CN 03-06 Medicare Entitlement/Enrollment and Expanded Medicaid
Contents
1. SSI Approval Notices The SSI approval notice notifies the recipient about prescription drug coverage The notice includes the following text ou are eligible for all medical care services covered by the North Carolina Medicaid Program unless you also receive Medicare If you receive Medicare Medicare is responsible for your prescriptions II III EXPANDED MEDICAID NORTH CAROLINA HEALTH CHOICE NCHC CHILDREN BIRTH THROUGH FIVE MOVE TO MEDICAID The North Carolina General Assembly in Senate Bill 622 The Appropriations Act under Section 10 22 a changed the North Carolina Health Choice NCHC program to be for children between ages six through eighteen as of January 1 2006 The General Assembly also said effective January 1 2006 infants under the age of one and children age one through five with family incomes equal to or less than 200 federal poverty level shall be covered for Medicaid benefits Refer to DMA Administrative Letter No 15 05 which provides policies and procedures for the migration from NCHC to Expanded Medicaid MIC 1 of these children ages 0 5 MANUAL SECTION CHANGES A Volume 1 La EIS 1050 EIS INQUIRY Two new Medicare Data screens are added a Medicare A B C MB Bis Medicare D MD Za EIS 1054 INDIVIDUAL INQUIRY Two new Medicare Data screens are created a Medicare A B and C Entitlement Data Dis Medicare D Entitlement and Enrol2. MIC 1 a Program Transfers D Change in Household Composition Ex Added MIC 1 in Changes to from Medicaid Classifications 6 EIS 4300 PART SIX NC HEALTH CHOICE NOTICES CODES System produced change code 9H is added for children aged 0 5 that are moved from NCHC to Expanded Medicaid MIC 1 on December 2 2005 Th ffective date is January 1 2006 Ta EIS 4900 APPENDIX C PART FOUR Changed references from RMDS to X PTR IV EIS MANUAL INSTRUCTIONS SECTION REMOVE PAGES INSERT PAGES ONLINE CHANGE A En EIS USER ER MANUAL TAB ABLI Table of Contents OF CONTENTS MANUAL T ABLI 1 2 I D Individual o VI Medicare A B C VII Medicare D Table of Contents OF CONTENTS HIS 23 04 III H 3 Information amp Comments Listed on the Notice Register Report EIS 2305 Adult Mail In Application Reports o e ASAS EIS US ER MANUAL ABL E 1 6 1 6 Table of Contents OF CONTENTS EIS 3100 No page number No page number Table of Contents Change EIS 31 57 68 57 71 I Timely Notices II EEE OS cece ncttces EIS 3151 EIS 3151 a ss RR References EIS 3520 1 10 New Section Medicare Entitlement Enrollment a a PR References 10 UAL TABLI OF CONTE 1 7 1 7 IV NCHC Program Part Five Transfers V Change in Household
3. code added MIC 1 for Expanded Medicaid Zu EIS 4000 APPENDIX B a Approval Codes If the Medicaid classification changes to D EIS prints the following text on the automated approval notice Your coverage is limited to Family Planning Waiver services Your partner may be potentially eligible also b Change Codes 1 3 EIS 4000 4 EIS 4300 oe EIS 4300 Expanded If the Medicaid classification changes to D EIS prints the following text on the automated approval notice Your coverage is limited to Family Planning Waiver services Your partner may be potentially eligible also If Medicare A and or B is entered as Y EIS prints the following message on the automated notice If you receive Medicare Medicare is responsible for your prescriptions New timely change code 1X has been added Us this code for Medicaid programs when Medicare is the only change on the DSS 8125 APPENDIX D SPECIAL ASSISTANCE CODES New timely and adequate change notices are produced due to changes in Medicare status PART ONE NC HEALTH CHOICE INTRODUCTION NC Health Choice covers children from ages 6 through 18 effective January 1 2006 PART FIVE NC HEALTH CHOICE CASE MAINTENANCE T T E Changes to NC Health Choice with the addition of new Medicaid
4. CE REGIST ER REPORT New comment MEDICARE D EIS 2305 ADU indicates changes in iT MAI IN on the Notic n Application Reports Medicare status Register Report APPLICATION REPORTS New section has 2 new reports tracking adult mail in applications and those mail in applications that are denied Volume 3 EIS USER MANUAL New section for TABLE OF Medicare New timely and adequate c changes in Medicare status EIS 3151 REQU Changed references from RMDS to X PTR CONTENTS Entitlement and EIS 3101 CHANGES TO MEDICAID CASES hange notices generated du Enrollment to T ESTING A MEDICAID 1D CARD EIS 3520 MEDICARE ENTITLEMENT AND New section explai the payment of prescriptio eligible recipients ENROLLMENT ns the process that allows or disallows n drugs for Medicare Medicaid a MMA Data and Response Files b Medicare Data Screens Ci Application and Reapplication Approvals d Medicaid Drug Coverage Indicator e Medicaid Card Changes Notices ore EIS 3556 NOTICE REGISTER REPORT New comment MEDICARE D on the Notice Register Report indicates changes in Medicare status Volume 4 bee EIS 4000 CODES APPENDIX New Medicaid Classification
