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EIS 2255 – APPROVING M-IC NEW APPLICATIONS OR REAPPLICATIONS



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a. If you are reopening a case that at the time of termination was suspended due to incarceration or residence in an Institution for Mental Disease (IMD), the Medicaid Effective Date must be the ongoing processing month. Authorize prior ongoing months on the DB/PML screen. Authorize retro months by using Retro MA 1 and/or Retro MA 2 fields.

            Refer to EIS-3105, DB/PML Transaction Instructions for Medicaid Application Approvals for completing authorization on the DB/PML screen.

          b. If approving ongoing coverage:
            (1) This date must be greater than or equal to the CERTIFICATION FROM DATE.
            (2) This date must not be before 10/1/87.
            (3) This date can be any day of the month if the MEDICAID CLASS CODE is “F”.
          b. If approving retroactive coverage with ongoing:
            (1) This date may be up to three months before the month of application if there is no break in ongoing coverage.

    REISSUED 02/01/11 - CHANGE NO. 03-11

    II. E. 2. b. (CONT’D)

            (2) This date must be greater than or equal to the CERTIFICATION FROM DATE.
            (3) This date must be the first day of the month unless the MEDICAID CLASS code is “F”.
            (4) This date must be before or equal to the ongoing month.
            (5) This date must be before the CERTIFICATION THRU month.
            (6) This date must not be prior to 10/1/87.
          c. If approving retroactive only (3 months prior to the month of application) do not enter.
        3. Enter the CERTIFICATION FROM DATE.
          a. This date must be greater than or equal to the month of application.
          b. This date must be the first day of the month.
          c. This date must be before or equal to the CERTIFICATION THRU DATE.
          d. If approving retro only, do not enter.
        4. Enter the CERTIFICATION THRU DATE.
          a. This date must be the last day of the month.
          b. This date must be no longer than six months from the CERTIFICATION FROM DATE, unless the case was established for automatic newborn coverage for a child whose mother is an AAF recipient. In this situation, the CERTIFICATION THRU DATE may be up to 13 months from the CERTIFICATION FROM DATE.
          c. If the CASE TERMINATION DATE is entered, the CERTIFICATION THRU DATE must be the same as the termination date.
          d. If approving Retro only, (3 months prior to month of application) do not enter.
          e. If approving an alien case for emergency services only, the CERTIFICATION THRU DATE must be the day the emergency services end as authorized by the Division of Medical Assistance.

    REISSUED 02/01/11 - CHANGE NO. 03-11

    II. E. 4. (CONT’D)

          NOTE: IF THE APPLICATION PENDS BEYOND THE FIRST SIX MONTHS, ENTER THE SECOND SIX MONTHS CERTIFICATION PERIOD ON THE DSS-8125 AND SUBMIT THE NEXT DAY.

        5. Enter MEDICAID CLASS.
        6. If applicable, enter the PATIENT MONTHLY LIABILITY (DB/PML) Type and DB/PML AMOUNT.

      F. RETRO MA 1 AND 2

        Complete RETRO MA 1 and 2 to authorize Medicaid before the month of application if the MEDICAID EFFECTIVE DATE does not cover all retroactive months to be authorized. The date must not be before 10/01/87. If you are completing both RETRO MA 1 and 2, the earliest retroactive period must be entered in RETRO MA 1. For example, if the recipient is eligible for retroactive months 04/90 and 06/90, 04/90 must be entered in RETRO MA 1.

        1. RETRO MA 1
          a. Enter “M” “IC” in AID PROGRAM/CATEGORY.
          b. Enter AUTHORIZATION FROM and AUTHORIZATION THRU dates.
            (1) AUTH FROM DATE:
              (a) Must be before the month of application.
              (b) May be up to three (3) months before the month of application.
              (c) Must be the first day of the month.
              (d) Must be before the MEDICAID EFFECTIVE DATE if the MEDICAID EFFECTIVE DATE is entered.
              (e) May be any day of the month if the MEDICAID CLASS is “F”.
            (2) AUTH THRU DATE:
              (a) Must be before the month of application.
              (b) Cannot be before the FROM DATE.

