501 - BCCP



TOC \o "1-2" \h \z 702.01Introduction PAGEREF _Toc83970012 \h 2702.02Protected Eligibility PAGEREF _Toc83970013 \h 2702.02.01Benefits Ended in Error During Emergency Period PAGEREF _Toc83970014 \h 7702.02.02Families First Act Extension Notice - Manual Notice for Extension of Benefits PAGEREF _Toc83970015 \h 7702.03Temporary Procedures for Pending Applications PAGEREF _Toc83970016 \h 8702.04Special Income Counting: Coronavirus Aid, Relief, and Economic Security (CARES) Act PAGEREF _Toc83970017 \h 9702.04.01Unemployment Insurance (UI) Compensation PAGEREF _Toc83970018 \h 9702.04.02Relief Payment to Individuals and Families Provided by the CARES Act PAGEREF _Toc83970019 \h 10702.05Electronic Document Submission and Signature Requirements PAGEREF _Toc83970020 \h 10702.05.01Electronic Document Submission PAGEREF _Toc83970021 \h 10702.05.02Electronic Signatures PAGEREF _Toc83970022 \h 10702.05.03Authorized Representatives PAGEREF _Toc83970023 \h 11702.05.04Admission and Billing Documents for Long Term Care PAGEREF _Toc83970024 \h 11702.05.05Admission and Billing Documents for Medicare Skilled Nursing Home PAGEREF _Toc83970025 \h 11702.05.06Level of Care for Initial COVID-19 Admission PAGEREF _Toc83970026 \h 12702.06Property and Probate Search Procedures During the COVID-19 Emergency Period PAGEREF _Toc83970027 \h 12702.07COVID-19 Limited Benefit Eligibility Group PAGEREF _Toc83970028 \h 15702.07.01Benefit Effective date PAGEREF _Toc83970029 \h 16702.07.02Eligibility Criteria PAGEREF _Toc83970030 \h 16702.07.03COVID-19 Limited Benefit Group Eligibility Processing PAGEREF _Toc83970031 \h 17Appendix ALinks to Important Reference Documents PAGEREF _Toc83970032 \h 18Appendix BCARES Act Update – Income Calculations for Medicaid PAGEREF _Toc83970033 \h 19Appendix CNon-MAGI and LTC Review Scenarios PAGEREF _Toc83970034 \h 20702.01Introduction(Eff. 03/18/20)The Family First Coronavirus Response Act, enacted on March 18, 2020, provides health provisions in response to the COVID-19 national public health emergency. This legislation provides provisions for coverage of testing for COVID-19 for uninsured individuals, as well as eligibility protections for the duration of the emergency. These provisions are in effect from the enactment date of the law and ends on the last day of the month in which the emergency period ends.702.02Protected Eligibility(Eff. 04/01/22)Per Section 6008 (b)(3) of the Act, the State must provide that “an individual who is enrolled in benefits under such plan (or waiver) as of the date of enactment of this section or enrolls for benefits under such plan (or waiver) during the period beginning on such date of enactment and ending the last day of the month in which the emergency period described in subsection (a) ends shall be treated as eligible for such benefits through the end of the month in which such emergency period ends unless the individual requests a voluntary termination of eligibility or the individual ceases to be a resident of the State.”NOTE:These guidelines apply to beneficiaries with active coverage, regardless of whether changes are submitted as a change of circumstance or on an application form. These guidelines do not apply to new applications for which eligibility has not yet been established for anyone in the household. These guidelines also do not apply to beneficiaries that were not “validly enrolled” due to eligibility worker error or fraud (after an investigation).Effective immediately, eligibility is protected for any beneficiary who is eligible for SC Medicaid in any payment category on March 18, 2020, or who become eligible on or after this date. The protected period will last until the end of the month in which the emergency period expires, regardless of changes in family income or other circumstances. The expiration date for the Act is not known at this time.This includes individuals at risk of losing eligibility due to a change in categorical eligibility (such as a child aging out or a pregnant woman at the end of her post-partum period). The individual must remain in their current payment category until the case can be reassessed, following the end-date (TBD) of the emergency period.The following exceptions apply:The individual diesThe individual requests a voluntary termination of eligibilityThe individual is no longer a resident of the state Do not close based on PARIS report during this emergency period. Only close if requested by the beneficiary or an Authorized Representative.The individual’s coverage is closed to complete a system of record (SOR) change (MEDS to Cúram or Cúram to MEDS)The individual’s coverage is closed to resolve a duplicate Person Record in Cúram The individual’s coverage is closed if they were initially approved due to worker error or fraud (after an investigation)The individual’s coverage is reduced from full benefits to emergency services due to the agency receiving verification that proves the individual is neither a citizen nor a qualified immigrantAt the end of the post-partum period, the coverage for a lawfully present pregnant woman subject to the 5-year/40 quarter bar can change. If she meets the criteria for a full Medicaid category, she can be approved for Emergency services only, or her eligibility ended if she is ineligible. The coverage for a lawfully present child who is subject to the 5-year/40 quarter bar can be changed when the child turns age 19. If the child is eligible for an adult Medicaid category, coverage can be approved for Emergency services only, or eligibility ended if ineligible.Refer to the Processing MAGI Reviews in Cúram During COVID-19 Emergency Period in Appendix A for how to process reviews