Review Due: Business Process for MDN SDs and LOC Changes (L3 WA)

These processes have been created to send coverage to KMMS past the review due month on non-MAGI cases and should be used specifically processing changes when:

• The review has been sent and not yet returned, and L3 has not yet run,

OR

• The review has been received, but a full determination cannot be completed without additional information.

Please note, this does not apply if the Review Discontinuance (L3) batch was previously run but the program did not appropriately close for failure to return the review (i.e., skipped reviews). Those cases should be discontinued if a review was sent and not returned.

NOTE: Super Come-up month refers to the month following the view month on the Case Summary Screen.

Establishing a new base period pending Review Due or Review Processing

The following instructions apply to cases that need a new base period established that would normally require running EDBC with RE-Run Reason.

1. Take note of the Review Due month on the applicable program block.

2. Update the Review Due month on the applicable program block in KEES to the month following the Come-up month or Super Come-up month (if available) on the EDBC page.

   1. Go to Case Summary and click View Details for the applicable program block.

   2. Click .

   3. Change the Review Due month to the month following the Come-up month or Super-come up month.

   4. Click Save and Return.

   5. A Warning Message will appear; re-enter the Review Due month based on the instructions in c (see above).

   6. Click Save and Return.

3. Ensure Review Due month on the applicable program block matches the actions performed above.

4. Run EDBC starting the first month that the new 6-month base period needs to be established through the Come-up month (if applicable).

5. Save and Accept the results.

6. Update the Review Due month back to the original Review Due month.

   1. Go to Case Summary and click view details for the applicable program block.

   2. Click Edit.

   3. Change the Review Due month back to the original month.

   4. Click Save and Return

7. Ensure Review Due month on the applicable program block matches the original Review Due month.

Level of Care Change Pending Review Processing

The following instructions apply to cases that have a change in the Level of Care in any month that would normally require running EDBC with RE-Run Reason

AND a review has not yet been returned

AND the Review Discontinuance batch (L3) has not ran yet.

This is also applicable when the review has been received, but a full determination cannot be completed without additional information.

NOTE: These directions are not applicable if going from a program with a higher resource limit to LTC.

1. Take note of the Review Due month on the applicable program block.

2. Update the Review Due month on the applicable program block in KEES to the month the following the Come-up month or Super come-up month (if available) on the Run EDBC page.

   1. Go to Case Summary and click View Details for the applicable program block

   2. Click Edit.

   3. Change the Review Due month to the month following the Come-up month or Super-come up month if available.

   4. Click Save and Return.

   5. A Warning Message will appear, re-enter the review due month determined in c (see above).

   6. Click Save and Return.

3. Ensure Review Due month on the applicable program block matches the actions performed above.

4. Run EDBC starting in the first month the LOC changes need established through the Come-up month or Super-come up month if applicable.

5. Save and Accept the results for each month.

6. Update the Review Due month back to the original Review Due month.

   1. Go to Case Summary and click view details for the applicable program block.

   2. Click Edit.

   3. Change the Review Due month to the month following the Come-up month or Super-come up month if available.

   4. Click Save and Return.

7. Ensure Review Due month on the applicable program block matches the original Review Due month.

Timely Received Reviews Discontinued by Review Discontinuance Batch (L3)

The following instructions are to be used when coverage has been discontinued due to failure to return review when the review was returned by the end of the review month but must pend for information to process the review. Verify a signed pre-populated review form was received in the month it was due or prior.

1. Rescind the discontinued program block. (https://content.dcf.ks.gov/ees/KEESWebHelp/Rescind_Program_-_Medical.htm)

2. Go to Case Summary and click View Details for the applicable program block

   1. Go to Case Summary and click View Details for the applicable program block

   2. Click Edit.

   3. Change the Review Due month to the month following the Come-up month or Super-come up month if available.

   4. Click Save and Return.

   5. A Warning Message will appear, re-enter the review due month determined in c (see above).

   6. Click Save and Return.

3. Verify previous coverage being received prior to discontinuance.

4. Ensure Review Due month on the applicable program block matches the actions performed above.

5. Run EDBC starting in the first unpaid benefit month through current available month or Super Come-up month if available to reinstate coverage with correct base period matching.

   1. Ensure  there are no negative changes from previous coverage. If there are negative changes, adjust records to maintain coverage.

   2. Save and Accept the results.

6. Update the Review Due month back to the original Review Due month.

   1. Go to Case Summary and click View Details for the applicable program block.

   2. Click Edit.

   3. Change the Review Due month back to the original month.

   4. Click Save and Return.

7. Ensure Review Due month on the applicable program block matches the original Review Due month.