1. Department of Medical Assistance Services
MMIS WebEx Training
Department of Medical Assistance Services – Eligibility and Enrollment Unit
June 2014
Welcome to the June 2014 MMIS WebEx training presented by the Eligibility and Enrollment Unit of the Department of Medical Assistance Services. 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
In today’s presentation there will be brief updates regarding the AC 058 Project II, MMIS Review Dates, Data Entry of Delayed LTC Determinations, Release 60, CCC, processing of IV-E and non-IV-E cases in the VaCMS. We will then cover information regarding Certain Newborns and the processing of Certain Newborns who have been enrolled in Hospital Presumptive Eligibility. Finally, we will review procedures for requesting assistance with MMIS and VaCMS.

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. 
Medicaid Manual Chapter M0320.B indicates the appropriate order of sequential evaluation. Medically needy is number eight on this list. These individuals have excess income and meet no other covered group. The 80% FPL aid categories are not appropriate.

4. Spenddown Processing (cont.)
M 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.
Medicaid Manual Chapter M D provides the appropriate enrollment of medically needy individuals and the correct aid categories to use. Currently, there are eight aid categories for enrollment of medically needy individuals including those who are SLMB and QMB. The number of individuals who are enrolled in aid category 058 in an open ended segment should be minimal. There are not any plans to add additional aid categories to this group.

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
An was sent out to all LDSS Eligibility Supervisors and Managers requesting a review of all open ended enrollments in aid category In this report we removed any members who have an alien status of “A” or “D” and those members receiving long-term care. We requested a response from each agency on the spreadsheet indicating the action taken for each member or if the member was enrolled correctly by May 16th. As of the deadline we have only received responses for 12% of the enrollments. There are still approximately 1,200 members who are enrolled in AC 058 without an end date. To avoid closing out the eligibility for this many members, we have extended the deadline of these responses to June 20th. Any members that remain open as of June 20th for whom we have not received a response will be closed effective July 31, We realize that all agencies are currently experiencing an exceptional amount of work, however, we cannot continue to leave these members open who are not eligible. Additionally, we want to avoid agencies incurring MEQC or PERM errors for incorrect enrollments. If assistance is needed with closures or if there is a question regarding the process please the Eligibility and Enrollment Inbox. Completed spreadsheets should be returned to Sarah Samick in the Eligibility and Enrollment Unit.

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.
Members are only enrolled in AC 058 when they are a long-term care member residing in a nursing facility. All other members who meet a spenddown and who are enrolled in AC 058 must have an end date. If there is technical difficulty entering the end date you the DMAS Eligibility and Enrollment Unit should be contacted for assistance.

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
The Eligibility and Enrollment has developed several tools and quick reference guides to assist workers in processing spenddowns and to answer frequently asked questions. A Power Point presentation on spenddown processing and entry as well as spenddown and SSA disability desk tools are available on the Eligibility and Enrollment Unit Webpage. These items can be found at the address shown as well as the MMIS User’s Guide.

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/ 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.
Broadcast 8520 announced that effective May 15, 2014 a fix has been put in place to allow for the entry of a review date that is one year plus three months in advance. This fix will allow for the processing of early renewals for those cases being processed through VaCMS. Shown are two examples of the change to the Review Date field to allow for the processing of early renewals.

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.
Effective for dates of service on or after July 1, 2014, DMAS will offset claim payments for long-term care services by the patient pay amounts recorded by local agency staff on the MMIS. Patient pay will be offset as claims are processed on a first in first out basis. Patient pay will not necessarily be collected by one provider. There will be no change to the local agency responsibilities or the patient pay calculation itself. Providers will be interested in prompt updates especially when members are transitioning from a facility (with a high patient pay) to HCBC waiver services (with a low or zero patient pay).

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.
Phase I of the CCC program rolled out to Tidewater and Central Virginia on March 1, Phase II of the program rolled out in Northern Virginia, Roanoke and Western/Charlottesville Regions on May 1st, In addition, over 29,000 letters were sent to potential enrollees in Northern Virginia, Roanoke and Western/ Charlottesville Regions explaining the program and the requirement to opt in or out of participation. The informational letters were sent in identifiable envelopes with specified “return service requested.” From the initial mailing in March, approximately 2,000 letters were returned to DMAS due to incorrect or insufficient address information in MMIS. Due to the high priority of this program, DMAS initially attempted to research the correct addresses for the letters that were returned between March through mid-April. Addresses for which the USPS provided a new member address were being updated in VaMMIS by DMAS staff in the EEU. EEU staff also researched address information in SPIDeR, ADAPT, and DMV systems and updated in MMIS, as appropriate, in order to update the system for these and future mailings. CCC mail that is returned to DMAS with an insufficient or incorrect address will be re-routed to the appropriate LDSS handling the recipient’s case as noted in MMIS. Effective June 2014, CCC mail will be automatically routed by USPS to the appropriate LDSS if the address is insufficient or the letter is otherwise undeliverable. Per Medicaid policy, the timeframe for acting on a change is 30 calendar days from the report of the change. It is important that LDSS’ adhere to this 30 day timeline as the CCC program automatically enrolls the recipient into the CCC program after the third letter is mailed.

