SR 14-10 Dated 04/14

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases:

·      New HEIGHTS’ automation of the Family Planning Medical Assistance (FPMA) eligibility determination process; and

·      changes in how the FPMA assistance group (AG) size is determined: the FPMA AG now includes all the FPMA applicant’s or recipient’s family members.

As a result of the policies described above, feedback from the Center for Medicare and Medicaid Services (CMS), and feedback from providers and staff who have been using the forms since their release in July 2013, the following DFA forms and their associated instructions were revised:

·      DFA Form 800FP, Application for Family Planning Medical Assistance; and

·      DFA Form 809, Proof of Family Planning Medical Assistance (FPMA).

POLICY

With the automation of Family Planning Medical Assistance (FPMA) in New HEIGHTS, eligibility and case information no longer have to be processed and tracked manually by specially-trained FSS in the CMU:

·      Any FSS located at any District Office can now process applications for FPMA. These applications no longer have to be forwarded to the Family Planning FSS located at CMU;

·      “Open” or “deny” notices of decision (NOD) no longer have to be manually issued to the FPMA applicant or recipient. These NODs will automatically generate out of New HEIGHTS once the application or redetermination is processed;

·      Because MMIS will not be updated at this time, and therefore Medicaid cards will still not be generated for FPMA recipients, New HEIGHTS created a new New HEIGHTS-generated version of DFA Form 809, the AE0124, which will be automatically generated with any “Open FPMA” NODs. The new AE0124 will be used by FPMA recipients in the same manner as the DFA Form 809, to prove to providers the individual’s eligibility for FPMA. As a result of the creation of AE0124, DFA Form 809, Proof of Family Planning Medical Assistance (FPMA), is now a paper back-up to the New HEIGHTS-generated AE0124 and no longer needs to be sent to the FPMA recipient, unless requested; and

·      Citizenship and identity can now be verified via the SSA crossmatch, and New HEIGHTS will automatically generate the DX0011, Citizenship Verification Request, with an enclosed DFA Form 800CITZ, Citizenship & Identity Acceptable Proof, if the SSA crossmatch is unable to verify citizenship or identity, eliminating the manual process the Family Planning FSS have been having to implement prior to automation.

Note: Claims and claim payments will continue to be processed manually until Xerox can make the appropriate changes to MMIS. OMBP staff will be responsible for entering claim and claim payment information into the Excel database. FSS no longer have to enter any information into this database.

FPMA assistance group size is determined as follows:

·      include the FPMA applicant or recipient;

·      include the FPMA applicant or recipient’s family members; and

·      increase the assistance group size by one.

Example:

Mom is applying for FPMA for herself. She is married and has two children. Mom’s assistance group size will be determined as follows:

·      Mom is included;

·      Mom’s spouse and two children are included; and

·      The assistance group size is increased by one.

Mom’s assistance group size is 5.

Note: Current policy remains unchanged that only the income of the applicant or recipient is counted in the FPMA determination process. In the above example, only mom’s net income will be compared to the income limit for an assistance group size of 5.

NEW HEIGHTS SYSTEMS PROCEDURES AND IMPLEMENTATION

FPMA Eligibility Process

Effective April 28, 2014, the FPMA eligibility process will be automated in New HEIGHTS. This means eligibility and case information no longer have to be processed or tracked manually by specially-trained FSS located in the CMU. FSS located at any District Office can now process FPMA eligibility through New HEIGHTS, and the Excel database created to process and track FPMA eligibility is only needed to process claims and claim payments. Claims and claim payments will be processed by OMBP staff, and FSS will no longer need to use the Excel database for any reason.

Support staff will no longer need to check New HEIGHTS before an FPMA application can be processed to determine if an FPMA applicant:

·      is already open for Medicaid; or

·      has already had citizenship and identity verified by the SSA crossmatch.

“Open” and “deny” NODs will automatically generate out of New HEIGHTS once FPMA has been processed. In place of a Medicaid card, which cannot be generated until MMIS can accept FPMA claims, new AE0124, the New HEIGHTS-generated version of DFA Form 809, Proof of Family Planning Medical Assistance (FPMA), will automatically generate along with any “open” NODs in lieu of a Medicaid card.

