June 2018 CBMS Build Before We Get S tarted Let us know how we - PowerPoint PPT Presentation

June 2018 CBMS Build

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HCPF Projects

Reasonable Compatibility is required by Federal regulation. The Verification Plan outlines how it is used for both MAGI and Non-MAGI categories. & Reasonable Compatibility CBMS MA Updates to IEVS Proj ect #11206

What is Reasonable Compatibility? A method of verification used for Medical Assistance Programs that compares a clients' self-attested income against income provided by electronic data sources.

The Change

Changes Applying RC to Non-MAGI categories • Verifying income for Continuous Eligibility/Guaranteed • Programs Members will be allowed to reapply if they were • previously terminated due to IEVS hit CBMS Pages •

Reasonable Compatibility Threshold of 10% • Income S tandard Check and Reasonable compatibility threshold of 10% : • If the reported income and interface income are less than a 10% variance, income is considered to be reasonably compatible • If the reported income and the interface income are greater than a 10% variance, but still under the FPL, income is considered reasonably compatible.

Exceptions Income Trust • Patient Payments •

Knowledge Check Which categories of Medical Assistance will be checking for Reasonable Compatibility: MAGI • Non-MAGI • Both MAGI and Non-MAGI •

CBMS

Reasonable Explanation • The opportunity is given to an applicant to explain a discrepancy of more than 10% between self-declared income and income as reported by CDOLE.

Case Individual Page

Display on Individual Countable Income Eligibility Results

CBMS Reasonable Compatibility Page

Case Wrap Up - Additional Information .

Display Medical Eligibility Results Page

PEAK

PEAK • All members including Non-MAGI will now be able to update the Reasonable Compatibility in PEAK.

Closed Cases PEAK –

Warning Message

Client Correspondence

Client Correspondence

Interfaces

& CDLE Changes IEVS • Monthly request process will be changed to include all members on the case whose income would be used to determine eligibility. • Post the income received for each quarter even if the income is the same as prior quarter • End date the prior quarters income

Examples

Non-MAGI Results Client is not reasonably • compatible Self-attested Income = $1,010 monthly Given an ROP • IEVS discrepancy letter sent • Below QMB Income Standard ($1,025) Stays in QMB during ROP • IVES Report: No reasonable explanation $3,405 quarterly ($3,405/3 = $1,132) provided? Client rolls into SLMB (with • Above QMB Income Standard ($1,025) 10 day noticing) Below SLMB Income Standard ($1,226) Individual Individual Individual IEVS Difference Under to Reasonably MBU’s MBU’s amount in FPL% 10% Compatible? WAGE CDLE over or threshold? Budget’s net Budget’s under income net income Income standard? OAP $1,010 $1,132 Over 11% No No recipient 99% 110%

Results MAGI CBMS use IEVS reported income • (determine reasonable compatibility) Compare Mom & Dad’s income to • the income standard and FPL% for IVES Report: 07/07/2017 each individual Based on aid code and MBU size • Dad = $1,500 monthly In this scenario the household self- • Mom = $1,000 monthly reported amount and the total ------------------------------- income using the IEVS reported $800 $1,300 amount are under the income Total Countable Income standard for each member = $2,500 Income is Reasonably Compatible • even though the threshold is greater than 10% No ROPs created • Individual Individual Individual IEVS amount Difference Under to Reasonably MBU’s MBU’s over or under in FPL% 10% Compatible? WAGE CDLE Income threshold? Budget’s net Budget’s net standard? income income Total Countable Income: $2,100 $2,500 Mom $2,100 102% Under 19% No Yes * Eligible for Medical Assistance * 121% $2,500 Dad $2,100 102% Under 19% No Yes 121% Mom & Dad = MAGI Adult (133%; $2,726.60) $2,500 Child 1 $2,100 102% Under 19% No Yes 121% Children = MAGI Children (142%; $2,911.00) $2,500 Child 2 $2,100 102% Under 19% No Yes 121%

WAwd Self-attested Income = $1,010 monthly Employer’s CDLE = $1,500 monthly Discrepancy Letter sent to Member: Requesting explanation Member expected to: Work out discrepancy with employer • Provide verification • Results Because a person on the Working Adults with Disabilities (WAwD) is considered a household of one, no other household member will be considered for the WAwD calculation. If a discrepancy that is unresolved is over 450% of FPL, the member will receive a termination notice for being over income for the program and will be reviewed for every other Medicaid program as required by federal law.

