101.20 APPLICATION AND REVIEW SUMMARY CHART

ACTION POLICY REQUIREMENT PROCEDURAL REQUIREMENTS Filing an Application, Submitting a Renewal Form, and Reporting Changes Means of submission: • In-person at any location where eligibility staff are on official duty • By mail to the agency, RO or Central Office (CO) • By fax to the agency (RO or CO) • Applications may be submitted on- line at www.medicaid.ms.gov. • By telephone – The telephonic signature must be recorded. • Applications and renewal forms may be submitted online through the Common Web Portal Applications & Renewal Forms must be signed but an original signature not required. Telephone signatures are recorded versions. Who Can File an Application • Adult applicants • Certain minors (pregnant, married, living independently, applying for own children) • Parent with primary physical custody or either parent if true joint custody exists • Caretaker relative • Authorized, designated or legal representative If application filed by incorrect person, do not deny; get signature of correct person. Applications must be signed to be valid. Authorizing a Representative (types allowed) 1) Authorized Representative – applicant or recipient designates in writing. Can be a person or organization. Limits can be placed on rep’s rights to act. 2) Self-Designated Rep – must be an individual except for owner/operator of state owned MAGI application form used to designate authorized rep for MAGI cases. DOM- 302A required for ABD authorized rep. Self-Designated requires DOM-302B; ACTION POLICY REQUIREMENT PROCEDURAL REQUIREMENTS LTC facility. Rights are not limited. Applicant must be incapable of designating authorized rep. 3) Legal Rep – legally appointed by court or other legal document (such as POA) and must be legally authorized to make healthcare decisions for applicant/recipient. Can be an executor of deceased applicant’s estate. Legal rep requires DOM-302C. Filing Date of an Application The date a signed application is filed or received by the agency (RO or CO) by any means of submission for filing an application. The date received by DOM or the FFM is the date filed Medicaid Applications Filed Outside of DOM 1) SSI applications, 2) Children in the custody of DCPS who are certified as eligible by DCPS, 3) Medicaid or CHIP applications filed with the FFM and transferred to DOM, 4) LIS applications filed with SSA and transferred to DOM, 5) HPE applications filed with qualified hospitals and PEP applications filed with providers/entities and transferred to DOM. DOM determines eligibility for FFM, LIS, HPE, and PEP applications. RO with Responsibility RO that serves the county where at-home recipients live is responsible for the case. Long term care cases are handled by RO that serves the county where the facility is located. Combo MAGI/ABD cases with one in a facility is handled by RO ACTION POLICY REQUIREMENT PROCEDURAL REQUIREMENTS where facility is located. Timely Processing of Applications (SOP or Standard of Promptness) • 45 days for MAGI and ABD if no DDS decision needed. • Applications filed with FFM have a SOP beginning with date received by DOM; filing date is date filed with FFM. • 90 days for ABD if DDS decision needed. Days are counted from date of filing application to decision date, except those filed with FFM. Making an Eligibility Decision Verification of eligibility factors comes from data available from electronic data sources and/or the applicant. If data is unavailable from data sources or if applicant provided information is inconsistent, verify independently, which includes obtaining from applicant. Case documentation is required to support an eligibility decision. Use the Case Narrative or document within the case record. Issuing Requests for Information (RFI) ABD applications utilize a 307 (1st RFI) and 309 (2nd RFI). If additional time is requested, hold to end of allowed processing time period applicable. MAGI applications require direct contact 1st, then utilize a 307 (1st RFI). If additional time is requested, hold to end of 45 days. Refer to “Reasonable Efforts to Assist All Applicants” to avoid multiple denials of eligibility when the applicant is incapable, or rep is unwilling to provide needed information. Compliance After Denial If MAGI or ABD applicant fully complies by providing needed information by the end of the month following the month of denial, use denied application and application date and reinstate the application. ACTION POLICY REQUIREMENT PROCEDURAL REQUIREMENTS MAGI Application Indicates Possible ABD Eligibility If a MAGI applicant indicates possible disability, issue the ABD DOM-300 & request only information not available through MAGI process. A signed ABD application is required. If ABD application is not received, process the MAGI application. FFM applicants indicating disability are sent a non-MAGI letter that must be signed & returned to start ABD