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.
No IV-E cases need to go into VaCMS at this time as the system cannot evaluate Medicaid eligibility for those groups.  It will be sometime on or after June 2015 before VaCMS will be ready to accept and complete Medicaid evaluations for those groups. New Non IV-E Foster Care and Adoption Assistance cases should have been having Medicaid evaluated in VaCMS  since last October.  Effective with renewals due in April 2014, all Non IV-E FC and AA renewals should be completed in VaCMS as those groups are now evaluated for Medicaid using 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.
The retro cancel reinstate function is used to move members who are enrolled in a limited coverage aid category to a greater full-coverage aid category with ongoing coverage. It is important to remember that this function should not be used for the entry of spenddowns or where the eligibility segment requires an end date. When using the retro cancel reinstate function the start date of the new greater line of eligibility cannot be prior to the start date of the line of coverage being replaced. If coverage also needs to be entered prior to the limited coverage start date then a separate line of closed coverage should be input in update mode.

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/ (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.
Here is an example of how to enter coverage for a member who is currently enrolled in ongoing Plan First coverage and who has now been found eligible for ongoing full-Medicaid coverage one month prior to the start date of the Plan First start date. First, use the retro cancel reinstate function to move the member to the greater aid category effective the start date of the Plan First coverage, update and save. Next, go back into the Eligibility screen and enter the coverage that is prior to the start date in Update mode as a closed period of coverage.

14. Enrollment of Certain Newborns in the MMIS
Child born to a woman who was eligible for Medicaid or FAMIS
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: M )
A child born to a woman who was eligible for Medicaid or to an individual covered by FAMIS at the time the child was born is eligible as a newborn child under the age of one. Remember, this includes a newborn child born to an alien eligible for Medicaid payment of emergency services only. A certain newborn’s coverage begins on their date of birth – regardless of the date of application as a Medicaid application is not required for certain newborns. An application is never required for certain newborns until the month that the child turns age one. If an application is not filed at that time, the Medicaid eligibility should be closed.

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: M )
A certain newborn is not required to meet any nonfinancial or financial eligibility requirements, nor is there a resource test. All newborns born to Medicaid mothers (including those born to alien mothers who are eligibility for Emergency Services) should be enrolled in Medicaid aid category 093 or FAMIS aid category 010.

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.
(M )
Changes in the household income do not affect the eligibility of a certain newborn during the first year, regardless of the affect of other member’s in the household. Failure to complete a renewal for other member’s in a certain newborn’s household does not affect the eligibility of the certain newborn.

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 DMAS staff will void the incorrect line of HPE eligibility to allow for the entry of the correct certain newborn AC.
Certain newborns are babies who are born to Medicaid mothers and should be enrolled in Medicaid aid category 093 or FAMIS aid category Certain newborns should not be enrolled in Hospital Presumptive Eligibility. The Eligibility and Enrollment Unit is monitoring these enrollments and making corrections where enrollment errors are found. If the local agency discovers the enrollment of a certain newborn in presumptive eligibility, send an to the Eligibility and Enrollment Unit Inbox at the address shown for correction by DMAS staff. We will void out the incorrect line of coverage to allow the local agency to input the correct certain newborn aid category. Leaving a certain newborn in a HPE AC can result in automatic closure if an application is not filed and prevents the newborn from being enrolled into managed care.

18. Coverage Correction Requests
MMIS Enrollment Issues –
DMAS Eligibility and Enrollment Unit
ADAPT and VaCMS – VDSS Help Desk
Phone: VITA (8482)
For VaCMS issues it is recommended that staff the Help Desk using the VaCMS template.   
Coverage Correction requests regarding issues with enrollment into the MMIS should be sent to the DMAS Eligibility and Enrollment Unit at the address shown. The VDSS Help Desk is unable to help with MMIS issues and can only forward tickets to us or advise the worker to contact DMAS. Issues with the ADAPT and VaCMS systems should continue to be directed to the VDSS Help Desk.

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, or postal mail.
Phone: (804) Fax: (804)
Mail: Commonwealth-Martin
1700 Venable Street
Richmond, Virginia 23223
The Medicaid handbook has been split into an ABD and Families and Children version and are available for order through Common-Wealth Martin. Copies may be ordered at no cost to the local agency by contacting the DMAS Order Desk at Commonwealth-Martin by telephone, fax, or postal mail. See Broadcast 8531 for information regarding the FAMIS Handbook.

20. Thank you…
Thank you for viewing this presentation. Continue to send questions and comments about this training or ideas for future trainings to: Eligibility and Enrollment issues should be sent to the Enrollment Inbox at Patient Pay enrollment questions or issues should be sent to the Patient Pay Inbox at
Thank you for viewing today’s presentation. Please continue to send ideas for future WebEx trainings to the MMIS WebEx Inbox shown. Issues regarding eligibility and enrollment or patient pay in the MMIS should be send to the appropriate addresses on this slide. The next MMIS WebEx presentation is scheduled for October A broadcast with registration links and an agenda should be expected in September.