    REISSUED 02/01/11 - CHANGE NO. 03-11

    II. F. 1. b. (2) (CONT’D)

              (c) Must be the last day of the month, unless the RETRO MEDICAID CLASS code is “F”.
              (d) Must be before the RETRO MA 2 FROM DATE if RETRO MA 2 information is entered.
              (e) Must be before the MEDICAID EFFECTIVE DATE if MEDICAID EFFECTIVE DATE is entered.
          c. Enter MEDICAID CLASS for the retroactive period.
          d. Do not enter DEDUCTIBLE BALANCE/PATIENT MONTHLY LIABILITY (DB/PML).
          e. Do not enter DB/PML AMOUNT.
        2. RETRO MA 2

          Do not enter RETRO MA 2 unless RETRO MA 1 has been completed. If there is a break in the retroactive coverage, complete the RETRO MA 2.

          a. Enter “M” “IC” in the AID PROGRAM/CATEGORY.
          b. Enter AUTHORIZATION FROM and AUTHORIZATION THRU dates.
            (1) AUTH FROM DATE:
              (a) Must be before the month of application.
              (b) May be up to three (3) months before the month of application.
              (c) Must be the first day of the month.
              (d) Must be before the MEDICAID EFFECTIVE DATE if the MEDICAID EFFECTIVE DATE is entered.
              (e) May be any day of the month if the MEDICAID CLASS code is “F”.
            (2) AUTH THRU DATE:
              (a) Must be before the month of application.
              (b) Cannot be before the FROM DATE.
              (c) Must be the last day of the month, unless the RETRO MEDICAID CLASS code is “F”.
              (d) Must be before the MEDICAID EFFECTIVE DATE if MEDICAID EFFECTIVE DATE is entered.

    REISSUED 02/01/11 - CHANGE NO. 03-11

II. F. (CONT’D)

          c. Enter MEDICAID CLASS for the retroactive period.
          d. Do not enter the DB/PML.
          e. Do not enter DB/PML AMOUNT.

      G. EARNED INCOME (IF ZERO, LEAVE BLANK)

        All fields must be in dollar and cents amounts.

        1. Enter the GROSS EARNED INCOME.
        2. Enter the WORK EXPENSES.
        3. Enter CHILD/ADULT CARE.
        4. Enter the DISREGARD.
        5. Enter the NET EARNED INCOME.
        6. Do not enter GRANT RECOUPMENT CODE, AMOUNT or END DATE.

      H. UNEARNED INCOME (IF ZERO, LEAVE BLANK)

        All fields must be in dollar and cents amounts.

        1. Enter the RSDI AMOUNT. If entered, RSDI CLAIM NUMBER is required.
        2. Enter the TOTAL NET UNEARNED INCOME.
      I. Enter the OTHER UNEARNED INCOME.
          1. The amount must be dollars and cents.
          2. The amount must be included in the TOTAL NET UNEARNED INCOME.
        J. Enter the TOTAL NET UNEARNED INCOME.
        1. The amount must be dollars and cents.
          2. The amount must be the same as the RSDI AMOUNT plus OTHER UNEARNED, if RSDI and OTHER UNEARNED INCOME is entered.
          3. TOTAL COUNTABLE MONTHLY INCOME must also be entered.

    REISSUED 02/01/11 - CHANGE NO. 03-11

II. L. (CONT’D)

      K. NEEDS

        1. Enter the MAINTENANCE AMOUNT. The amount must be a whole dollar amount. The amount must be more than or the same as the TOTAL COUNTABLE MONTHLY INCOME.
        2. Do not enter AMBULATION CAPACITY.
        3. Do not enter DOMICILIARY RATE.
        4. Enter TOTAL COUNTABLE MONTHLY INCOME. The amount must be in dollars and cents.