DFA Form 809, Proof of Family Planning Medical Assistance (FPMA), is considered the paper backup to the New HEIGHTS-generated AE0124. DFA Form 809 only needs to be sent to the FPMA recipient at the recipient’s request.

FPMA Redetermination Process

FPMA redeterminations will be processed according to one of the following three scenarios:

·      For FPMA recipients who are not open for any other DFA programs, New HEIGHTS has created new mail jobs PNCN74T5 and PNCN74C9, which will include:

-     DFA Form 800FP, Application for Family Planning Medical Assistance;

-     Business Reply Envelope (BRE);

-     SafeLink Information; and

-     the CS0005, Mail-In Rede Letter, if it is part of the PNCN74T5 mail job, or the CS0028, Online to Paper Rede Letter, if it is part of the PNCN74C9 mail job.

·      For FPMA recipients who are open for other DFA programs but are due for a redetermination for those programs in the same month they are due for a FPMA redetermination, New HEIGHTS will send out the usual redetermination package using the DFA Form 800R, Application for Continued Eligibility for Financial, Medical, Child Care, and Food Stamp Benefits; and

·      For FPMA recipients who are open for other DFA programs but are NOT due for a redetermination for those programs in the same month they are due for FPMA redetermination, the following will occur:

1.    If the FPMA redetermination occurs first and the redetermination for the other programs occurs later, the Centralized Medicaid Unit (CMU) will manually mail out DFA Form 800FP enclosed with a coversheet explaining to FPMA recipients that they must complete the redetermination process for FPMA, and then complete the redetermination process for the other DFA programs when that redetermination is due to continue to receive those other benefits. The temporary coversheet template the CMU will use in this circumstance has been attached to this SR for reference.

2.    If the FPMA redetermination is set to occur after the redetermination for the other programs though, New HEIGHTS will program the “case” redetermination date based on the earliest redetermination date, which might be for Food Stamps or the end of a spenddown, for example:

-     If the case redetermination happens on schedule, benefits will continue and the case redetermination will then continue to be aligned with the earliest scheduled case redetermination date.

-     If the redetermination is not completed for the case, New HEIGHTS will terminate Food Stamp and/or child care benefits at the end of the redetermination month, and the redetermination date will be automatically moved out 6 more months if there are only MAGI categories left in the case. If the case also contains individuals who receive cash or non-MAGI MA in addition to a member who receives FPMA, for example, the redetermination date will not be moved out, and the case will continue to show on the worker’s dashboard as an overdue redetermination. Before the worker goes to the Program of Assistance (POA) screen to terminate cash and/or medical for failure to complete the redetermination, the worker must check to see if the case is receiving a MAGI category of medical assistance. If so, only the non-MAGI categories of medical assistance should be closed at the POA screens, if appropriate, and the other MAGI categories must continue open until the 12-month redetermination date. If the worker attempts to set an individual to “Not Requesting MA” on the POA screen with the reason being that the redetermination was not completed, New HEIGHTS has created a warning pop-up in which the following text displays as follows: If you change the POA request to “No” for a MAGI individual, check the Due Date on the Rede Asst. Group Details before closing MA. The worker will then need to decide whether to actually close MA, per policy.

Note: This is a temporary process put in place until New HEIGHTS completes the automation of all MAGI based redeterminations, which is scheduled for the autumn of 2014.

When the DFA Form 800R or DFA Form 800FP have been returned and entered into New HEIGHTS, FSS must re-run the FPMA recipient’s information through the MAGI-related electronic cross-matching systems to verify FPMA eligibility.

DESCRIPTION OF REVISIONS MADE TO FORMS

DFA Form 800FP

DFA Form 800FP, Application for Family Planning Medical Assistance, is a two-page, double-sided form used by individuals who wish to apply for Family Planning Medical Assistance. The form allows:

·      males and females of any age to apply for Family Planning medical assistance; and

·      provision of the Family Planning applicant’s rights and responsibilities via page 3 of the application.

