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If the dates of service on the bill were during a transfer of property penalty period, the deviation request cannot be approved. Furthermore, if the member is currently in a transfer of property penalty period, a deviation is not allowable. See Section 2640.00.00 for additional information.

If the member has any Third-Party Insurances, including Medicare, who were not payors on the bill, verification from the insurer, which clearly documents the reason for non-payment, is required. Acceptable verifications include an Explanation of Benefits (EOB) documenting denial of payment or, in cases where the provider did not bill the insurer, documentation from the insurer showing that the specified services are not covered. If a member has Managed Medicare (also referred to as Medicare Advantage or Part C), the managed care entity will submit the EOB for Medicare billing. When documentation is missing or incomplete, the worker must send a written request which clearly advises the member, and their authorized representative(s) of the information needed and gives a deadline of 13 days from the date the request is mailed. The worker shall attach a copy of the submitted deviation request to the Pending Verifications for Applicants/Recipients (DFR Form 2032). If the member refuses or fails to provide the requested documentation within the designated 13- day period, the worker will, on the first day following the expiration of the 13-day period, mail a manual notice which indicates the reason for denial of the deviation request. Medicaid eligibility shall not be discontinued for failure to provide necessary documentation related to a deviation request. If the requested information is provided, and deemed valid, the worker will take appropriate action to process the liability deviation. A deviation request calculator is available for worker use in IEDSS Online Help under Resources. A liability deviation is calculated as follows: 1. Divide the total allowable expense amount by the member’s current liability amount to arrive at the length of the deviation. The number before the decimal is the total number of months where the member will have a $0 liability, also referred to as “whole months.” 2. Multiply the whole number of months by the member’s current liability amount to arrive at the amount of the expense that will be paid in the months with $0 liability. 3. Subtract the amount of expenses that will be paid in the whole months from the total allowable unpaid expense amount. The remaining amount of the expense will be used to reduce the liability for the final deviation month, also referred to as “partial month.” Liability deviations are processed according to change reporting guidelines and are regarded as a positive change. The effective date of the change is the first of the month following the month in which the change was both reported and verified. If the Eligibility System does not form the correct reduced liability of as of the first following month, then the case should be reviewed for a possible liability override or fiat. Refer to sections 2220.00.00 through 2220.20.00 for additional