      L. SPECIAL DATA

        1. Enter the FOOD STAMP NUMBER if known.
        2. Enter a STEPPARENT INDICATOR if known. This is an optional field. See the Codes Appendix to determine the appropriate code.
        3. Mark “YES” or “NO” for VA PAYMENT.
        4. Enter SPECIAL REVIEW TYPE and DATE if needed.
          a. If entered, the DATE must be more than the ongoing month.
          b. Not allowed for Open/Shut approvals.
          c. See the Codes Appendix to determine the appropriate special review code and date.
        5. Do not enter JOBS/WORK REGISTRATION/EXEMPTION data.
        6. Enter SPECIAL USE CODE and DATA if needed. This is not allowed for Open/Shut approvals. See the Codes Appendix for codes and date information.

      M. SPECIAL COVERAGE GROUP DATA

        1. Do not enter CODE, BEGIN DATE or END DATE.
        2. Do not enter SPECIAL NEEDS INDIVIDUAL ID, SPECIAL NEEDS CODE, SPECIAL NEEDS FROM DATE, or SPECIAL NEEDS THRU DATE.

      N. SUPPLEMENTAL NOTICE INFORMATION

        The following two data elements have been added to the DSS-8125 Data Entry screen. A recommended form in which to enter the information can be found at the end of this section. This form should be attached to your DSS-8125 if submitting to Data Entry for keying.

    REISSUED 02/01/11 - CHANGE NO. 03-11

    II. N. (CONT’D)

        1. AUTHORIZED REPRESENTATIVE NAME AND ADDRESS

          If an applicant had an authorized representative acting in his behalf, the authorized representative's name and address may be entered for the purpose of mailing an automated notice to the authorized representative in addition to the applicant.

        2. SECONDARY NOTICE CODE

          This code may be used in addition to the disposition code at approval time only. You may use it in situations when additional information is needed. Refer to Secondary Notice Codes in the Codes Appendix.

      O. INDIVIDUAL DATA

        The casehead name and the individual data for the individual(s) included on the case will be brought forward from the case or the application and cannot be changed. When a DSS-8125 is keyed, EIS reads the common name database to retrieve the individual assigned to the case id with a casehead/payee status of “P”. If any of the individual data is incorrect, use the NAME CHANGE screen to make the appropriate corrections.

        Enter the following data:

        1. Enter the INDIVIDUAL TERMINATION DATE if an individual is ineligible in the ongoing case.
          a. Do not enter if there is only one individual on the case.
          b. This date must be the last day of the month of eligibility.
          c. This date may be the date of application. This should only be entered if an individual is on the application but should not be included on the case.
          d. This date must be before or the same as the current calendar month.
          e. This date may be the last day of the month before the month of application. (Ongoing and retroactive coverage must both be approved.)
          f. If DATE OF DEATH is entered, do not enter.
        2. Do not enter CASE STATUS. The system automatically enters “R”.

    REISSUED 02/01/11 - CHANGE NO. 03-11

    II. O. (CONT’D)

        3. Enter the RSDI CLAIM NUMBER if the individual has Social Security benefits or Medicare coverage.
        4. Enter “Y” or “N” in MEDICARE A to indicate whether or not the individual has Medicare A. If “Y” is entered, the RSDI CLAIM NUMBER must also be entered.
        5. Enter “Y” or “N” in MEDICARE B to indicate whether or not the individual has Medicare B. If “Y” is entered, the RSDI CLAIM NUMBER must also be entered.
        6. Do not enter FAMILY STATUS. EIS generates.
        7. Enter a LIVING ARRANGEMENT CODE. This code must be the same for all individuals on the case. See the Codes Appendix to determine the appropriate living arrangement code.
        8. Do not enter SPECIAL REPORT CODE.
        9. Do not enter JOBS/WORK REGISTRATION/EXEMPTION.
        10. Enter SPECIAL USE DATA CODE and DATA if needed. Do not enter if the approval is Open/Shut. See the Codes Appendix to determine the appropriate special use code and dates.
        11. Enter the REFUGEE STATUS CODE and U.S. ENTRY DATE (in MMCCYY format), if applicable. See the Codes Appendix to determine the appropriate Refugee Status Code.
        12. Enter DATE OF DEATH if applicable.
          a. If the deceased is the only individual in the case, CASE TERMINATION REASON and DATE are required.
          b. The DATE OF DEATH must be before or the same as the CASE TERMINATION DATE.
          c. The DATE OF DEATH must be less than or equal to the current date.
        13. Enter the two digit CITIZEN/ID code and the date (in MMDDCCYY format), if applicable. Enter Citizen/ID codes for refugee, asylee, Cuban/Haitian status, Amerasian, trafficking victim or special immigrant. See the Codes Appendix to determine the appropriate Citizen/ID code and what the date reflects.
        14. Enter Alien ID number, if applicable. Key only the numeric parts of the Alien ID number. Do not enter the alpha “A”.
        15. Enter the RELATIONSHIP TO PAYEE code. See Codes Appendix to determine the appropriate code.