CBwD A child receiving the Children with Disabilities Buy-In (CBwD) program: The entire countable family income reviewed for reasonable • compatibility through IEVS Example: Mom received a raise but has not reported it through PEAK • CDLE record reports more than 10% reasonable compatibility discrepancy Discrepancy letter sent to the family: Requesting explanation Family expected to: Work out the discrepancy with the employer • Provide verification • Results If the discrepancy is not resolved, the member will receive a premium change notice due to an increase in income and may receive an increased premium in the following month. If a discrepancy that is unresolved is over 300% of FPL, the child will receive a termination notice for being over income for the program and will be reviewed for every other Medicaid program as required by federal law.

Questions?

This proj ect is making updates to the logic for Psych <21, OAP Med Psych ≥65, and Incarceration to properly align with policy guidelines. Updates are needed to the living arrangement and housing situation logic, along with several preventative measures, to ensure that individuals are being placed into the appropriate category of Medical Assistance. MA Updates to Psych < 21 Psych ≥ 65 and Incarceration Updates Colorado Benefits Management System (CBMS) Proj ect #11668

The Change

What the Change Is Updates to the Individual Attributes Page • Modifications to the Field and Values for: • Living Arrangement ituation • Housing S

Medical Assistance (MA) Modifications • Psych < 21 • OAP- A MED ≥ 65 Ft. Logan • Colorado Mental Health Inst – Pueblo • Colorado Mental Health Inst – Ft. Logan • Involuntary Treatment Act in CMHI – • Involuntary Treatment Act in CMHI – Pueblo • Psychiatric Facility

Living Arrangements for Incarceration • Division of Youth ervices Corrections/ S • City/ County Jail tate/ Federal Prison • S • Wilderness Camp under Gov. Control • Work Release

Living Arrangements Living Arrangement Values • Inter Care Facility • Nursing Facility ervices • Division of Youth Corrections/ S • Psychiatric Facility

Division of Youth Corrections/ S ervices and Psychiatric Facility • Adult Financial • Colorado Works • Food/ Expedited Food Assistance

Knowledge Check What page in CBMS is being affected with this Build? Individual Demographics A. Medical Conditions B. Individual Attributes C. Individual Benefit D.

Knowledge Check What Field on the Individual Attributes Page will eligibility recognize as it relates to this training? ituation Housing S A. Living Arrangements B. ource (Living Arrangements) S C. Job Attached D.

Living Arrangements

Children under 10 The following living arrangements will no longer be selectable from the Living Arrangements field for a child under the age of 10 years old: ervices • Division of Youth Corrections/ S • City/ County Jail tate/ Federal Prison • S • Wilderness Camp under Gov. Control • Work Release

PEAK Change Where does this person live question ervices • Division of Youth Corrections/ S • Psychiatric Facility • Wilderness Camp under Gov. Control • Work Release

ituations Invalid Housing S • Psychiatric Facility • Work Release

Long-Term Care Value Update • Long-Term Care-LC • Long-Term Care-LT

Knowledge Check Psych categories will no longer be considered for clients that are incarcerated and they will only be eligible for limited benefits. True 1. False 2.

Knowledge Check Children under 10 may have a living arrangement of City/ County Jail. True 1. False 2.

Questions?

This proj ect addresses the termination of the Home and Community Based S ervices Children with Autism (HCBS CWA) Waiver effective June 30, 2018. CBMS HCBS CWA S unset Proj ect #11819

The Change

What is the Change unset • HCBS CWA S • No New Enrollments • Changes to Level of Care Page • Notice of Action (NOA)