ADDENDUM 4 COCA Processing

ADDENDUM 4

COCA Cost of Care PROCESSING

A. THE COCA Cost of Care SCREEN

The COCA Cost of Care Screen is Individualized Supports used to calculate the amount of money a client is required to pay for the care he or she is receiving.

CF109-I NEW COCA Cost of Care AMT CALCULATED - PRESS ENTER TO CONFIRM - F9 TO CANCEL EIS Eligibility Information System COCA Cost of Care COST OF CARE SCREEN 020204 14:26 WORKER B CASE NAME: DOE, JOHN CASE NUMBER: 00024573 MONTH: 0304 CLIENT: JOHN D CLIENT NO: 0600055441 INCOME EXPENSE SOC SECURITY (SS) : 1200.00 PERSONAL NEEDS : 1656.00 SUPL SECURITY (SI) : INCOME TAXES : SENIOR BENEFITS : CHILD SUPPORT GARNISH : VETERANS ( VA ) : SPOUSAL MAINTENANCE : PENSION PERS Public Employees Retirement System : 1500.00 DEPENDENT MAINTENANCE : ANNUITY : INSURANCE PREMIUM : UNCOVERED MED EXPENSE : 140.00 EARNED INCOME : HOME MAINT (6 MO MAX) : ADULT PUBLIC ASSISTANCE : EXPENSE ADJUSTMENT : INCOME ADJUSTMENT : TOTAL INCOME : 2700.00 TOTAL EXPENSE : 1796.00 Comments: NEW COST OF CARE LIABILITY AMOUNT: 904.00 NEXT-->

B. DESCRIPTION OF FIELDS ON COCA Cost of Care SCREEN

FIELD DESCRIPTION / USE INCOME SOC SECURITY (SS) If the client receives Social Security ( SSA Social Security Administration ) income (RE, DI, etc), input the amount in this field. SUPL SECURITY (SI) If the client receives Supplemental Security Income ( SSI Supplemental Security Income ), input the amount in this field. SENIOR BENEFITS If the client receives Alaska Senior Benefits Program (SBP) payments, input the amount in this field. VETERANS ( VA ) If the client receives payments from the Department of Military and Veterans Affairs, input the amount in this field. PENSION If a client is receiving an employer pension, enter the amount in this field. Open Field by PENSION The field beside Pension opens and allows the caseworker to enter the source of the Pension (i.e. PERS Public Employees Retirement System , Railroad, etc.) ANNUITY If a client is receiving an annuity from a private source, enter the amount in this field. Open Field by ANNUITY The field beside ANNUITY opens and allows the caseworker to enter the source of the annuity (i.e. SBS, Roth IRA, etc.) Open Field between ANNUITY and EARNED INCOME fields Use this field to enter any supplemental or additional income not otherwise specified. EARNED INCOME If a client has wages, enter the amount of gross earnings (including self-employment) in this field. ADULT PUBLIC ASSISTANCE If a client receives APA Adult Public Assistance benefits, enter the total amount of APA Adult Public Assistance benefits in this field. INCOME ADJUSTMENT Enter any amounts of offsetting income. (e.g. when an incorrect amount of income was used in determining the cost of care in a previous month.) TOTAL INCOME This field displays the total amount of countable income. COMMENTS This is a free form field for caseworkers to enter information regarding any of the data entry on the COCA Cost of Care screen. DO NOT DUPLICATE information that is recorded on the online Case Notes ( CANO ).

FIELD DESCRIPTION / USE EXPENSES PERSONAL NEEDS This amount is hard coded and is determined by the Medicaid subtype entered on the MERE Medical Reference s creen . INCOME TAXES If a client pays taxes on any income (e.g. (retirement or annuity), enter the amount paid in this field. CHILD SUPPORT GARNISH If a client has any income garnished for child support during the month, enter the amount of the garnishment in this field. SPOUSAL MAINTENANCE Enter the amount allowed for spousal maintenance in this field. DEPENDENT MAINTENANCE Enter the amount allowed for dependent maintenance in this field. INSURANCE PREMIUM If a client pays an insurance premium for private insurance coverage, enter the amount of premium in this field. UNCOVERED MED EXPENSE Enter the amount for uncovered medical expenses in this field. HOME MAINTENANCE (6 MO MAX) If a client lives in a nursing home and intends to return to his or her private residence, enter the amount of maintaining the private residence in this field. EXPENSE ADJUSTMENT Enter any offsetting expenses in this field. TOTAL EXPENSES The total amount of allowed expenses will display in this field. NEW COST OF CARE LIABILITY AMOUNT Upon <ENTER> this field will display the clients new cost of care amount.