during the COVID-19 public health emergency period.If in MEDS and no action was taken on the case:No Contact in Pathos- Due date for requested information has not passed; andDocument in System of Record and Documentation Template so case can be evaluated at the end of the emergency period.IMPORTANT: If it is determined that a beneficiary is not validly enrolled due to worker error or fraud (after an investigation), coverage can be reduced or ended after giving the appropriate adverse action notice. If an eligibility specialist closes a beneficiary’s coverage in Cúram for a valid reason during the Public Health Emergency, the reason code, “Moved State/Country” must be used to prevent the case from reopening. The eligibility specialist should also explain the reason for closure on the Notes screen and the Documentation Template, suppress the system-generated closure notice, and send the beneficiary a manual closure notice with the proper closure reason.Inmate CoverageIf the individual becomes an inmate of a public institution, the eligibility specialist must add the “I” system indicator to reflect inmate status. However, the individual must remain in their current payment category (e.g. PCR, ABD, etc.)Assumptive Pregnant Woman Eligibility and Deeming InfantsDuring the emergency period, if a woman is approved assumptively for Pregnant Women coverage and eligibility cannot be verified for a full determination, the beneficiary’s eligibility must continue until the end of the emergency period. Document in the System of Record and on Documentation Template and send to follow-up in OnBase for six (6) months.During the emergency period, if a child is born while the mother is still only assumptively approved for Pregnant Women coverage and a full determination is not possible at that time, the infant should still be deemed for eligibility.COVID Manual Eligibility End-Dates Refer to the following to maintain eligibility during the Public Health Emergency when re-opening cases or continuing eligibilityCúram:End-date for Certification Period: 9/30/22 (This date will continue to be adjusted as the PHE continues.)MEDS:Leave Next Review Date blank if possible. If a date must be added, set NRD to 1 year from date of action.MAGI ConsiderationsIf eligibility for an existing HH is going to be negatively impacted by a change of circumstance, the coverage must be extended using the COVID Manual Eligibility for Re-Opening Cases job aid in Appendix A.Level of coverage for beneficiaries may be increased during the review process. (e.g. FP to PW) A beneficiary can be moved from a full coverage category to another full coverage category. (e.g. PCR to TMA)At the end of the post-partum period, the coverage for a lawfully present pregnant woman subject to the 5-year/40 quarter bar can change. If she meets the criteria for a full Medicaid category, she can be approved for Emergency services only, or her eligibility ended if she is ineligible. The coverage for a lawfully present child who is subject to the 5-year/40 quarter bar can be changed when the child turns age 19. If the child is eligible for an adult Medicaid category, coverage can be approved for Emergency services only, or eligibility ended if ineligible.If a beneficiary is not currently eligible after completing a review or change of circumstance and the beneficiary was initially approved incorrectly due to worker error or fraud (after an investigation), end coverage after giving the appropriate adverse action notice.Non-MAGI ConsiderationsMaintain eligibility regardless of change of income or addition/removal of HH members. If a beneficiary is not currently eligible after completing a review or change of circumstance and the beneficiary was initially approved incorrectly due to worker error or fraud (after an investigation), end coverage after giving the appropriate adverse action notice.LTC ConsiderationsThis does not apply to changes in cost of care and vendor payment.Continue to respond to changes that impact cost of care, including income, insurance premiums, etc. Vendor payment will be terminated if person is no longer receiving services or leaves the facility. Medicaid eligibility is not to be closed.If a person moves from NH to Waiver, or vice versa, standard procedure must be followed, and the individual moved to the appropriate PCAT once enrolled/admitted.If processing a Cost of Living Adjustment, re-budget for the COLA but do not process the review. Refer to the Resource Transfer Procedures below if there is a resource transfer that results in a transfer penalty.Resource Transfer ProceduresNew Nursing Home ApplicationsCalculate the Resource Transfer penalty period, including the start and end datesApprove Medicaid eligibilityIf the penalty period is 12 months or less, put the case into follow-up so that it will enter workflow at the end of the penalty period.When the case enters workflow, rebudget the case to start the vendor paymentIf the penalty period is greater than 12 months, do not put into follow-up.New Nursing Home Applications with Income TrustCalculate the Resource Transfer penalty period, including the start and end datesApprove Medicaid eligibilityIf the penalty period is 6 months or less, put the case into follow-up so that it will enter workflow at the end of the penalty period.When the case enters workflow, rebudget the case to start the vendor paymentIf the penalty period is greater than 6 months, put the case into follow-up for 6 monthsFuture action will be determined based on the status of the Public Health Emergency (PHE)Note:For Income Trust application approvals with a penalty, the applicant would be approved for Medicaid, but no