EDBC will fail for current or past months when a consumer has PACE even if LTC Late Change is used for the Timely Notice Exception. EDBC must be overridden if a change is needed.
Example 1: Consumer submits an expense change 08/25/2020. This expense will need to be applied to the month 09/2020 due to this being a late change when running EDBC the results will be failed. An override is needed to apply the expense.
Example 2: A PACE consumer has been in a PACE nursing facility for a long term stay. They are discharged to the community on 10/28 and remain on PACE. The PIL will change from $62 to $1,157 for the month of October since there are days in the community. Since it is the current or prior month in KEES (depending on when it is worked), an override is needed to apply this change.
STEP 1: Enter all PACE Information from the ES-3166 into the LTC Data page. Ensure all other KEES pages are updated as appropriate.
STEP 2: Run EDBC for the month impacted by the change.
STEP 3: Select the Medical EDBC results for the Not Accepted EDBC.
STEP 4: On the Medical EDBC Summary page, select the Override Program Configuration button.
STEP 5: On the Program Configuration Override List select the Override button.
STEP 6: On the Program Configuration Override Detail in the drop-down Role select MEM. For the status drop down select Active. Role reason and Status reason need to be blank. Select Save and Return.
STEP 7: Update EDBC Override Reason to Administrative Decision. In the User Override section, select Active for the Program Status. Select Deemed Eligibility for the Program Status Reason. Select Semi-Annual Reporting for the Reporting Type. Select Save and Return.
STEP 8: On the Medical EDBC Summary, select Override Medicaid Summary at the bottom.
STEP 9: Select the Override button for the Medically Needy program.
STEP 10: In the LTC Details section of the Medical EDBC Override Detail page, select the ADD button.
STEP 11: Select the consumer in the Override Applies to drop down list. Select PACE under LTC Type. Select PC under Living Arrangement. Select NA under the Level of Care. Enter the first day of the month and the last day of the month for the month EDBC is being ran for. Enter the Obligation Amount and the Resource Number of the PACE provider. Select Save and Return.
STEP 12: On the Medical EDBC Override Detail page under User Override, select Pass under Test Results. Enter the first day of the month and the last day of the month for the month EDBC is being ran for. Enter the Obligation Amount. Select the Aid Code “Medically Needy- (Disabled or Age) below SSI Standard Cost Share” then select Save and Return.
STEP 13: On the Medical EDBC Override List page, check the box next to Medically Needy Pass and click Save and Return.
STEP 14: On the Medical EDBC Summary page, if the EDBC results read 300/DS/N/N PC/PC/NA or 300/OA/N/N PC/PC/NA, then continue to step 19. If the 300/DS/N/N portion does not appear, continue to step 15.
Step 15: If the 300 code did NOT appear, click the Override Medical Summary button on the Medical EDBC Summary page.
Step 16: Click the Edit button for the Medically Needy Pass row.
Step 17: On the Medical EDBC Override Details page select Medically Needy- (Disabled or Age) below SSI standard Cost Share then click the Save and Return button.
Step 18: Select the box for Medically Needy that shows 300/DS/N/N/ or 300/OA/N/N PC/PC/NA and select Save and Return.
Step 19: Click ACCEPT on the Medical EDBC Summary page. Click Save and Continue on the EDBC List page.
Note: These steps will need to be repeated to run EDBC for each month with a late change until the come-up month.