Procedures

Follow the steps below to determine ABD Medicaid eligibility under the NOW/COMP COA.

Step 1 Accept the A/R’s application, the Form 1008, NOW/COMP Communicator, and approved LOC instrument After April 1, 2003, DMA-6s will no longer be completed by GMCF/Alliant but by private vendors contracting with Mental Health. Instead of an actual DMA-6, it will be a mailer containing pertinent information. A new LOC instrument is required upon entry into NOW/COMP Step 2 If the A/Rs income includes SSI, STOP, deny application. SSI NOW/COMP A/Rs' claims are directly billed to DCH through the NOW/COMP agency. Step 3 If the A/R is institutionalized or resides in the community, and is ABD Medicaid eligible, schedule a review when information is received from the Support Coordinator or provider. Proceed to Step 6. Step 4 If the A/R is institutionalized or resides in the community, and is not currently eligible for Medicaid, schedule an initial interview when information is received from the Support Coordinator or provider. Step 5 Determine basic eligibility. Refer to Chapter 2200, Basic Eligibility Criteria. Step 6 Determine financial eligibility. Refer to 2500 ABD Financial Responsibility and Budgeting Overview . Complete a Medicaid Cap Budget to determine income eligibility. Refer to 2510 Medicaid Cap Budgeting . Step 7 Determine if the Length of Stay criteria is met. Refer to 2235 Length of Stay for ABD Medicaid . Step 8 The system will determine the A/R’s Cost Share for NOW/COMP services. Refer to 2559 Patient Liability / Cost Share Budgeting e. The PNA is the same amount as the Medicaid Cap. Step 9 Approve if the A/R meets all eligibility criteria. Do not approve Medicaid under the NOW/COMP COA for any month prior to the month of either the NOW/COMP Enrollment Date or Date Services Begin listed on Form 1008, NOW/COMP Communicator, or prior to 2/1/94, the effective date of the NOW, or 10/1/97, the effective date of the COMP amendment. Step 10 Complete Section III of Form 1008, NOW/COMP Communicator. Enter the Medicaid number at the top of the form. Send to the originating I & E Team with a copy to the Regional Office (as noted on Form 1008). A list of Regional Office addresses and the counties they serve is found at the end of Section 2132. The I & E Team will complete the return address for the I & E Team and the Regional Office. File a copy in the case record. The NOW/COMP Communicator is used to provide required information to the NOW/COMP agency. If the NOW/COMP agency is listed as AREP in Gateway to receive the required notices, it is not necessary for the DFCS case worker to also complete and return the NOW/COMP Communicator. Step 11 Notify the A/R and any authorized representative of case disposition.