vendor payment. Medicaid eligibility will remain open for Income Trust beneficiaries throughout the Emergency Period rather than approving for the initial monthly only to start a penalty periodExisting Nursing Home eligibilityCalculate the Resource Transfer penalty period, including the start and end datesDo not terminate Medicaid or Vendor Payment eligibilityIf the sanction period begins before the start of the public health emergency (PHE), submit an overpayment summary only for the time period before the start of the PHEExample: In June during the PHE, it is discovered Joe Leffler transferred his home in October 2019. The penalty period is calculated as 12 months. An overpayment summary is completed for the period from October 1, 2019, through March 16, 2020, before the start of the PHE.If the end date for the penalty period is more than 3 months from the current date, place the case into 6-month follow-upWhen the case comes back into workflow, determine if the sanction period expired before the PHE endedIf the sanction period ended before the end of the PHE, no additional action is neededIf the sanction period is still in effect at the end of the PHE, take action to submit an overpayment summary beginning with the end of the PHE, and if appropriate, terminate the vendor payment based on adverse action rules.Example: Peter Armstrong’s case comes back into workflow on October 20, 2020. Mr. Armstrong’s penalty period will end January 1, 2021. The PHE ended on August 31, 2020. Mr. Armstrong’s case will be terminated effective November 30, 2020. An overpayment summary will be completed for the period beginning September 1, 2020 through November 31, 2020.Existing Waiver eligibilityCalculate the Resource Transfer penalty period, including the start and end datesDo not terminate Medicaid or Waiver servicesIf the sanction period begins before the start of the public health emergency (PHE), submit an overpayment summary only for the time period before the start of the PHEExample: In June during the PHE, it is discovered Joe transferred his home in October 2019. The penalty period is calculated as 12 months. An overpayment summary is completed for the period from October 1, 2019, through March 16, 2020, before the start of the PHE.If the end date for the penalty period is more than 3 months from the current date, place the case into 6-month follow-upWhen the case comes back into workflow, determine if the sanction period expired before the PHE endedIf the sanction period ended before the end of the PHE, no additional action is neededIf the sanction period is still in effect at the end of the PHE, take action to submit an overpayment summary beginning with the end of the PHE, and if appropriate, terminate Medicaid and waivers based on adverse action rules. Specialty ConsiderationsRefugee beneficiaries should remain in their current payment category, even if their eligibility period has ended.702.02.01Benefits Ended in Error During Emergency Period(Rev. 04/17/20)If benefits have been ended in error for a beneficiary during the Emergency Period, the case must be re-opened immediately.INSTRUCTIONS FOR RE-OPENING A CLOSED CASEIn MEDS:On ELD01, type 100 over the closure code. If the Budget Group has been closed for over 30 days, a new Budget Group will need to be created in order to restore coverage for the beneficiary.Press the Home button on the keyboard and Modify (MOD) the action.If error message is received, submit a Service Manager Ticket for a MEDS correction.In PathOS, put case in Finish Later.Wait for a response on the ticket.HelpDesk may ask you to open a new budget group. Respond as directed.Document in MEDS and on the documentation template:“Eligibility re-opened due to Families First Coronavirus Response Act.”MEDS scenarios for which you would need to submit a Service Manager ticket:When recipient your trying to re-open is in an active budget group. Recipient is eligible in a limited benefit budget group but was eligible in a full benefit budget group that closed for 04/01/2020 or after. A deceased member is listed in the closed budget group that you need to re-open.In Cúram:Use Manual Eligibility to restore benefits using the Manual Eligibility Job Aid.Document in Cúram and on the Documentation Template: “Eligibility re-opened due to Families First Coronavirus Response Act.”Cúram scenarios for which you would need to submit a Service Manager ticket:After updating evidence and applying changes the eligibility is incorrect.When the Insurance Affordability Case has been closed.If there is overlapping coverage after changes have been applied.702.02.02Families First Act Extension Notice - Manual Notice for Extension of Benefits(Rev. 04/17/20)The Families First Act Extension Notice is available upon request, for beneficiaries whose benefits have been ended or reduced in error but then re-opened due to the Families First Coronavirus Response Act. The notice template can be found at Families First Act Extension Notice.If a beneficiary or Authorized Representative requests a notice to indicate why benefits were restored, enter the beneficiary information on the manual notice using the fillable fields on the form. Upload the notice into OnBase and send the notice to the beneficiary and their Authorized Representative(s) if applicable.702.03Temporary Procedures for Pending Applications(Rev. 04/01/22)Prior to sending a DHHS Form 1233, Medicaid Eligibility Checklist, an Eligibility Specialist must attempt to call the applicant/AR to:obtain missing information, clarify what is still needed, attempt three-ways calls with 3rd parties, and answer questions.Central eligibility is not required to complete a collateral