process. Determining Beginning Dates of Medicaid Eligibility If all factors of eligibility are met, the begin date is: • 1st of month of application, or • 1st day of the 1st, 2nd or 3rd month prior to the month of application. • QMB eligibility begins no earlier than the month following the month of approval. • HPE and PEP eligibility begins on the day of the month the hospital determines an individual to be eligible for HPE and providers/entities determine an individual to be eligible for PEP. Retroactive Medicaid does not have to be authorized at the time of application. It can be requested and added at any point in time. Determining Beginning Date of CHIP Eligibility • 1st of month following month of application eff. 12/01/2016 • If a newborn application is taken within 31 days of birth and approval is authorized within 60 days of application, CHIP eligibility is retroactive to the date of birth. There is no retroactive eligibility for CHIP eligible children, except newborns. Determining End Dates of Eligibility For Medicaid and CHIP, the end date of eligibility is either: • The last day of the month that eligibility ends, • The death date of the recipient, ACTION POLICY REQUIREMENT PROCEDURAL REQUIREMENTS • The date of entry into a public institution. • HPE and PEP ends the last day of the month of the HPE and PEP period or the actual day of the month that the full application for Medicaid is denied. Filling in the Gap for SSI Eligibles Missing months of SSI eligibility may be evaluated with the application for retroactive Medicaid or under a separate application at a future date. SSI payments begin the month following the month of application. The month of application is the E02 month. DOM covers the E02 month automatically since SSI determines the person eligible for the E02 month. Processing Applications & Renewals of DOM Employees & Family Members Medicaid or CHIP cases involving DOM employee family members may not be handled directly or indirectly by the DOM employee with the family relationship. Assigned Central office staff is responsible for processing applications and renewals. Ensuring Continuous Eligibility for Children under Age 19 Children determined eligible at the time of application and renewal are locked into a protected period of eligibility for 12-full months. Only a limited number of early termination reasons can interrupt the 12- months of continuous eligibility. Applies to both MAGI-related children and ABD children Ensuring Eligibility for the 1st Year of Life for the Deemed Eligible Infant An infant born to a Medicaid-eligible mother is eligible from the date of birth through the month the child reaches age one (13 months). Central Office staff inputs deemed eligible infant eligibility upon direct notification by ACTION POLICY REQUIREMENT PROCEDURAL REQUIREMENTS the birthing hospital. Assigning Review Due Month at Application MAGI – Medicaid application month starts the 12-month count. MAGI – CHIP benefit month starts the 12-month count. MAGI application month (Medicaid) or benefit month (CHIP) + 11 months = review due date. MAGI -Pregnant Post-Partum review will be set for 12 months after the pregnancy ends. ABD – month of supervisor authorization starts the 12-month count ABD authorization month + 11 months = review due date. Assigning Review Due Month at Redetermination MAGI and ABD are determined using the time period begin month to start the 12-month count. Begin month of time period + 11 months = review due date. Administrative Renewal Processing If eligibility can be approved in the same program (Medicaid or CHIP or ABD in the same COE) based on updated data from electronic data sources and reliable case record information, then the recipient is notified of the approval and asked to report any changes. Any changes reported are acted on as part of the redetermination process. ABD cases with an asset test can be renewed through this process. Adm. renewals must be initiated before scheduled mailings of pre- populated forms. Processing Renewals Using Pre-Populated Review Forms Pre-populated renewal forms are issued by MEDS for MAGI & ABD cases. Due date for return of the signed form MAGI and ABD form is 30- days from date form is issued. Returned forms with missing information require the use of a309 for ABD and telephone contact for MAGI. New or Refer to the Reinstatement policy for compliance after termination. ACTION POLICY REQUIREMENT PROCEDURAL REQUIREMENTS additional information requires use of 307 (MAGI) and 307/309 (ABD). Must attempt telephone contact prior to terminating (for MAGI and ABD) to try to secure missing information. Timely Authorization of a Renewal Review is timely if authorized by the last day of the month in which review is due. If case is closed, action to close must be authorized by the adverse action deadline date. Reviews are considered overdue if not authorized timely. Adverse Action Deadline(s) for