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KEES Review Scenarios

 

The scenarios and examples below are expecting that normal business processes have been followed.  Please note, staff cannot take negative action to discontinue eligibility for failure to return review prior to the due date.  

 

 

Refer to the Processing Deadline Code Cards in the KEES Repository for Timely Notice and Discontinuance Review Batch dates.

https://khap2.kdhe.state.ks.us/kees-train/Info/Training/Content/KEES-Info-Training.htm   

 

 

Add a Deemed Newborn/Newborn/Person BEFORE KMMS Monthly file in Review Due Month – Review has not been returned

  1. Add the DN/NB/Person to the case following normal business processes.

  2. Run EDBC for the months requested through the month prior to the Review Due Month.

  3. Save and accept EDBCs.

  4. Ensure the Notices are correct.

  5. Coverage is now high dated in KMMS and the Review Due Month does not need to be ran until the review is received.

Example:

  1. Program has a RE Due Date of 4/2023

  2. On 3/20/23 the PA calls to report she just had her baby (Review has NOT been submitted)

    • Note that 3/20 is after 5/2023 becomes the come-up month in KEES, and before the KMMS Monthly has run.

  3. Worker adds the newborn and runs EDBC for 3/2023 and 4/2023. When they try to run 5/2023 (because they are told to run thru come up), they get the Review is Due error message.

  4. Worker should stop running coverage after 4/2023 is accepted and saved because at this point coverage is high dated in KMMS.

 

Add a Deemed Newborn/Newborn/Person AFTER KMMS Monthly file runs in Review Due Month

  1. Add the DN/NB/Person to the case following normal business processes.

  2. Run EDBC for the months requested through the month prior to the Review Due Month.

  3. Save and accept EDBCs.

  4. Ensure Notices are correct.

  5. The worker should set the task they are working (Review, Add a Person, etc.) with a due date that matches the Due Date that displays on the household’s Review form. Staff should enter the following into the task details: “Holding for Review Due Date.”

  6. If a determination CAN be completed within Timely Notice time frame, the Review or Add a DN/NB/Person task can be worked following normal business processes. No further action needed.

  7. Use the RE Run Reason when running EDBC for the come-up month. This establishes a new Review Due date for the program.

  1. If the review ISN’T returned, the worker should run EDBC for the Review Month and Discontinue the other family members for Failure to Return Review & continue the DN/NB/Person(s) coverage. This would establish a new RE Due Date & set up the Reconsideration Periods for the other family members.

NOTE: Follow existing process for adding consumers to overpayment spreadsheet.

 

 Example:

  1. Program has a RE Due Date of 4/2023

  2. On 3/24/23 the PA calls to report she just had her baby (Review has NOT been submitted)

  3. Note that 3/24 is after 5/2023 becomes the come-up month, and after the KMMS Monthly has run

  4. Worker adds the newborn and runs EDBC for 3/2023 and 4/2023. When they try to run 5/2023, they get the Review is Due error message. This means the newborn is still Pending in 5/2023.

  5. The worker should set the task they are working (Review, Add a Person, etc.) with a due date for two days before the Review Discontinuance Batch.

  6. If the review ISN’T returned, the worker could run EDBC for 5/2023 and Discontinue the other family members for Failure to Return Review & continue the baby on. This would establish a new RE Due Date & set up Reconsideration Periods for the other family members.

  7. If the review IS returned, worker needs to process Review using regular processing and void the Future Dated Task that was created.

 

New App Received to Move 19-yr old to Their Own Case in Review Due Month on Existing Case

  1. Using normal business processes, work coverage request for the 19-yr old on their own case in the come-up month.

  2. On the existing case where the 19-yr old has coverage, the worker will need to update the Customer Reporting Record to Received.

  3. Run EDBC using the RE Run reason.

  4. Ensure notices are correct.

Example:

  1. Program has a RE Due Date of 4/2023

  2. On 3/20/23 the 19-yr old applies for coverage on their own case

  3. Worker adds the 19-yr old to their own case in 5/2023. When they attempt to run EDBC to close out the parent’s case, they get the Review is Due error message.

  4. The worker would need to update the Customer Reporting Record to Received, then run EDBC using the RE Run Reason.

 

New App Received to Move 19-yr old to Their Own Case & Review is Due for Other Family Members on Existing Case

  1. Using normal business processes, work coverage request for the 19-yr old on their own case in the come-up month.

  2. On the existing case the worker should set a Follow Up Needed task with a with a due date that matches the Due Date that displays on the household’s Review form. Staff should enter the following into the task details: “Holding for Review Due Date.”

    1. If the review ISN’T returned, worker will void the Follow Up Needed task as the Review Discontinuance Batch will run and close all members who are pending review on the case.

    2. If the review IS returned, proceed to step 3.

  3. On existing case if a determination CAN be completed within Timely Notice time frame, worker will need to void the Follow Up Needed task and work the Review task following normal business processes.

  4. If the Review IS returned but NOT able to be completed Timely, staff will need to update the CE Dates for all Active MEMs on the program who have received benefits past the Review Due date. Worker will also need to Update the Program Review month. CE Dates and Program Review Month should be set to the last day of the current system month.

NOTE: For instructions on how to edit CE dates and the Program Review Due date, see Updating Individual Continuous Eligibility and Review Dates.

  1. Use the RE Run Reason when running EDBC for the come-up month. This establishes a new Review Due date or Reconsideration Period for the program.

  2. Ensure Notice is correct.

NOTE: Follow existing process for adding consumers to overpayment spreadsheet.

 

Example:

  1. Program has a RE Due Date of 4/2023

  2. On 3/20/23 the 19-yr old applies for coverage on their own case

  3. Worker adds the 19-yr old to their own case in 5/2023. When they attempt to Negative Action the 19-yr old from the family case in 5/2023, they get the Review is Due error message. There are other Active family members who are due for a review & it has not been returned.

  4. The worker should set the Follow Up Needed task with a due date for two days before the Review Discontinuance Batch.

    1. If the review ISN’T returned, void the Follow Up Needed task and the Review Discontinuance Batch will close coverage.

    2. If the review IS returned, worker needs to process Review using regular processing and void the Follow Up Needed task that was created.

    3. If the review IS returned and NOT able to be completed timely, worker will update the CE Dates and Program Review Dates for all Active Mems.

 

Only Active MEM has Review Due and is Deceased

  1. Worker will need to update case using normal business processes for Date of Death being reported.

    1. Refer to Discontinuing Benefits Due to Death (ks.gov)

  2. Update the Customer Report Record to Received.

  3. Run EDBC using the RE Run Reason in come-up month.

  4. Ensure Notice is correct.

Example:

  1. Program has a RE Due Date of 4/2023

  2. Consumer passed away in March or April

  3. Worker runs EDBC in the come-up month and they get the Review is Due error message.

  4. Worker should update the Customer Report Record to Received, then run EDBC in the come-up month using the RE Run Reason.