call attempt pending and mailing out the DHHS Form 3400-A Addendum for MSP/QI electronic applications received from the Social Security Administration.If a checklist has been sent before and new information is needed, any calls made for the first checklist do not count towards the call attempts for the new request.Prior to attempting to call the Applicant/AR, review System of Record and Documentation Template for documentation that may help with the determination as well as documentation of previous call attempts.Determine whether the applicant has called the Member Services Contact Center (Conduent) and what resulted. Review the casefile to make sure required documentation has not already been received.Call ProceduresAttempt to call the applicant/AR. Note: If you do not reach the person on the initial call, follow current procedures, and leave a message that you will follow up with another call in 5 minutes. Do not put the case in "finish later" while waiting the 5 minutes. The initial and follow-up calls are part of the same attempt.Exhaust all options for obtaining needed information if you cannot reach the applicant. Attempt to call any legal representatives (such as a POA) or Authorized Representative(s) with proper documentation in the record. (Note: This is part of the same attempt, not a separate attempt.) If the applicant has multiple authorized representatives listed, call each one until you have spoken to someone or cannot reach anyone.If the applicant and any legal representatives or Authorized Representatives cannot be reached, send the checklist(s) at this time.Document each attempted call in the SOR and in the General Comments section on the Documentation Template. Record all calls on the same day as part of one entry. Attempted to call applicant/AR. Provide details of the person(s) called, why, and result. The attempt may include phone calls to several individuals if the applicant has more than one Authorized Representative. Document each contact as appropriate. If the call is successful and needed information could not be obtained during the collateral call, then:Send DHHS Form 1233 checklist to the applicant and each of the authorized representatives. Send case to follow up in OnBase for a total of 21 days (15 days + 6 days to allow for scanning).If the call is NOT successful, then Leave a voice message according to current process. Send DHHS Form 1233 checklist to the applicant and each of the authorized representatives. Send case to follow up in OnBase for a total of 21 days (15 days + 6 days to allow for scanning).702.04Special Income Counting: Coronavirus Aid, Relief, and Economic Security (CARES) Act(Eff. 4/17/20)702.04.01Unemployment Insurance (UI) Compensation(Eff. 4/17/20)The Coronavirus Aid, Relief and CARES Act makes several changes to Unemployment Insurance (UI) in response to the COVID19 public health emergency. Section 2104 provides that, under the Federal Pandemic Unemployment Compensation program, eligible individuals who are collecting certain UI benefits, including regular unemployment compensation, will receive an additional $600 in federal benefits per week for weeks of unemployment ending on or before July 31, 2020.Unemployment benefits are typically countable income under both Modified Adjusted Gross Income (MAGI) and non-MAGI financial methodologies. However, section 2104(h) of the CARES Act states: “The monthly equivalent of any Federal pandemic unemployment compensation paid to an individual under this section shall be disregarded when determining income for any purpose under the programs established under titles XIX [the Medicaid program] and title XXI [the CHIP program] of the Social Security Act.”When making an eligibility determination, the worker must disregard the $600 weekly Pandemic Unemployment Compensation (monthly equivalent of $2,580) in determining underlying income eligibility for both Medicaid and CHIP. This includes post-eligibility treatment-of-income.If the worker is unclear about whether attested UI income and/or UI income verified by electronic data sources includes the Federal pandemic unemployment compensation paid to the applicant, the worker must reach out to the applicant to verify this information. First attempt to clarify via collateral call with the applicant. If collateral call attempts are not successful, send a DHHS Form 1233 checklist to request clarification.702.04.02Relief Payment to Individuals and Families Provided by the CARES Act(Eff. 4/17/20)Section 2201 of the CARES Act allows a refundable tax credit for 2020 to eligible individuals. It also directs the Internal Revenue Service to provide payments in 2020 as an advance refund of the credit to eligible individuals, called “Recovery Rebates.”MAGI DeterminationsThe payments are not taxable income and are therefore not countable in MAGI-based eligibility determinations.Non-MAGI Determinations26 U.S.C. § 6409 prohibits the counting of federal tax rebates or advance payments with respect to refundable tax credits as income, and, for 12 months following receipt, resources, in the eligibility determination of any federal needs-based program (such as Medicaid).The payments may not be counted as income, and for 12 months cannot be counted as resources, in non-MAGI financial eligibility determinations. 702.05Electronic Document Submission and Signature Requirements702.05.01Electronic Document Submission(Eff. 05/01/20)Applicants, beneficiaries, authorized representatives, and third parties providing application assistance are now encouraged to submit documents electronically to SCDHHS using the email address 8888201204@fax.. For third parties assisting multiple individuals, a separate secure email must be sent for each applicant or beneficiary. The secure email must include the applicant or beneficiary’s name, phone number, date of birth, Medicaid number (if applicable), and Social Security number. 