    REVISED 02/01/11 - CHANGE NO. 03-11

    II. O. (CONT’D)

        16. Do not enter E&T (Employment/Training).
        17. Do not enter JOBS/WORK REQUIREMENT SAVINGS REASON and AMOUNT.
        18. Do not enter ED. EMPL (Education Employment).
        19. Do not enter INCOME.
        20. Do not enter EXPENSES.
        21. Do not enter CHILD/ADULT CARE.
        22. Do not enter NET INCOME.
        23. Do not enter EDUCATIONAL LEVEL.
24. Enter type and date of EDUCATION provided. Refer to EIS 4100, Community Care of North Carolina, for more information. These fields are not required for an individual who has a suspended living arrangement code.
        25. Enter “Y” or “N” for ISSUE CARD. If the individual has an annual Medicaid card from a prior time, enter “N”. A new card will not be issued. If the individual states they do not have an annual Medicaid card, enter “Y”. A new card will be produced the night the approval processes and mailed the following workday.
        26. Enter COMMUNITY CARE OF NORTH CAROLINA (CCNC) provider or exempt number. Refer to EIS 4100, Community Care of North Carolina, for more information.

          EIS automatically populates the CCNC field with an exemption code based on the living arrangement code entered for an individual suspended due to incarceration or suspended due to residence in an Institution for Mental Disease.

        NOTE: WHEN THERE IS MORE THAN ONE INDIVIDUAL, USE A DSS-8126 AS A CONTINUATION OF THE DSS-8125 TO ENTER INDIVIDUAL DATA. If there are three or more individuals, use a second
        DSS-8126. A sample of the DSS-8126 is located at the end of this volume.

      P. SIGNATURES AND DATE

        1. Enter DATE COMPLETED.
        2. Sign the DSS-8125 in the WORKER'S SIGNATURE field.
        3. The county director or his designee must sign the form in the DIRECTOR'S SIGNATURE field.

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    III. KEY THE DSS-8125 and DSS-8126's.

    REISSUED 02/01/11 - CHANGE NO. 03-11

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    IV. OUTPUTS

      When the DSS-8125 has processed successfully, the following are received:

      A. CASE PROFILE

        A Case Profile is produced the night the approval processes and is mailed to the county the following workday.

      B. APPLICATION TURNAROUND DOCUMENT

        If one part of a two part application is approved, an Application Turnaround Document is received for the second part of the application still pending.

      C. CASEWORKER SUPERVISOR REPORT

        The application approval is reported on the Caseworker Supervisor Report. The number of approvals completed is determined from the WORKER NUMBER.

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    V. AUTOMATED NOTICES

      A. An automated notice (DSS-8108A) is produced for each MIC approval the night the DSS-8125 processes in the system unless “Y” is entered for “NOTICE OVERRIDE”.

      B. The DISPOSITION REASON CODE and the SECONDARY NOTICE CODE entered on the DSS-8125 determines the text of the notice.

      C. The system calculates the 60th calendar day for the notice.

      D. The date of the automated notice is the next county workday after the DSS-8125 processes. This is the date the notice is mailed to the recipient and is the date of disposition for Alexander reporting purposes. A copy of the notice will be mailed to the authorized representative if the Authorized Representative Name and Address fields were entered on the DSS-8125. A copy of the notice is not mailed to the county.

      E. A Notice Register Report is produced each night and is mailed to the county the following workday. This report lists vital information related to all automated notices produced for that day. See EIS 2304 for more information regarding the Notice Register Report.

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