Advance Notice Advance notice (10-days) is required to take an adverse action. The deadline is the 15th day of the current month (exception is February – deadline is the 13th) to allow 10- days advance notice plus 5-days mailing time. Adverse action must be authorized on or before the deadline date to be effective the following month. Advance Notice to Reduce or Terminate Benefits Advance notice is required to: • Terminate eligibility • Convert a case to a reduced services COE (QMB, SLMB, QI) • Terminate a nursing facility per diem payment • Switch from CHIP to Medicaid or Medicaid to CHIP Advance Notice = 15 full days following the date an adverse action is taken on a case. Medicaid Income increase is the exception. Advance Notice to Increase Medicaid Income Advance notice is 10-days before the date DOM makes its payment to the nursing facility, which is always in the month following the current month. Advance notice is 10 calendar days before the 1st of the following month for the change to be effective ACTION POLICY REQUIREMENT PROCEDURAL REQUIREMENTS in current month. Requirement for Ex Parte Reviews Any recipient losing eligibility in one COE must be reviewed under any/all available COE’s using existing information prior to terminating eligibility. If additional information is needed, allow a reasonable opportunity to provide additional information which may include a separate application form (ABD to MAGI & vice versa). If recipient is being terminated for failure to comply with the renewal process, an ex parte review is not applicable. SSI Terminations Due to Excess Income or Resources These types of SSI terminations are issued an SSI Redetermination Form for possible eligibility in a Medicaid COE. An abbreviated review form is issued by the system. Continuing eligibility is decided using the completed review form along with data on the SDX and SVES records. If additional information is needed, contact with the individual may be required. An SSI renewal is a type of ex parte review; however, all factors of eligibility must be verified. Renewal Processing MAGI and ABD renewals may be returned to the RO by any means allowed for submission of an application. Telephone renewals that are not recorded must be sent to the recipient for signature. Renewals and 12- Months of Continuous Eligibility for Children Children in a case may have different review due dates. Attempt alignment of review dates at the time of renewal if possible but continuous eligibility cannot be shortened (without a written request from the parent/caretaker). A new period of continuous eligibility can be assigned when Children require a full review at the end of their 12-month protected period of eligibility; future end dates ACTION POLICY REQUIREMENT PROCEDURAL REQUIREMENTS eligibility is reestablished for all HH members. are not permitted. Special Reviews due to Reported Changes Reported changes that result in a negative action for adult(s) in the case cannot affect eligibility for children in the case. Reported changes that will not affect eligibility for the household must be acted on, but do not terminate eligibility if a request for information yields no response. Children must be reviewed at the end of their 12-month review period; no future closure dates are permitted. Changes from CHIP to Medicaid must be acted on. Reported changes resulting in updated information on all household members can result in a new annual review period for the HH. Reinstatements Due to Failure to Issue Advance Notice If advance notice was not issued as required to reduce benefits or terminate eligibility, reinstate eligibility for all affected months then issue advance notice to terminate or reduce benefits. Reinstate regardless of whether HH or individual is eligible to remedy failure to issue advance notice. 90-Day Reinstatement Period for MAGI & ABD Compliance within 90-days following effective date of closure to return the signed renewal form and/or provide requested information will result in reinstatement back to the date of closure. If additional information is needed, attempt telephone contact 1st, then use 307 (MAGI/ABD) and 309 (ABD). • If information not provided, no further action required except to close the reinstatement contact & delete time period. This rule is not applicable for the return of unsigned renewal forms. ACTION POLICY REQUIREMENT PROCEDURAL REQUIREMENTS • If information provided & eligibility is established, approve reinstatement. • If information provided & ineligibility exists, cancel the reinstatement & set an application contact. Refer to policy for details. Corrective Action Requirements If corrective action adversely affects a recipient, handle via completion of an Improper Payment Report. If corrective action favorably affects a recipient, handle as a reinstatement back to the month the error occurred. There is no time limit imposed for corrective action.