702.05.02Electronic Signatures (Eff. 05/01/20)The South Carolina Department of Health and Human Services (SCDHHS) has modified the eligibility signature policy in recognition of the current challenges in obtaining physical signatures from individuals during the COVID-19 emergency response period. An applicant, or a person authorized by SCDHHS policy to apply on behalf of an individual, may “sign” an application by typing the name on the signature line and completing the “Is someone helping you fill out this application?” section of the form. This signature will be considered valid and will commit the person completing the document to the penalty of perjury if signing under false pretenses or if false or inaccurate information is provided. All current policies regarding applicant rights and responsibilities are still applicable.702.05.03Authorized Representatives(Eff. 05/01/20)If the applicant wishes to designate an Authorized Representative but is unable to sign the appropriate form (DHHS FM 1282), the form allows for an individual to sign on someone’s behalf. The reason the applicant cannot sign the form must also be entered as instructed on the form.702.05.04Admission and Billing Documents for Long Term Care(Eff. 05/01/20)The following forms have been modified to allow the Eligibility Specialist to enter an electronic signature for documents sent to a provider or the OSS Program Area. DHHS Form 181, Notice of Admission, Authorization & Change of Status for Long Term Care, and DHHS Form CRCF-01, Optional State Supplementation (OSS) Slot Reservation Request & Notice of Admission, Authorization & Change of Status for Community Residential Care FacilityUse this feature when printing is not available so that documents can be sent timely. If emailing documents to a facility, be sure the documents are sent via secure email by entering “[secure]” in the subject line of your email.702.05.05Admission and Billing Documents for Medicare Skilled Nursing Home(Eff. 06/01/20)During the COVID-19 period, CMS has waived Medicare requirements that skilled nursing facility (SNF) care can only be reimbursed when a beneficiary has met at least three consecutive inpatient hospital stay dates.DHHS Form 181s with a SNF admission received from a NH facility during the duration of the Public Health Emergency period will not contain hospital stay dates. Facilities may/may not indicate in the comments “no hospital stay dates” on such 181s. For Active PCAT 10 or 33 recipients, workers should process the SNF 181 without further verification of hospital stay dates from the facilities during the emergency period. For Approvals of PCAT 10/33 cases, worker must reach out to the facility and/or AR to determine if the individual was in a community setting at any time during the month of admission to a nursing facility as per MPPM 304.18.02.702.05.06Level of Care for Initial COVID-19 Admission(Eff. 09/01/20)In response to a CMS waiver, SCDHHS has amended the current Level of Care (LOC) and Notice of Admission, Authorization, and Change of Status for Long Term Care, DHHS Form 181, policies as followed:The initial Level of Care, DHHS Form 185, will still be completed by CLTC upon admission to the nursing facility during the COVID-19 emergency period. However, the facility will change the LOC to Medicare (Medicare Spell of Illness) for individuals who will remain in the facility under observation or quarantine due to COVID-19. When the individual needs to convert back to Medicaid, the facility must reassess if the individual meets Intermediate or Skilled LOC.?The new LOC will be completed and documented by the facility on the DHHS Form 210, Resident Case Mix Classification Change.?The facility will complete a Medicaid Conversion Form 181 with “COVID” or “CVD” written in the top right-hand corner or Section II under comments, indicating it to be a COVID-19 related case. These forms will be sent to Medicaid Eligibility to be processed by an LTC eligibility worker.?702.06Property and Probate Search Procedures During the COVID-19 Emergency Period(Rev. 08/01/20)The following procedures for Property and Probate searches must be followed during the COVID-19 Emergency Period for pending institutional applications only that require a 5-year look backProcedureResearch the followingReview the application to verify where the applicant/spouse has lived in the last 5 years and if any property ownership has been alleged.Review the case history for any previous applications, information, and documentation to determine if property ownership was alleged and/or verified in the past.Research the county/counties where the applicant/spouse has lived in the last 5 years to determine if a deed search is accessible online. If so, follow the normal procedures for uploading and documenting the verification(s).Determine if current property and deed searches are accessible online for current county of residence and any counties where the applicant alleges property or lived for long periods of time.South Carolina: refer to the Property Search Contact Information spreadsheet in SharePoint. All other states: follow the normal procedures of searching online via Netronline () Refer to MPPM Chapter 104, Appendix H.Register of Deeds – Clerk of CourtIf a deed search is not available online, send a 1255 directly to the county Register of Deeds (or Clerk of Court) office AND complete the following procedures (DO NOT wait for Form 1255 to be returned)County