5. Coverage Indicator Medicare D This is an indicator and date created and updated by EIS which indicates whether Medicaid is paying for prescription drugs EIS creates the Medicaid Drug Coverage indicator based on the Medicare D Entitlement indicator a If the Medicare D Entitlement indicator is Z or Y EIS creates a Medicaid Drug Coverage indicator of N N indicates Medicaid is not paying for drug coverage because the recipient has Medicare b If the Medicare D Entitlement indicator is a space or an N EIS creates a Medicaid Drug Coverage indicator of Y Y indicates Medicaid is paying for drug coverage because the recipient does not have Medicare Medicaid Card Changes The word MEDICARE is displayed at the bottom of the pharmacy stub on the Medicaid card for Medicaid excluding MOB recipients who have a Medicaid Drug Coverage indicator of N This change is effective with the January 2006 Medicaid cards that are produced in the regular run beginning in December 2005 Automated Approval Notices DSS 8108 An individual approved for Medicaid excluding MOB who is also Medicare receives an automated approval notice that indicates Medicaid does not cover prescription drugs When Y is keyed for Medicare A and or B on the DSS 8125 EIS prints the following sentence on the approval notice If you rec
6. DATE MANUAL CHANGE NO TO CHANGE NOTICE FOR MANUAL November 23 2005 EIS 03 06 MEDICARE ENTITLEMENT ENROLLMENT AND EXPANDED MEDICAID COUNTY DIRECTORS OF SOCIAL SERVICES This change notice transmits revisions to the EIS Manual Revisions are effective January 1 2006 unless noted otherwise MEDICARE ENTITLEMENT AND ENROLLMENT A Background Effective November 15 2006 the new Medicare Part D prescription drug plans will be available to people with Medicare Medicar endorsed prescription drug plans PDPs will provide insurance coverage for prescription drugs The regulatory basis for this change is the Medicare Prescription Drug Improvement and Medicare Modernization Act MMA of 2003 Refer to MA 2312 of the Adult Medicaid Manual which provides policy and procedures regarding Medicare drug coverage Beginning January 1 2006 individuals receiving Medicare and Medicaid in North Carolina will no longer have prescriptions paid by the Medicaid program Instead the prescriptions will be paid by the Medicare program Timeline for Implementation of the Medicare Part D Program T Week of November 21 2005 EIS sends the MMA data file to CMS shortly after buy in runs before the 25 of the month The file is created from the Medicare A and B Buy In files 2 Week of November 28 2005 CMS transmits to the State the MMA response file that includes Medicare A B C and D da
7. MA response file on a monthly basis Medicare information from the response file is updated in EIS the 2 worknight from the end of each month January 1 2006 The Medicaid claims contractor begins using the Medicaid Drug Coverage indicator for processing drug claims Changes Due To Medicare Prescription Drug Coverage 1 MMA Data and Response Files Each month the MMA data file created from the Medicare A amp B Buy In files is transmitted to CMS between the 15 and the 25 day of the month Several days following CMS transmits a response file back to North Carolina This response file contains information regarding Medicare A B C and D entitlement and enrollment On the pre worknight from the end of each month EIS compares the most current Medicare information in EIS to the most current Medicare information on the response file to determine if there is a change that needs to be posted to the Medicare Data screens in EIS Medicare Data Screens Two new Medicare Data screens have been created and are populated with Medicare information keyed on the DSS 8125 as well as information from the monthly MMA response file On screen displays Medicare A B and C Entitlement Data Medicare C information comes only from the MMA response file The second screen displays Medicare D Entitlement and Enrollment data as well as the Medicaid Drug Coverage indicator created by EIS Medicaid Drug
8. XIII Changes in Medicaid Cl ssification Bart Six EIS 4900 X PTR References APPENDIX C Part Four a o If you have any questions please contact your Medicaid Program Representative Sincerely L Allen Dobson Jr M D Assistant Secretary for Health Policy and Medical Assistance This material was researched and prepared by Chris Hager Wanda McLeoud and Mary Spivey EIS Program Consultants and Sharon McDougal EIS Project Director 11
