101.15.03 ADMINISTRATIVE EX PARTE RENEWALS

An administrative ex parte renewal allows eligibility to be renewed based on reliable information contained in the case record and other more current information available to the regional office, such as current data secured from electronic data sources. • An ex parte review must be attempted on every client due for review. An ex parte review is required annually for SSI-only cases in Long Term Care in COE-005. SSI-only reviews must be completed, or, at a minimum, a redetermination contact must be registered, prior to the scheduled mailing of a pre-populated renewal form for the SSI-only case to prevent a pre-populated renewal form from being issued. For SSI-only reviews, the action needed is to verify the individual remains in the facility, check the SDX for any changes and attempt verification of any resources, such as a patient account or other type(s) of resources available to the SSI recipient. • An ex parte review is processed without contacting or requiring information from the household. If there is no known change in household circumstances and if all reported income types can be verified through available electronic data sources, use current income verification from these sources to renew eligibility. • When electronic data sources indicate a different employer for a household member than the previous year, an ex parte review is still possible if the income results in eligibility for a beneficiary. A change in employer is not a factor in determining eligibility for an ex parte review. • When a client is approved with zero income at application or full review, DOM can complete future reviews ex parte if no data is returned showing countable income at renewal. The client can be renewed ex parte up to 3 times before a full review is needed to get a new attestation of zero income. • Individuals with retirement benefits that are verified at initial application and remain the same for each payment period (month/quarter, etc.) can be renewed ex parte with notation in case narrative that the retirement/pension benefit is stable income and does not change. Individuals who draw retirement benefits that include an annual cost of living adjustment, such as state retirees from other states, are not candidates for ex parte review since their benefit will gradually increase each year. • FAM should be requested as part of the ex parte process for all resource based COEs. Give FAM 5 business days to return. If FAM does not return on a previously verified resource, the worker can use the amount from the last decision when completing the ex parte review. Document in case narrative that FAM did not return, and DOM is assuming no change in assets. Any FAM data returned following completion of the renewal must be documented and addressed if needed. • If all beneficiaries due for a review can be approved in the same or better program using current information verified through electronic data sources, the recipient is notified of the approval. A pre- populated renewal form is not generated for administrative ex parte renewals. • If an ex parte review does not result in an approval in the same or better program, a pre-populated form must be issued to allow the recipient to provide current information. It is possible to move a beneficiary from one Medicaid program to another Medicaid program that provides the same or better coverage based on an administrative ex parte review; however, a child cannot go from Medicaid to CHIP or CHIP to Medicaid. • If some household members due for a review can be renewed ex parte, but other household members due for a review cannot, a prepopulated form must be issued. The household members eligible for an ex parte review must be renewed ex parte when the review form is returned. If the form is not returned, the household members eligible for ex parte review still must be renewed ex parte. • If a recipient reports a change in response to an administrative ex parte renewal approval, document all changes on the “Administrative Review Contact Documentation” form located in the Appendix page by the same name. Attempt verification of a reported change through electronic data sources before requesting information directly from the recipient. • Handle reported changes as a redetermination contact in the system. The appropriate approval or denial notice will be issued based on the outcome of the reported change. Children may not be terminated or switched from Medicaid to CHIP due to a reported change after an ex parte review is completed. • Automated generation of pre-populated review forms take place on a schedule that is published annually and is based on the review due month. Ex parte renewals must be registered as a redetermination contact with a time period pending before the scheduled generation of a pre-populated form. Medicare cost-sharing cases marked “Yes” under “reduced Coverage Adm Review Criteria Met” on the RJ831 and RJ831w will not have an automated prepopulated review form mailed by MEDS. These cases will require a manual prepopulated form to be mailed if an administrative ex parte review cannot be completed. Every regional office must have a process in place to ensure ex parte administrative renewals are attempted as required prior to the scheduled mailing date for the system to issue a pre-populated review form.