DATE: FEBRUARY 22, 2002
SUBJECT: Application Processing Changes Due to the Dismissal of the Alexander Consent Order
DISTRIBUTION: County Directors of Social Services
Income Maintenance Supervisors and Caseworkers
As you were advised in a terminal message, Judge Graham C. Mullen, Chief Judge, United States District Court for the Western District of North Carolina, dismissed the Alexander Consent Order on February 5, 2002. Judge Mullen dismissed the Consent Order based on the Exit Plan which exhibits the commitment of both the State and the counties to continue to provide accurate benefits to our citizens in a timely manner. Each county deserves recognition for its efforts. It is imperative that we continue to meet the goals of providing accurate benefits in a timely manner.
Full implementation of the requirements of the Exit Plan will require extensive changes to the Eligibility Information System (EIS). The EIS changes will be implemented as soon as possible once the funding is approved. In an effort to give counties some immediate relief, there are several changes that can be implemented without the system support. This letter outlines those changes and provides implementation instructions.
Continue to follow all other processing requirements in the Family and Children’s and Adult Medicaid Manuals and Administrative Letters. If something is not mentioned in this letter, you must continue to follow the applicable processing requirements.
II. CHANGES TO BE IMPLEMENTED
Five changes can be implemented without system support.
Counties are no longer required to hold an application pending for three months when the client or third party fails to provide needed information and the county followed the appropriate procedures for requesting the information. (Refer to E.). When a client or third party fails to provide information needed to determine eligibility and the procedures for requesting information have been followed, deny the application on the 45th, 60th or 90th day. If the 45th, 60th or 90th day falls on a weekend or holiday, deny the application on the next workday.
The county must continue to hold the application pending for six months when all factors of eligibility have been met except for proof of meeting a deductible or for determination of disability. Follow policy in MA-2303 or MA-3303.
System changes will need to be made to EIS to stop issuance of penalty checks. Until those changes can be made, checks will be pulled and voided by the Controller’s Office. Counties are no longer required to call DMA or the Controller’s Office to have the checks pulled or to fax information to DMA regarding the penalty payments. The county will continue to be charged for the check on the 449 Penalty Check Register. However, in the second month after the check is pulled, the county will be reimbursed. The reimbursement appears on the Monthly Adjustment Register.
Checks for remedial fines have not been printed since May 1998. Until a final ruling was made and the effect on remedial fines was known, the State required counties to request waivers for report card failures when appropriate. The county is no longer required to request the waivers.
Disability Determination Services (DDS) may now deny disability if the client fails to respond to requests for additional information. DDS must request information following the guidelines in E. DDS may deny the claim after one request for information unless the applicant has a mental impairment. If there is a mental impairment, DDS must make two requests for the information. The county will be notified of these denials on the DD screen with a disability indicator of N. Until further notice, use denial code D1 to dispose of these cases. The DMA-4037 will document the denial was due to insufficient evidence to determine disability.
A client must be interviewed the same day he appears at the DSS unless he arrives within one hour of close of business and there is insufficient staff to complete the interview. Obtain a signed application and schedule an appointment to complete the application according to policy in MA-2300 and MA-3300. Regardless of the reason for the appointment, the agency is required to schedule only two appointments. See E. for procedures to follow.
The county DSS must make two requests for information needed to process the application. There must be at least 12 calendar days between the requests. This includes information from the client for which he is responsible, information from the client that he agrees to provide, information needed from a third party source and scheduling of appointments to complete the intake interview.
Also, prior to denying an application for failure to provide the requested information, 12 calendar days must have passed since the second request was made. Do not deny the application on the 45th, 60th or 90th day if 12 days have not passed since the second request for information. Hold the application pending for the full 12 days, even if it pends beyond the 45th, 60th or 90th day. If the 12th day falls on a weekend or holiday, deny the application on the next workday.
For example, an individual applies for MAF on March 1, 2002. On that day, the IMC gives him a DMA-8146M for information to be returned. If the information is not provided, another request must be made no earlier than March 14. The county may make more frequent requests for the information but there must be two requests with at least 12 days between them. If the individual fails to provide the information, the application can be denied on April 15, 2002, which is the 45th day. In this example, two requests were made with 12 calendar days between them and 12 calendar days have passed since the second request was made.
Because we are unsure when the EIS changes will be made to fully implement the Exit Plan, monitoring will continue using current policy requirements.
The monitors will complete the process for those counties from whom records have already been requested. We are presently finishing the last four counties for the April-June 1999 quarter and are half way through the October 1997-March 1998 quarter. No additional counties will be monitored for the October 1997-March 1998 quarter.
Upon completion of these counties, monitoring will begin with the October-December 2001 quarter. This quarter was selected because it is unlikely that records from this period would be pulled again under the Exit Plan. No administrative dispositions will be requested for this sample. The monitors will review case records for improper denials and withdrawals and for discouragement.
In a Dear County Director Letter dated October 12, 2001, the Applications Time Standard Chart for 2002 was issued. This chart will be reissued at some point to reflect the 13th day instead of the 11th day. While this chart reflects the correct 45th, 60th or 90th day, the chart needs to be changed to reflect the new 12-12 rule.
The change in the penalty check procedure is effective immediately. Waiver requests are no longer required with the February report card to be run in March.
Apply all other changes to applications with a date of application on or after March 1, 2002.
Continue to apply all other application processing policy in the Family and Children’s and Adult Medicaid Manuals and Administrative Letters. For example, you must continue to complete the DSS-1295 and the DSS-1322, to explain all programs, to document inquiries and to request only information required to determine eligibility.
We are continuing to study the Exit Plan to determine if any other changes can be implemented without system support. Again, we appreciate your continued commitment to provide accurate and timely benefits to the citizens of North Carolina.
If you have any questions, please contact your Medicaid Program Representative.
Nina M. Yeager
(This material was researched and written by Renee Boston, Policy Consultant, Medicaid Eligibility Unit.)
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.