9. eive Medicare Medicare is responsible for your prescriptions Timely Action Notices DSS 8110 EIS produces an automated timely ten workday notice when a recipient becomes Medicar ligible This notice serves to notify the Medicaid Medicare excluding MOB recipient that Medicaid no longer covers prescription drugs Note For MMA response file changes indicating the recipient has Medicare this is a new notice The notice will be a special laser printed notice not a DSS 8110 See Section 2312 Figure 1 of the Adult Medicaid Manual a For actions on the DSS 8125 where the Medicare A and or B is changed to Y and the caseworker is completing some other adverse action and has keyed a timely action code EIS adds the following to the notice text Now that you ar nrolled receiving Medicare Medicaid will not pay your prescriptions Medicare is responsible for your prescriptions b For actions on the DSS 8125 where the Medicare A and or B is changed to Y and an adequate action is completed on the same form with an adequate action notice code EIS edits the action and displays an online error message that indicates the caseworker must override the automated notice and complete a timely action notice If you complete a manual timely notice it must include the following text Now that you ar nrolled receiving Medicare Medicaid will not pay your prescriptio
10. lment Data 3 EIS 1057 MASTER CLIENT INDEX The MCI Match Report is modified to better identify inconsistencies in match criteria The changes are effective with the report printed on 1 2 06 All individuals on the MCI File are reviewed daily Only those individuals with data inconsistencies appear on the daily MCI Match Report The report heading new updated individual is replaced with problem individual The column Match ID is removed 4 EIS 1061 X PTR REPORT DISTRIBUTION SYSTEM Added the following new reports to the listing a DHREJA ADULT MAILIN APPS TRACKED b DHREJA ADULT MAILIN APPS DENIED Er DHREJA TWO IND ID VE MANAG CARE d DHRRLA FAMPLAN PER ANNUAL REPORT e DHRRLA FAMPLAN PER MONTH TO DATE f DHRRLA FAMPLAN PER YEAR TO DATE g DHRRLA KATRINA P ER ANNUAL R EPORT Volume 2 h DHRRLA KATRINA PER MONTH TO DATE 1 DHRRLA KATRINA PER YEAR TO DATE j DHRRLA PROVIDER EARNINGS CY k DHRWDB 0 5 CHILDREN NCHC TO MED 1 DHRWDB MEDICARE FOR X REF IDS m DHRWDB MIC QUARTERLY DISP REP n DHRWDB MPW QUARTERLY DISP REP O DHRWDB MPW QUARTERLY PROV REP EIS USER MANUAL TABLE OF CONTENTS New section for Adult Mail I EIS 2304 NOTI
11. ns Medicare is responsible for your prescriptions Enter the change in Medicare to Y after the ten workdays have elapsed You may also use the new timely notice code developed for use when the only change on the DSS 8125 is a change in Medicare to Y This code is 1X With this code EIS will produce the timely notice and hold the Medicare action for the 10 workdays Cu Th ffective date for the change is the first day of the ongoing month Adequate Action Notices DSS 8110 Note For MMA response file changes indicating the recipient does not have Medicare this is a new notice The notice will be a special laser printed notice not a DSS 8110 See Section 2312 Figure 2 of the Adult Medicaid Manual Unless overridden by the county caseworker EIS produces an automated adequate notice when a recipient no longer receives Medicare This notice serves to notify the Medicaid recipient that Medicaid will cover prescription drugs a For actions on the DSS 8125 where the Medicare A and or B is changed to N the notice includes the following text Now that you are no longer enrolled receiving Medicare Medicaid will pay your prescriptions b EIS will not react to changes in Medicare from Y to N on the DSS 8125 If a caseworker needs to correct a Y keyed in error they must contact the Claims Analysis Unit to make the correction
12. ta 3 December 9 2005 EIS reads the MMA response file The initial load of the MMA response file is run at the end of the nightly cycle on December 9 2005 EIS populates the Medicare Data screens for active individuals with Medicare as indicated by the MMA response file 4 December 12 2005 as New Medicare A B C and D Data screens are available for inquiry in EIS The new Medicaid Drug Coverage indicator is displayed on the Medicare D Data screen C b A laser printed notice is mailed to each active authorized Medicaid Medicare excluding MOB recipient for whom data was loaded to the EIS Medicare Data screens The notice is a 10 workday timely notice indicating that effective January 1 2006 Medicaid will no longer pay for prescription drugs Medicare D is noted in the Comment section of the Notice Register Report in XPTR d EIS begins transmitting the Medicaid Drug Coverage indicator for each Medicaid Medicare recipient to the Medicaid claims contractor e EIS begins loading Medicare A B and D data to the Medicare Data screens in EIS on a nightly basis using data entered by caseworkers in the Medicare A and B data fields on the DSS 8125 fe All Medicare Medicaid excluding MQB recipients have MEDICARE displayed on the pharmacy stub of the Medicaid card beginning with the January card December 29 2005 EIS begins reading the M
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