Processing

Ensure that the AEM application is relatable to a Classic Medicaid program. These would typically include: Individuals age 65 or older and not a caretaker for a child under age 19; Individuals eligible for Medicare;

Complete the AEM Referral/Checklist in Barcode as follows: If not already provided, send a request for information letter to the individual for the required supporting medical documents on referral/checklist. If the individual is still hospitalized at time of application and after contact with the hospital, the discharge date cannot be determined, refer to HCA medical consultant with the following: Admission History and Physical (signed by the admission doctor); The most recent physician notes; and Note from the worker that the individual is still inpatient. Once all documents are provided, forward the referral/checklist and documents to the HCA medical consultant through the Barcode AEM Referral system. AEM applications cannot be approved until the HCA medical consultant has approved the AEM Referral. The HCA medical consultant can be contacted at: Health Care Authority Health Care Benefits and Utilization Management MS 45506 Telephone: 800-562-3022 FAX: 360-586-1471 All communication pertaining to an AMP referral should be made through the Barcode AEM Referral system. Once the AEM referral is returned by the medical consultant, follow the ACES manual on how to process.

Approval Source field

Leaving the Approval Source field blank will result in the AU being denied. This field should only be left blank for applications being denied when a Barcode referral to the HCA medical consultant is not appropriate

Noncitizen children eligible for CN coverage

Noncitizen children are eligible for full-scope CN coverage through MAGI through the end of the month in which they turn 19. Young adults age 19-21 who are hospitalized for over 30 days may be eligible for either MAGI based new adult coverage OR Institutional Family coverage using K03. If the individual meets these criteria and is NOT eligible for MAGI-based new adult coverage, refer to the HCA for a K03 eligibility determination. The individual will still have to meet the criteria in Section 2 above. Send an email indicating the individual needs AEM under the K03 program.

ACES calculates a certification period for the individual. Verify the certification period and adjust in ACES accordingly, using the coverage end date given by the HCA medical consultant. Certification periods for AEM: Cannot be more than 12 months for non-spenddown AUs; Cannot be less than 1 month or more than 6 months for spenddown AUs; Won't be synchronized with other related AUs; and Won't continue beyond the end date when a renewal request (for instance, in the case of dialysis or cancer treatment) is initiated or received but not completed.

Renewal processing

During renewal processing, the system won't auto-extend the certification period in order to sync up renewal cycles. For certification periods less than 60 days, ACES does not send out renewal forms or notices because the renewal cycle is not triggered.

Approval dates

If the approval dates span more than one calendar month, the certification period shown in ACES includes all months within the approval period. However, the certification period in ACES for AEM does not show the actual approval period in ProviderOne. Coverage in ProviderOne will be for the actual dates approved.

Approval periods

Approval period is 6/5/xx - 7/12/xx. The certification period is 6/1/xx - 7/31/xx; however, eligibility is only established from 6/5/xx - 7/12/xx. If this is a spenddown AU, the AU begin date would be the date spenddown is met, which could be no earlier than 6/5/xx.

When the HCA medical consultant-approved coverage period expires

Once the HCA medical consultant-approved coverage period has expired, a new application, referral checklist, and medical documentation are required.

If an AEM application is denied, update the approval source field under Alien Medical on the ALAS screen in ACES with "N". ACES will deny the AU with reason code 276 - No Medical Emergency, with auto text reading: "Your medical condition doesn't meet the emergency requirements." You will need to add the following free-form text: We have reviewed your application and you are not eligible for any HCA/DSHS medical program. You are not eligible for the Alien Emergency Medical Program because you did not receive medically necessary treatment for a qualifying emergency medical condition.