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

June 2018 CBMS Build

• Let us know how we are doing!
• Your questions are not being ignored.
• Attendance tracking is not immediate.
• We are recording.
• The Build Guide and PPT are available!

Before We Get S tarted

HCPF Projects

CBMS MA Updates to IEVS & Reasonable Compatibility

Proj ect #11206

Reasonable Compatibility is required by Federal regulation. The Verification Plan outlines how it is used for both MAGI and Non-MAGI categories.

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.

PEAK – Closed Cases

Warning Message

Client Correspondence

Client Correspondence

Interfaces

IEVS & CDLE Changes

• 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

Self-attested Income = $1,010 monthly Below QMB Income Standard ($1,025) IVES Report: $3,405 quarterly ($3,405/3 = $1,132) Above QMB Income Standard ($1,025) Below SLMB Income Standard ($1,226)

Individual Individual MBU’s WAGE Budget’s net income Individual MBU’s CDLE Budget’s net income IEVS amount

• ver or

under Income standard? Difference in FPL% Under to 10% threshold? Reasonably Compatible? OAP recipient $1,010 99% $1,132 110% Over 11% No No

Results

• Client is not reasonably

compatible

• Given an ROP
• IEVS discrepancy letter sent
• Stays in QMB during ROP

No reasonable explanation provided?

• Client rolls into SLMB (with

10 day noticing)

MAGI

IVES Report: 07/07/2017 Dad = $1,500 monthly Mom = $1,000 monthly

• Total Countable Income

= $2,500

Total Countable Income: $2,100

Mom & Dad = MAGI Adult (133%; $2,726.60) Children = MAGI Children (142%; $2,911.00)

Results

• CBMS use IEVS reported income

(determine reasonable compatibility)

• Compare Mom & Dad’s income to

the income standard and FPL% for each individual

• Based on aid code and MBU size
• In this scenario the household self-

reported amount and the total income using the IEVS reported amount are under the income standard for each member

• Income is Reasonably Compatible

even though the threshold is greater than 10%

• No ROPs created

* Eligible for Medical Assistance *

Individual Individual MBU’s WAGE Budget’s net income Individual MBU’s CDLE Budget’s net income IEVS amount

• ver or under

Income standard? Difference in FPL% Under to 10% threshold? Reasonably Compatible? Mom $2,100 102% $2,500 121% Under 19% No Yes Dad $2,100 102% $2,500 121% Under 19% No Yes Child 1 $2,100 102% $2,500 121% Under 19% No Yes Child 2 $2,100 102% $2,500 121% Under 19% No Yes

$1,300 $800

WAwd

Self-attested Income = $1,010 monthly Employer’s CDLE = $1,500 monthly 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. Discrepancy Letter sent to Member: Requesting explanation

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

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. CDLE record reports more than 10% reasonable compatibility discrepancy Discrepancy letter sent to the family: Requesting explanation

Questions?

MA Updates to Psych < 21 Psych ≥ 65 and Incarceration Updates Colorado Benefits Management System (CBMS)

Proj ect #11668

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.

The Change

What the Change Is

Updates to the Individual Attributes Page

• Modifications to the Field and Values for:
• Living Arrangement
• Housing S

ituation

• Psych < 21
• OAP-A MED ≥ 65
• Colorado Mental Health Inst –
• Ft. Logan
• Colorado Mental Health Inst –

Pueblo

• Involuntary Treatment Act in CMHI –
• Ft. Logan
• Involuntary Treatment Act in CMHI –

Pueblo

• Psychiatric Facility

Medical Assistance (MA) Modifications

Living Arrangements for Incarceration

• Division of Youth

Corrections/ S ervices

• City/ County Jail
• S

tate/ Federal Prison

• Wilderness Camp under
• Gov. Control
• Work Release

Living Arrangements

Living Arrangement Values

• Inter Care Facility
• Nursing Facility
• Division of Youth Corrections/ S

ervices

• Psychiatric Facility

• Adult Financial
• Colorado Works
• Food/ Expedited Food Assistance

Division of Youth Corrections/ S ervices and Psychiatric Facility

Knowledge Check

What page in CBMS is being affected with this Build?

A.

Individual Demographics

B.

Medical Conditions

C.

Individual Attributes

D.

Individual Benefit

Knowledge Check

What Field on the Individual Attributes Page will eligibility recognize as it relates to this training?

A.

Housing S ituation

B.

Living Arrangements

C.

S

• urce (Living Arrangements)

D.

Job Attached

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:

• Division of Youth Corrections/ S

ervices

• City/ County Jail
• S

tate/ Federal Prison

• Wilderness Camp under Gov. Control
• Work Release

PEAK Change

Where does this person live question

• Division of Youth Corrections/ S

ervices

• Psychiatric Facility
• Wilderness Camp under Gov. Control
• Work Release

Invalid Housing S ituations

• 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

• nly be eligible for limited benefits.

1.

True

2.

False

Knowledge Check

Children under 10 may have a living arrangement of City/ County Jail.

1.

True

2.

False

Questions?

CBMS HCBS CWA S unset

Proj ect #11819

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

The Change

What is the Change

• HCBS

CWA S unset

• No New Enrollments
• Changes to Level of Care Page
• Notice of Action (NOA)

HCBS CWA S unset

• HCBS

CWA Waiver will terminate as of June 30, 2018

• Eligibility requirements will need to be met
• The Waiver can be end dated in CBMS

prior to the termination date

New Enrollments

• Enrollment is closed for HCBS

CWA

• Ongoing HCBS

CWA

• Additional information

Knowledge Check

When will the HCBS CWA Waiver end?

1.

July 1, 2018

2.

January 31, 2018

3.

June 30, 2018

4.

