Medical Assistance Certification Periods

Minnesota Financial Workers & Case Aides Association Conference

September 28-30, 2011

DHS – Health Care Training

Presenter: Ge Her

Note: Unresolved questions asked during the presentations are being reviewed and will be posted soon.

Table of Contents What is a Certification Period How a Certification Period is Created When to Interrupt a Certification Period When Not to Interrupt a Certification

Period Adding a New Household Member Overlapping Certification Periods Spenddowns and Changes to Certification

Periods2

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Definition of a Certification PeriodTwo meanings: A certification period is the period of

time a client can be active before the next renewal is due.

For income purposes, the certification period, sometimes referred to as a budget period, is the time period in which income is calculated to determine income eligibility, as well as the premium or spenddown amount.

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Initial Certification Period

Jan

Feb

Mar

Apr

May

Jun

Retro = Actual Income

Anticipated Income

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How a Certification Period is Created

MAXIS sets up the initial certification period when:

A new case is created and health care is requested.

A closed case is put into PND2 status through APPL.

Health care is requested through STAT/HCRE on an active case.

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STAT/HCRE

Note: All case names and numbers used in this presentation are fictional and were created for learning purposes only.

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STAT/BUDG

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STAT/BUDG Continued…

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When to Interrupt a Certification Period A previously scheduled cash, or Food Support (FS),

annual recertification, six-month report or MA renewal is due during a current certification period.

A MCRE renewal is due during an existing MA certification for other household members. Exceptions exist for cases that have active Food Support or cash programs.

Adding a household member who increases the household size. Exception: Do not interrupt the certification period when adding a newborn already included in the household size as an unborn.

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When to Interrupt a Cert Period Continued… A person who is included in the household size,

but did not request MA with other household members, now requests MA for a period before the household’s original certification period.

A client’s automatic MA eligibility ends (MSA). When a client in a single person household dies,

end the current certification period on the last day of the month in which the death occurred.

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Aligning Cert Periods

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STAT/BUDG - Aligning

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STAT/REVW Updated

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STAT/BUDG Updated

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ELIG/HC – Updated

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MinnesotaCare Redetermination Date

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Automated Cert Period CreationMAXIS creates a new

certification period in most instances when a certification period must be interrupted.

Automated Cert Period Creation Example

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Automated Cert Period Example Continued

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New Certification Period

If a PF11 system patch is needed, see TE09.13.15 – HCRW SHORTENED SPENDDOWN FIXES – PHASE 1.

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Notes for Interrupted Certification Periods

When a new certification period is created, adjustments must be made to the old certification period, such as a shortened spenddown calculation.

If the new certification period has a spenddown, all household members must use the same spenddown type unless an exception is met.

Update MMIS according to the MAXIS changes.

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When Not to Interrupt a Certification Period A person on stand-alone MA becomes eligible for

automatic MA with cash assistance, or the MSA and RCA programs.

A client enters or leaves an LTCF. QMB, SLMB or QI eligibility is added to MA. MA eligibility is added to QMB, SLMB or QI. The household size decreases because a person

dies or leaves a current MA household. A client’s income changes.

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When Not to Interrupt a Cert Period Continued…

A person who was included in the existing household size but did not request MA is now requesting coverage within the same income certification period.

A client’s eligibility changes from MA-EPD to basic MA, resulting in a lower income standard. Redetermine eligibility for the remaining months of the certification period using a monthly spenddown.

People on basic MA become eligible for TMA or TYMA.

People on TMA or TYMA become eligible for basic MA.

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Notes on When a Cert Period is Not Interrupted On a six-month spenddown, you cannot decrease

benefits as eligibility has already been approved through the six-month certification period. (HCPM24.10.10)

If the six-month spenddown adjustment results in a lower spenddown amount or earlier satisfaction date, make the adjustment in MMIS and notify the client of the changes so they can submit additional bills that may now be covered by MA. (HCPM 24.25)

If the client has a monthly spenddown, you must allow for 10-day notice before taking adverse actions on the case. (HCPM 24.25)

Update MMIS according to the MAXIS changes.

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Adding a New HH MEMB Eligibility is determined based on his/her living

arrangement before entering the home. If the new member lived with other mandatory

members, deeming and HH composition rules apply from the previous HH.

The new member may gain a basis of eligibility but HH size rules do not apply in the month of entry or retro months. New member must be determined under old HH factors for those months.

A new HH member cannot be eligible with existing members until the first full month they have lived in the home, except for auto-newborns.

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Adding a New HH MEMB

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Adding a New HH Member Continued

MAXIS creates a new certification period.

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Overlapping Cert PeriodsNew health care requests that

overlap with previous certification periods with eligible or ineligible months.

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Overlapping Cert Periods

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Overlapping Cert PeriodSeptember Application

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FIAT Required

Reason Code 05 – System Override

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Overlapping Cert Period

Update month of August with new application information. POLI/TEMP TE09.12.01

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Which type of spenddown can be shortened?

A six-month spenddown can be shortened.

Monthly spenddowns are determined one month at a time so changes take effect the next available month allowing for 10-day notice.

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Recalculating a SPDNStep 1:

Update the information that interrupts the certification period in the month the change occurred.

Step 2:

Once the update is made, change the footer month to the beginning of the certification

period.

Step 3:

Use the BGTX command in STAT to request new background transactions.

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When a SPDN DecreasesAct on a change when the client

reports it but do not verify the change until the next certification period.

Changes may result in earlier satisfaction dates or changes to the recipient amounts.

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SPDN Decrease - Example

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Spenddown Decrease Example Continued…

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SPDN Decrease - SPDN

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SPDN Decrease – Shortened Cert Period

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STAT/BUDG Alignment

Don’t forget to update STAT/REVW!

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SPDN Decrease Shortened SPDN

SPDN Decrease - MMIS

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Spenddown Increases Increase in income beyond normal

projected amounts – e.g. new job. A household member enters or leaves the

home. Client reports income that was not

anticipated when the original income calculation was determined.

The months before the change were high income months in shortened spenddown situations.

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SPDN Increases - ExampleRichard and Jane receive an

unexpected lump sum payment of $4,000.00 in July.

Update income in the month of the change.

Recalculate spenddown.

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SPDN – Increased SPDN

Do not send notice due to increased six-month SPDN amount.

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Other Changes

Review HCPM 21.05 – Certification Period Review case to see if interruption of

certification period is needed. Update spenddown amounts and make

updates if changes are beneficial to client. If case is set up as monthly spenddown,

allow 10-day notice if taking adverse action.

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Questions?

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Thank you!