C. COCA PROCESSING EXAMPLES

Example 1: John Doe is currently eligible for Medicaid under the Special Long Term Care category and is receiving HCB Home and Community-Based Waiver Services. He lives in his own home. His monthly income consists of $1200 in SS-RE and $1500 in PERS Public Employees Retirement System retirement for a combined monthly income of $2700. He has a Qualifying Income Trust ( QIT ) that he deposits $1044 each month. He also incurs uncovered medical expenses and this month the total of uncovered medical expenses is $140.

Step 1: Input all demographic and income information. Step 2: On the MERE Medical Reference : " Input" the correct Medicaid Subtype and Eligibility Code. Step 3: On the APA Adult Public Assistance METHOD MEDICAID ONLY AUTHORIZATION ( APMM ) screen: 1. <TAB> to the UNEARNED INCOME field and enter the combined unearned income 2. <ENTER> 3. Input PCN and REVIEW DUE DATE 4. <ENTER>

APMM APA Method Medicaid Only Authorization screen APA Adult Public Assistance METHOD AUTHORIZATION ONLY 020204 13:50 WORKER B CASE NAME: DOE, JOHN CASE NUMBER: 00024573 MONTH: 0304 ADJ GROSS EARNED INCOME : 0.00 HOUSEHOLD TYPE : WAV $65 AND 1/2 WORK INCENT : 0.00 QMB Qualified Medicare Beneficiaries / SLMB HH SIZE : AB Aid to the Blind WORK DEDUCTIONS : 0.00 NET EARNED INCOME : 0.00 APA Adult Public Assistance NEED STANDARD : 1656.00 UNEARNED INCOME : 2700.00 COUNTABLE EARNED INCOME : 2700.00 $20 DISREGARD : 0.00 NET UNEARNED INCOME 2700.00 PENDED? : INFORMATION ONLY AUTHORIZATION : DENIAL/CLOSURE REASON : COUNTABLE RESOURCES : 0.00 INSTITUTIONALIZED? : BENEFIT ISSUANCE : R REVIEW DUE DATE : 0105

Step 4:

Upon <ENTER> the COCA Cost of Care screen will appear. On the COCA Cost of Care screen:

1. In the SOC SECURITY field input the SS-DS payment of $1200

2. <TAB> to the PENSION field, beside the PENSION field enter the source of the pension

3. In the PENSION field input the PERS Public Employees Retirement System pension of $1500.00

4. <TAB> to the UNCOVERED MED EXPENSE and enter the allowed $140 deduction

5. <TAB> to the COMMENTS field and enter any comments (optional step)

6. <ENTER> to calculate the New Cost of Care Liability amount

7. If correct<ENTER> again to confirm

EIS Eligibility Information System COCA Cost of Care COST OF CARE SCREEN 020204 14:03 WORKER B CASE NAME: DOE, JOHN CASE NUMBER: 00024573 MONTH: 0304 CLIENT: JOHN D CLIENT NO: 0600055441 INCOME EXPENSE SOC SECURITY (SS) : 1200.00 PERSONAL NEEDS : 1656.00 SUPL SECURITY (SI) : INCOME TAXES : SENIOR BENEFITS : CHILD SUPPORT GARNISH : VETERANS ( VA ) : SPOUSAL MAINTENANCE : PENSION PERS Public Employees Retirement System : 1500.00 DEPENDENT MAINTENANCE : ANNUITY : INSURANCE PREMIUM : UNCOVERED MED EXPENSE : 140.00 EARNED INCOME : HOME MAINT (6 MO MAX) : ADULT PUBLIC ASSISTANCE : EXPENSE ADJUSTMENT : INCOME ADJUSTMENT : TOTAL INCOME : 2700.00 TOTAL EXPENSE : 1796.00 Comments: NEW COST OF CARE LIABILITY AMOUNT: 904.00 NEXT-->

Example 2: Jane Doe is currently eligible for Medicaid under the Special Long Term Care category and is receiving HCB Home and Community-Based Waiver Services. She lives in an assisted living home. Her monthly income consists of $1200 in SS-RE and $300 from an annuity for a combined monthly income of $1500. She has no expenses.

Step 1:

Input all demographic and income information

Step 2:

On the MERE Medical Reference :

"Input" the correct Medicaid Subtype AS and Eligibility Code

Step 3:

On the APA Adult Public Assistance METHOD MEDICAID ONLY AUTHORIZATION ( APMM ) screen:

1. <TAB> to the UNEARNED INCOME field and enter the combined unearned income

2. <ENTER>

3. Input PCN and REVIEW DUE DATE

4. <ENTER>

Step 4:

Upon <ENTER> the COCA Cost of Care screen will appear. On the COCA Cost of Care screen:

1. In the SOC SECURITY field input the SS-DS payment of $1200

2. <TAB> to the ANNUITY field, beside the ANNUITY field enter the source of the annuity

3. In the ANNUITY field input the $300.00

4. <TAB> to the COMMENTS field and enter any comments (optional step)