Revisions have been made to this form, as follows:

·      Fields were created for FPMA applicants to list the members of their household;

·      Federal income tax questions were included for New HEIGHTS processing purposes;

·      The request for a waiver of cooperating with third party medical liability requirement was included at the end of the application;

·      Per feedback from CMS, immigration questions were included; and

·      A question regarding where an individual can be reached if they have no permanent address was included for ease in contacting the applicant.

Instructions for DFA Form 800FP were revised accordingly.

The old version of DFA Form 800FP must be recycled and the new version used immediately. A Certificate of Destruction has been included with the SR. A small supply of DFA Form 800FP will be provided to each office by the end of the month. This form is also available internally on the Lotus Notes Family Services database.

DFA Form 809

DFA Form 809, Proof of Family Planning Medical Assistance (FPMA), is a one-page, single-sided form that is the paper back up to the New HEIGHTS-generated AE0124. The form provides verification of Medicaid eligibility for Family Planning medical assistance; because no permanent MA ID cards will be issued for this program until the MMIS system is able to accept billing for FPMA. The information on the form enables an individual with a medical need to obtain Family Planning medical services upon the eligibility determination and during the entire eligibility period. The form is used solely to indicate eligibility for FPMA and only for the period between the time the FSS determines eligibility for FPMA and the individual’s redetermination date 12-months later or until circumstances change and the individual is no longer eligible for FPMA, whichever occurs first.

Revisions have been made to this form, as follows:

·      The term "Certification" was removed from the title and replaced with “Proof” to bring down the reading level;

·      Due to automation of the program and that a Medical Identification (MID) number will now be generated, a field was added to the form to collect this number; and

·      The term "Family Planning medical assistance FSS" was removed, as any FSS can now process FPMA.

Instructions for DFA Form 809 were revised accordingly.

Because the DFA Form 809 is now a paper back-up to the New HEIGHTS-generated AE0124, all versions of DFA Form 809 can be recycled. If an office needs DFA Form 809, the worker can access the form on the Lotus Notes Family Services database, as this form will not be printed. A Certificate of Destruction has been included with this SR.

DFA Form 800FP is available in the DHHS Warehouse and can be ordered using current forms reordering procedures, via the Quarterly Forms Order (QFO). Both DFA Form 800FP and DFA Form 809 are also available electronically, for Department staff only, on the Lotus Notes Family Services database.

POLICY MANUAL REVISIONS

Revised Medical Assistance Manual Topics

Section 227.03  Family Planning MA Application Process

Section 227.05  Family Planning MA Income Requirements

IMPLEMENTATION

The policy released in this SR is effective April 28, 2014.

The old version of DFA Form 800FP must be recycled and the new version used immediately. A Certificate of Destruction has been included with the SR. A small supply of DFA Form 800FP will be provided to all District Offices by the end of the month.

All versions of DFA Form 809 can be recycled. If an office needs DFA Form 809, the worker can access the form on the Lotus Notes Family Services database as this form will not be printed due to it being a paper back-up to the New HEIGHTS-generated AE0124. A Certificate of Destruction has been included with this SR.

DFA Form 800FP is available in the DHHS Warehouse and can be ordered using current forms reordering procedures, via the QFO. Both DFA Form 800FP and DFA Form 809 are also available electronically, for Department staff only, on the Lotus Notes Family Services database.

CLIENT NOTIFICATION

No special client notification is planned.

TRAINING

Staff in all District Offices were provided with an overview of the FPMA policy in March during the MAGI refresher training that occurred at that time.

FORMS MANUAL POSTING INSTRUCTIONS

DISPOSITION

This SR may be destroyed or deleted after its contents have been noted and the revised manual topics released by this SR have been posted to the On-line manuals.

DISTRIBUTION

This SR will be distributed according to the electronic distribution list for Division of Family Assistance policy releases. This SR, and revised On-Line Manuals, will be available for agency staff in the On-Line Manual Library, and for public access on the Internet at www.dhhs.nh.gov/DFA/publications.htm, effective June 2, 2014. Additionally, this SR, and printed pages with posting instructions, will be distributed under separate cover to all internal hard copy holders of the Medical Assistance and Forms Manuals.

DFA/LRB:s