
Enter information as though the person is receiving CBC and answer the first three questions on the MA Institutionalized Individual screen in the MA Institutionalized Individual Information section

12. The Known Issues -continued-
If there was a spenddown that was overridden
You may have to delete the Spenddown adjustment to get the system to run correctly if the person changes to institutionalized
The Home exclusion(M A. 2 & 3)
After the individual is in the NH over 6 months, the ‘home’ is no longer the ‘home’ per policy definition. The worker must change the Type to Other Real Estate
If there was contiguous property, be sure to also change the answer to the question Is this property contiguous to the home? to no

13. The Known Issues -continued-
VaCMS is not calculating the ownership interest correctly for jointly owned property with contiguous property(Appendix 1 to sub chapter S1130)
The VaCMS is deducting the $5, exclusion from the customer’s share instead of allowing the deduction prior to dividing the equity shares

14. Tips of the Trade
The Burial Resource section in VaCMS is only for the Burial Space Items, not the Burial Set Aside resources- reference the desk help sheet
When processing a Resource Assessment as part of an application, change the demographic and resource screens to reflect the month of the RA
Veteran’s income-you must know the type of benefit being received and whether or not it is countable income for patient pay . Never use ‘veteran’s income’ as the type of income

15. Veteran’s Benefits Aid & Attendance - $90.00 deduction (S0830.308)
Compensation disability or death (S A&B)
Pension - S A & B
Clothing Allowance S
Interest – M C. 2
Vocational Rehabilitation – S , S
Adjustment for unusual Medical expenses – S

16. Still Not Right? What Now?
Tickets –
Best Practice – Submission of VaCMS Tickets
In Spark, under VaCMS, All Eligibility Workers, Guidance & Procedures, Best Practice – Submission of VaCMS Tickets & Ticket template
Be sure you have researched policy first with your Supervisor
Contact your Regional Consultant to see if she/he has any suggestions
Submit a ticket
Request a patient pay correction -
The form is found in SPARK, under Divisions, Benefit Programs, BP Forms, Medical Assistance, Long Term Care, MMIS Patient Pay Correction Request

18. Requesting a Patient Pay Correction
There are only two reasons you can override a prior patient pay(M )
The community spouse is owed money for spousal allowance and the institutionalized spouse is deceased or no longer LTC
A deceased person had medical expenses
Don’t request a PP adjustment if the adjusted amount is equal to or more than the NH rate or when the underpayment is over $1, (M )

19. Patient Pay in MMIS One month Spenddown eligibility
Deceased individuals and other closed cases
Positive changes (up to end of month prior to effective month)
Months prior to VaCMS conversion
Special situations

20. Helpful Hints Make sure enrollment is correct prior to sending request
Use the most recent version of the request form
Complete the form and check for errors; include comments on form (not )
Request only changes allowed by policy
Patient pay should be for a full month unless AG recipient entering from ACR or for month of death

21. Helpful Hints -continued-
Don’t authorize more than one patient pay within the month
If you realize the patient pay sent by VaCMS is incorrect, suppress the Notice of Obligation and resolve any errors; MMIS will send a notice when the correction is made
Don’t run EDBC after a requested change is made until you correct VaCMS – or patient pay will revert back to the system-calculated amount

22. Department of Medical Assistance Services
Where to Send the Forms
Patient pay correction requests should be sent to
Coverage correction requests should be sent to
Kelly Pauley
Senior Policy Analyst
Department of Medical Assistance Services
(804)

23. SPENDDOWNS IN VaCMS (M13)
Enter spenddown allowable expenses under Expenses, Spenddown Medical Expense
If there are oldexisting expenses, change the effective begin date to the 1st month of the new spenddown and change the amount to ‘0’ or enter the carry over amount if applicable
Add additional expenses with the effective begin date as the 1st month of the spenddown you are evaluating.
The date of service must be a date within the spenddown period. If it is an old unpaid bill or a carryover expense, enter the 1st day of the 1st month of the spenddown period and document why you are doing so
Run RCR from the 1st month of the spenddown

24. SPENDDOWN RESULTS
The expense will be listed under the month in which it was deducted.
Under the last month, the remaining amount will be listed. This amount can be used as a carryover expense.

25. NOTICE OF SPENDDOWN RESULTS
When expenses are entered and the VaCMS has determined that the spenddown has not yet been met, a Notice of Action will be generated.
The Notice will only show the remainder balance.
The worker will need to add additional documentation prior to authorizing
the case indicating the submitted
bills have been evaluated and the
spenddown liability has been
adjusted.

26. LTC SPENDDOWNS (M1460.710-750, M1470.600-640, M1480.450-460)
If the spenddown amount is less than or equal to the Medicaid rate (NH), the case is approved as ongoing. VaCMS will calculate this correctly if you entered the NH rates correctly.
If the spenddown is greater than the MA rate or the case is CBC, VaCMS calculates a monthly spenddown.
Enter the daily CBC expenses and other allowable medical and dental expenses under the Spenddown Medical Expenses.
Be sure to adjust any old spenddown bills that are still listed.

27. CBC MONTHLY SPENDDOWN

28. ADJUSTING THE PATIENT PAY
Once the spenddown is met for the month, enter any medical expenses (other than the CBC cost of care) under Medical Expense.
Run RCR and check the patient pay tab. Compare the contributable income to the Medicaid rate for the month. The patient pay is the lesser of the two amounts.

29. YOU CAN RIDE THE WAVES OF VACMS THANK YOU!