Voluntary Contributions Added to KEES

Use the following steps when adding a voluntary contribution to ensure financial calculation is correct in KEES.

For Institutional coverage (including institutional PACE), the Voluntary Contribution shall be entered in KEES with an income type of “Other – Exempt”. The income will then be included in the patient liability determination but excluded when determining MSP eligibility and the 300% special income limit.

For HCBS and community PACE coverage, the Voluntary Contribution shall be entered in KEES with an income type of “Other – Countable”. The income will be correctly included in the determination of client obligation or participant obligation.

NOTE: When QMB is discontinued due to voluntary contributions, use the following business process.

EDBC Override when QMB is discontinued due to Voluntary Contributions

1. From the Medical EDBC Summary page, click the Override Program Configuration button.

2. On the Program Configuration page, update the following fields:

   1. EDBC Override Reason: Administrative Decision.

   2. Program status: If the program block has a discontinued or denied status, please update this field to Active. Otherwise, leave blank.

   3. Update Reporting Type: Semi-Annual Reporting. This field is required.

3. Click the Override button next to consumer who needs information updated.

4. On the Program Configuration Override Detail page in the User Override section update the following fields:

   1. Role: MEM

   2. Status: Active

   3. QHP Screened: NO

   4. Claiming Code: Federal

   5. Status: leave blank

   6. Role Reason: leave blank

   7. Adult Child Code: leave blank

5. Click Save and Return button.

6. On the Program Configuration Override List page, click the Save and Return button.

7. On the Medical EDBC Summary page, click the Override Medical Summary at the bottom of the page.

8. The Medical EDBC Override List page displays. Next override a new budget.

9. Overriding a budget:

   1. From the Medicaid EDBC Override List page click the Override button.

   2. From the Medicaid EDBC Override Detail page, in the User Override complete the following fields:

      1. Test: Ensure that the appropriate Test Category is: Medicare Saving Plan

      2. Test Result: Pass

      3. FPL%: Leave as is.

      4. Premium: if applicable

      5. Start date: First day of the month EDBC is being ran for.

      6. End Date: Last day of the month EDBC is being ran for.

   3. In the Individual Budget Unit (IBU) section complete the following fields:

      1. For the individual

         1. Person: Name of individual

         2. Role: MEM

         3. Aid Code: Select the appropriate Aid Code:

            1. Qualified Medicare Beneficiary

      2. If LTC Details need to be added, select Add under the LTC Details section.

      3. The Medical EDBC LTC Override Detail page displays.

         1. Override Applies to: if applicable

         2. LTC Type: if applicable

         3. Living Arrangement: if applicable

         4. Living Arrangement/ HC Level of Care: if applicable

         5. Living Arrangement/ Level of Care End Date: if applicable

         6. Liability $: if applicable

         7. Resource: if applicable

      4. Select Save and Return.

   4. Click the Save and Return button to go back to the Medicaid EDBC Override List page. Continue to step 10.

10. The Medical EDBC Override List page displays again. Now the budget has been created. Check the box next to the budget and click Save and Return.

11. The EDBC Medical Summary page now displays showing the newly created budget for our consumer. Click the Accept button.

12. The EDBC List page displays. Click Save and Continue button.

13. Create a Journal using the Journal Pro and put the following approved Journal language in the Additional Information section:

    1. “VC KEES business process used as VC shall not adversely affect MSP eligibility per PM2019-12-01. MSP coverage updated to pass per KEES UM Instructions.”

14. If necessary, create a manual Form using the Standard Copy and Paste spreadsheet; as an overridden EDBC will never create a NOA.