Treasurer’s OfficeResearch the county treasurer’s office website using the information that is available in the file (current and history) to determine if the applicant/spouse paid taxes on any property in the last 5 years.Verify each tax year of the 5-year look back (if the site allows the search by year option).Document in the “Look-Back” section of the template of each county searched and the search result(s):If no property is found, document the tax year(s) and include, “No property found”.If property is found:Document the tax year(s) and the tax information (TMS, address, type of property, etc.)If the applicant/spouse is no longer paying taxes, document the tax year the applicant/spouse no longer paid taxes on the property and/or property was no longer in the applicant/spouse’s name.County Assessor’s OfficeResearch the county assessor’s office website to determine if ownership changed from the applicant/spouse during the 5-year look back:Search by applicant/spouse’s name and search the last known addressDocument in the ‘Look-Back’ section of the template of each county searched and the search result(s):If no property found, document the tax year(s) and “No property found”. If property is found:Document the date the ownership was deeded to another person if it occurred during the 5-year look back and include the property details (TMS, address, type of property, etc.)For discrepancies in online search resultsConduct a collateral call to the county Register of Deeds office to verify if there are/were any deeds for the applicant/spouse in the last 5-years.If Register of Deeds indicates a deed of transfer took place during the 5 year look back period, document on the template the details (TMS#, date of transfer, Grantor/Grantee, amount received, etc.) and verify the tax value at the time of the transfer.Conduct a collateral call to the applicant/AR to discuss findings and obtain clarification as to the circumstances surrounding the transfer and explain the potential transfer penalty and possible exceptions. (see MPPM 304.09.03).Send a DHHS Form 1233 to the applicant to obtain any necessary documentation concerning the transfer as discussed during the collateral call.Seek supervisor’s assistance:The supervisor will determine if the agency should wait to see if Form 1255 is returned (allowing 20 days from the date it was mailed).If additional assistance is needed, the supervisor will submit a Service Manager ticket to Policy and Process Management.Probate Court SearchInheritancesIf an inheritance is not alleged on the application, do not complete a probate search.If an inheritance is alleged on the application and the probate office is available online, conduct a searchIf an inheritance is alleged on the application and the probate office is not available online, conduct a collateral call to the county probate office where the estate was probated.Have ready the name of the deceased and the date of death. Verify if the probate was completed and the value of any asset(s) the applicant received from the probate of the estate.If unable to contact the county probate office by phone:Send a DHHS Form 1255 to the county probate office where the estate was probated and allow the 15 days for return of information plus 5 days for scanning. On the DHHS Form 1255 include the name of the deceased and date of death.Conduct a collateral call to the applicant/AR to explain the need to provide verification of the inheritance and to discuss what type of documentation could be usedSend DHHS Form 1233 to the applicant/AR requesting verification of the inheritance received. Allow the 15 days for return of information plus 5 days for scanning.Deceased SpouseIf the applicant’s spouse passed away within the 5-year look back period and the application notes probate has been completed:Check online for probate records.If probate records are not available online:Conduct a collateral call to the county probate office where the spouse passed away. Have ready the name of the deceased and the date of death.Verify if probate was completed and the value of any asset(s) the applicant received from the probate of the estate. Determine if the applicant received the at least the elective share of 1/3 of the estate. (MPPM 304.10)If there is no will for the estate (intestate), assume the applicant received the elective share of 1/3 of the estate unless the probate court indicates otherwise.If there is a will for the estate (testate), ask if the applicant received the elective share of 1/3 of the estate or filed a petition to claim the elective share.If the probate court is unable to provide confirmation of any details of the estate, including the receipt of the elective share, conduct a collateral call to the applicant/AR to explain what information is required. Send a DHHS Form 1233 to request the necessary information.If unable to contact the county probate office by phone:Send a DHHS Form 1255 to the county probate office where the estate was probated and wait 20 days for the probate information to be returned and scanned in. On the DHHS Form 1255, include the name of the deceased and date of death.Conduct a collateral call to the applicant/AR to explain the requirement to obtain the elective share of the estate.Send the DHHS Form 1233 and request verification that the applicant received or petitioned the court for the spouse’s required elective share of the estate.If the applicant’s spouse passed away within the 5-year look back period and the application does NOT indicate that probate has been completed:Check online for probate recordsIf there are no probate records found on the probate court website, or if the county does not have