5. <ENTER> to calculate the New Cost of Care Liability amount

6. If correct<ENTER> again to confirm

EIS Eligibility Information System COCA Cost of Care COST OF CARE SCREEN 090204 14:03 WORKER B CASE NAME: DOE, JANE CASE NUMBER: 00024573 MONTH: 1004 CLIENT: JANE D CLIENT NO: 0600055441 INCOME EXPENSE SOC SECURITY (SS) : 1200.00 PERSONAL NEEDS : 1396.00 SUPL SECURITY (SI) : INCOME TAXES : SENIOR BENEFITS : CHILD SUPPORT GARNISH : VETERANS ( VA ) : SPOUSAL MAINTENANCE : PENSION PERS Public Employees Retirement System : DEPENDENT MAINTENANCE : ANNUITY : 300.00 INSURANCE PREMIUM : UNCOVERED MED EXPENSE : EARNED INCOME : HOME MAINT (6 MO MAX) : ADULT PUBLIC ASSISTANCE : EXPENSE ADJUSTMENT : INCOME ADJUSTMENT : TOTAL INCOME : 1500.00 TOTAL EXPENSE : 1396.00 Comments: NEW COST OF CARE LIABILITY AMOUNT: 104.00 NEXT-->

D. THE COCB SCREEN

The COCB screen provides a history of the cost of care for the case. This screen displays all months of benefits, including months that have auto-rolled. The only instance where the COCB will not show a benefit month is if a worker accidentally passed through the COCA Cost of Care screen without making any entries. To access the COCB screen:

<NEXT> to the COCB from the COCA Cost of Care or any EIS Eligibility Information System menu

Caseworkers can access a specific COCA Cost of Care screen directly from the COCB screen by:

1. Placing an X in the SEL (select) field by the benefit month

2. Pressing <ENTER>

IE002-I END OF DATA EIS Eligibility Information System COCB COST OF CARE BROWSE 020204 14:06 WORKER B CASE NAME: DOE, JOHN CASE NUMBER 0002457 SEL BEN MONTH COCA Cost of Care AMOUNT INCOME AMOUNT EXPENSE AMOUNT COMMENTS 03/04 904.00 2700.00 1796.00 02/04 844.00 2700.00 1856.00 03/00 712.83 1240.00 527.17 02/00 1713.98 2291.87 577.89 NEXT -->

Note: When the COCA Cost of Care displays from the COCB, the NEXT field will automatically display COCB.

E. MAKING RETROACTIVE COCA Cost of Care ADJUSTMENTS

Example 3: Retroactive Adjustment due to Reported Uncovered Medical Expense It is March 3, 2004 and Mr. Doe has submitted a podiatrist bill for $75 for services received on February 19, 2004.

Step 1:

Access the 0404 COCA Cost of Care screen and input the $75 in the Expense Adjustment field and <ENTER>

Step 2:

Upon <enter> EIS Eligibility Information System will update the COCA Cost of Care liability

Step 3:

Send notice to Mr. Doe explaining that his COC Cost-of-care for 0404 has been reduced due to the uncovered medical expense occurred in 0204.

Step 4:

Access the 0504 COCA Cost of Care screen and remove the $75 from the Expense Adjustment field and <ENTER>

Step 5:

Upon <ENTER> the COCA Cost of Care screen will update the COC Cost-of-care amount

Step 6:

Send a second notice to Mr. Doe explaining that his COC Cost-of-care liability will increase in 0504.

Example 4: Retroactive Adjustment due to Increased Income Mr. Doe receives Social Security Retirement. It is January 10, 2004 and the caseworker has just realized that the COC Cost-of-care was not adjusted with the increase in Social Security due to the cost-of-living adjustment. Mr. Does Social Security increased from $1200 to $1226.

Step 1:

Access the 0204 COCA Cost of Care screen and enter the new SS-RE amount of $1226.00 in the SOC Security field.

Step 2:

Enter the $26 of the missed Social Security for 0104 in the INCOME ADJUSTMENT field and <ENTER>

Step 3:

Send the COC Cost-of-care notice informing Mr. Doe that his 0204 COC Cost-of-care liability has increased due to Social Security adjustment

Step 4:

Access the 0304 COCA Cost of Care screen and delete the $26 from the INCOME ADJUSTMENT field and <ENTER>

Step 5:

Send a second notice explaining what the new COC Cost-of-care liability amount is beginning with 0304 benefits.

F. CONTACTING sYSTEMS SUPPORT

If COC Cost-of-care adjustments cannot be made within a four-month timeframe, contact Systems Support to adjust the COCA Cost of Care for earlier months.

When contacting Systems Support to make a change to the Cost of Care Liability, provide the following information for each month to be corrected:

All income information

All expense information

The corrected liability amount

Systems Support will email Policy to determine if the request is valid and can be approved. If the request is denied, Systems Support will email the ET who requested the correction.

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