January 2, 2018

Knowledge Check

When will new enrollments for the HCBS CWA no longer be accepted?

1.

July 1, 2018

2.

January 31, 2018

3.

June 30, 2018

4.

January 2, 2018

CBMS Mass Update

CBMS Mass Update

• CBMS

Mass Update is scheduled to run June 10, 2018.

• The Mass Update will affect any

individual that has active HCBS CWA.

The Transition

• CBMS

will attempt to transition individuals to MAGI Child Continuous Eligibility (CE) effective July 1, 2018.

• The individual will be evaluated for all other higher

benefit categories before passing for MAGI Child CE.

• At redetermination the individual may remain on

MAGI Child without CE, move to another benefit category or terminate services.

LTC Level of Care Page

• Level of Care Type field
• CWA 0-5
• CWA in HCBS

Med S pans

• HCBS

CWA benefit category Med S pans

• Transition to MAGI Child CE
• Med S

pans will not be created for HCBS CWA

Notice of Action (NOA)

• Termination NOA will not be generated for HCBS

CWA when a Client transitions to another Medical Assistance (MA) category.

• When a Client terminates MA completely a termination

NOA will be generated.

• Effective July 1, 2018 an approval NOA will be

generated in the new category.

S cenario 1

An MA application dated 12/04/2017 is processed on 02/01/2018. The applicant is approved by a Case Management Agency for the waiver type of ‘CWA in HCBS’ as of 12/06/2017. The individual is approved for MA HCBS CWA on 12/06/2017. Additionally, the individual submits all required case verification.

Knowledge Check

What is the last month the applicant will be eligible for HCBS CWA?

A.

February 1, 2018

B.

December 4, 2017

C.

July 2, 2018

D.

June 30, 2018

MA Application date 12/4/2017 LOC Received 12/6/2017 Application Processed 2/1/2018

Knowledge Check Answer

What date will HCBS CWA terminate?

A.

February 1, 2018

B.

December 4, 2017

C.

July 2, 2018

D.

June 30, 2018

S cenario 2

An MA application dated 12/04/2017 is processed on 02/01/2018. The applicant is approved by a local Case Management Agency for the waiver type of ‘CWA in HCBS’ as of 12/05/2017. In addition, the individual is approved for MA HCBS CWA on 12/05/2017. The individual also submits all required case verification. On June 10th EDBC runs the case based on the mass update and will transition to an eligible category.

Knowledge Check

What begin date will the new Med S pan show after the mass update?

A.

January 2, 2018

B.

June 1, 2018

C.

July 1, 2018

D.

August 1, 2018

MA Application date 12/ 4/ 2017 LOC Received 12/ 5/ 2017 Application Processed 2/ 1/ 2018 EDBC runs Mass Update 6/ 10/ 2018

Knowledge Check Answer

What begin date will the new Med S pan show after the mass update?

A.

January 2, 2018

B.

June 1, 2018

C.

July 1, 2018

D.

August 1, 2018

S cenario 3

An MA application dated 12/ 04/ 2017 is processed on 07/ 02/ 2018. The applicant is approved by a local Case Management Agency for the waiver type of ‘ CWA in HCBS ’ as of 12/ 06/ 2017. The individual is approved for MA HCBS CWA on 12/ 06/ 2017. Additionally, the individual submits all required case verification. On June 10t h EDBC runs the case based on the mass update. This time on June 24t h, a Long-Term Care LOC for CHCBS in HCBS with a S tart Date of 7/ 1/ 2018 is entered into CBMS .

Knowledge Check

What will be the effective date of the CHCBS in HCBS Waiver go into effect?

A.

August 1, 2018

B.

December 4, 2017

C.

July 1, 2018

D.

June 24, 2018

MA Application date 12/4/2017 LOC Received 12/6/2017 Application Processed 2/1/2018 LOC w/start date 7/1/18 received 6/24/18

Knowledge Check Answer

What will be the effective date of the CHCBS in HCBS Waiver go into effect?

A.

August 1, 2018

B.

December 4, 2017

C.

July 1, 2018

D.

June 24, 2018

Post Implementation

Post Implementation

Additional action is needed to process applications:

• Dated prior to 6/ 30/ 2018 and,
• Received and or processed at the eligibility

site after 6/ 30/ 2018.

Post Implementation Actions

An MA application dated 12/ 04/ 2017 is processed

• n 07/ 02/ 2018. The application has a Long-Term

Care application is approved by a local Case Management Agency for the waiver type of ‘ CWA in HCBS ’ as of 12/ 08/ 2017. The MA HCBS CWA application is approved on 12/ 08/ 2017. All required verifications are received.

• End-User action necessary

Post Implementation Process

• A Help Desk Ticket is processed and a data fix is

completed in CBMS to add the Level Of Care (LOC) record of CWA in HCBS to the Long-Term Care (LTC) LOC page.

• EDBC is run
• Member is now CWA in HCBS

eligible

• Med S

pan 12/ 8/ 2017 to 6/ 30/ 2018

Continuous Eligibility Results

If they transition to MAGI Child, Med S pans will reflect:

• New Record:

Begin Date 07/01/2018 Primary Category: MAGI Children CE Indicator = Yes

Knowledge Check

An application dated 12/ 15/ 2017 was received 7/ 6/ 2018 approved for LTC with an approved LOC CWA in HCBS Waiver. What action will the Eligibility Technician need to take?

A.

Deny the case

B.

Request a new LOC

C.

Submit a HDT

D.

Nothing

Questions?

Thank You

For all June 2018 Build proj ects and further training opportunities, visit TrainColorado.com for more information.

Courses > CBMS Build Training > June 2018 CBMS Build

Responses to questions that were unanswered during this session will be posted in a Q&A document at the same TrainColorado.com location on June 22, 2018.