probate online, attempt a collateral call to the probate court to collect the information.If you are unable to contact the probate court by phone, send a DHHS Form 1255 to the county probate office where the spouse passed away and wait for the probate information to be returned. On the DHHS Form 1255, include the name of the deceased and date of death.If the DHHS Form 1255 is returned and no probate has been completed:Complete a collateral call with the applicant/AR notifying them of requirement for the applicant to claim the elective share within 8 months of the decedent’s death or within 6 months from the date the estate is probated.Send a DHHS Form 1233 to the applicant/AR notifying them of requirement for the applicant to claim the elective share within 8 months of the decedent’s death or within 6 months from the date the estate is probated and to request documentation. If the DHHS Form 1255 is not returned, make a collateral call to the applicant/AR to explain the requirement to obtain the elective share of the estate.Send the DHHS Form 1233 and request verification that the applicant received or petitioned the court for the spouse’s required elective share of the estate.If the estate has not been probated, follow up at the next annual review.At the next annual review, if probate has been completed and the elective share is not obtained, a transfer penalty may be incurred.Document search efforts, findings and actions taken on the template.702.07COVID-19 Limited Benefit Eligibility Group(Eff. 01/01/21)The Families First Coronavirus Response Act Section 6004(a)(3) includes an optional eligibility group for uninsured individuals during the COVID-19 public health emergency. Coverage for this limited benefit group is for services related to testing and diagnosis of COVID-19 that are provided during the emergency period. The COVID-19 Limited Benefit Program will also provide coverage for COVID-19 vaccine administration. Individuals who are already eligible for Medicaid benefits, including Family Planning, do not have to apply separately for this coverage.702.07.01Benefit Effective date(Eff. 07/06/20)Coverage for the COVID-19 Limited Benefit Group may be effective for services provided no earlier than March 18, 2020.The application date is the date the application is received by SCDHHS.For COVID-19 diagnostic tests conducted on or after March 18, 2020, retroactive coverage can be approved for up to three months before the application date as long as the individual did not have other health insurance at the time and services were not provided earlier than March 18, 2020.702.07.02Eligibility Criteria(Eff. 01/01/21)Uninsured IndividualsThe individual must meet the definition of an “uninsured individual” (FFCRA Section 1902(ss), as amended by section 1902(a)(10)(A)(i)(VIII) of the Act). Specifically, an individual must:Not be eligible to receive coverage under a Medicaid eligibility groupNot be enrolled in Medicaid coverageIndividuals enrolled in a limited-benefit group such as Family Planning, are not considered to be uninsured since COVID-19 testing and COVID-19 vaccine administration are covered services for this benefit category.Not be enrolled in another health care program funded by the federal government (e.g. Medicare, TRICARE, Veterans Administration, and federal employee health plans)Not be enrolled in a group health plan or health insurance coverage offered by a health insurance issuer (e.g. marketplace coverage, employer-sponsored health insurance, retiree health plans, and COBRA)Financial CriteriaIncome: There is no income test for this benefit.Resources: There is no resource test for this benefit.Non-Financial CriteriaThe individual must be a resident of South Carolina (MPPM 102.03)The individual must furnish a Social Security Number (MPPM 102.05)Citizenship and Immigration status (MPPM 102.04)US citizens and immigrants who are lawfully present with a satisfactory immigration status are eligible.If a person attests to US citizenship or having satisfactory immigration status, but the agency is unable to verify through electronic sources, approve the individual for coverage with a reasonable opportunity period to provide documentation.The reasonable opportunity period will be 90 days or the end of the Public Health Emergency, whichever is greater.If a person attests to being undocumented or to not having satisfactory immigration status, approve coverage with the Emergency Services indicator.702.07.03COVID-19 Limited Benefit Group Eligibility Processing(Eff. 07/06/20)ApplicationAn individual may apply for COVID-19 Limited Benefits by completing and submitting DHHS Form 3404, COVID-19 Limited Benefit Application, or by calling the SCDHHS Member Contact Center to complete the application telephonically.ProceduresEligibility for COVID-19 Limited Benefits is processed in Cúram, using Manual Eligibility Procedures. See Job Aid: Processing COVID-19 Limited Benefit Application in Cúram. COVID-19 Limited Benefit Applications will be scanned in OnBase as a Cúram Application with a claim type COVID. The payment category for COVID-19 Limited Benefit is PCAT 89. The QCat for COVID-19 Limited Benefit is 42. Note: BabyNet cases have the same PCAT of 89 but a different QCat of 70.NotificationManual notices are used to notify an applicant if they are approved or denied for COVID-19 Limited Benefits.A Medicaid card will not be sent to the beneficiary. Approval Closure Denial ALinks to Important Reference Documents(Rev. 11/01/20)Families First Act Extension NoticeEligibility FAQs_Families First Coronavirus Response Act Processing MAGI Applications During the COVID-19 Emergency PeriodMEDS Reopen Tasks in the Non-MAGI Exceptions PathwayProcessing MAGI Reviews in Cúram During COVID-19 Emergency PeriodProcessing Non-MAGI Reviews During the COVID-19 Emergency PeriodProcessing LTC Reviews During the COVID-19 Emergency PeriodProcessing LTC Form 181/MSCs TypesProcessing COVID-19 Limited Benefit Application in CúramAppendix BCARES Act Update – Income Calculations for Medicaid(Eff. 08/01/20)The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) is a federal bill that provided direct payments to citizens, as well as other economic stimulus measures. When we assess your eligibility for Medicaid, your income must fall within a certain range to qualify. The CARES Act adjusts how we count some forms of income.Pandemic Unemployment Compensation Benefits While unemployment benefits are considered countable income, we do not count weekly Pandemic Unemployment Compensation income toward an applicant’s total income. This special provision only applies to federal pandemic unemployment benefits. We will continue to count regular unemployment insurance income and any extension of that regular unemployment income associated with various pandemic-related federal programs. Medicaid Applicants: Do not include federal pandemic unemployment benefits on your application. For example, if you are reporting income between April and July, 2020, and you received pandemic unemployment benefits, do not include the $600 weekly payments. If federal law extends the benefit past July, yet changes the benefit amount, simply deduct the new benefit amount from your income for those additional months.Impact Payment (Stimulus Money) Refundable tax credits and “Recovery Rebate” payments from the Internal Revenue Service associated with the CARES Act are not counted as taxable income for Medicaid purposes. Impact Payment income that you set aside in an account, such as a savings account (i.e. a “resource”), will not be counted as a resource for Medicaid purposes for the first 12 months you set it aside.Medicaid Applicants: Do not include this payment as income on your application.Retirement WithdrawalMoney withdrawn from a retirement account is considered countable income; however, Medicaid applicants who took an early “Coronavirus-related” withdrawal up to $100,000 may spread out the inclusion of that income over three years. For a $30,000 withdrawal, for example, an applicant could count $10,000 per year as income for the next three years, instead of claiming the entire $30,000 as income in year one.Employer Student Loan PaymentAmounts that an employer pays for an employee’s student loan principal and interest are not considered part of the employee’s countable income for Medicaid purposes.Medicaid Applicants: Do not include these payments as income on your application.Appendix CNon-MAGI and LTC Review Scenarios(Eff. 07/01/21)Reminder: During the COVID emergency period reviews should have three primary outcomes: (1)Beneficiary meets eligibility requirements and benefits continue for another year, (2)“Validly enrolled” Beneficiary does NOT meet eligibility requirements and benefits continue, OR,(3)Beneficiary enrolled in error does NOT meet eligibility requirements after redetermination and benefits are ended with adverse action rules.Client DeceasedOld Review on file; No Current ApplicationOld Review on file; Current Application on fileApplication on file; No ReviewNo Review on file; No Application on fileCurrent Review Completed; No Action in MEDS TakenCheck MEDS for date of death on HH Member Screen (MEDSHMS06)If this is an individual case (not a couple) and there is a date of death, the Review is not needed.If it is a couple case, change the surviving spouse to the Primary Individual and complete a review on the surviving spouse if applicable.Update all screens in MEDS. Close eligibility for the deceased member (053 code) and complete Act on Decision in MEDS.Document both in MEDS and the Doc Template and update Phoenix if needed.If it is an individual case, the action in Pathos will be “DENY”If it is a couple case and the surviving spouse’s eligibility is continued, the action in Pathos will be “APPROVE”. If the surviving spouse is no longer eligible, the action in Pathos will be “DENY”. If additional information is needed to determine the surviving spouse’s continued eligibility, the action in Pathos will be “PEND”.Process review using current electronic data sources and/or other verifications on file.Update all screens and Act on Decision in MEDS.Document both in MEDS and the Doc Template and update Phoenix if needed.Action in Pathos will be “APPROVE”Use the current application to complete the review using current income and resources.If follow-up is needed, send a 1233 to request additional information. Send Tracking Form to Follow Up for 15 days plus the 5 days to allow for scanning.Document both in MEDS and the Doc Template and update Phoenix if needed.If a decision can be made, action in Pathos is “APPROVE” or “PEND” if additional information is needed.Document both in MEDs and the Doc Template and update Phoenix if needed. Action in Pathos will be “NO CONTACT”Search all previous household numbers and names for each recipient.If none found, send 1233 with FM 3400 & 3400A or 3400B.Do not close case until a full determination can be made.Document both in MEDS and Doc Template and update Phoenix if needed.Action in Pathos will be “PEND”Review workbook and verifications for accuracy.Make Decision in MEDS and set the NRD for 1 year from today and Act on Decision.Document both in MEDS and the Doc Template and update Phoenix if needed.Action in Pathos will be “NO CONTACT” ................
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