11182022 Dispatch

November 2022 Medical KEES Release Q & A'S PM Session

Topic

Question

Answer

Additional Information

Are these review period notices going to show up on NOA’s from here on out? Also, will they be on the v200 when we have to send that?

Program Level Review Due Dates

Would MSP have a 12-month set for CE?

MSP is not a CE program; however, the person level review would be set to 12 months for the consumer.

While running EDBC, eligibility staff should be ensuring that the review due dates are accurate prior to accepting EDBC, correct?

Yes, correct.

When we have a PA and SP on one PB and open SP on new PB for LTC, will KEES recognize the review date on the shared PB and carry that same review date to the new PB?

For LTC, no. This is because that is actually a new request for coverage and what’s going to happen is your new program block is going to get their 12 months of coverage for that program request.

Why is Dylan’s Program Level Review left as is? And Person level review?

Technically, everyone has a personal level review due date. It just so happens that anyone who is SSI gets what’s called a no review type in KEES. And so that may feel funky to y’all to see a person level review due for an SI person when they get the ‘no review’ however, if you’ve ever looked at an SSI program block and that’s the only coverage on it, they actually do have a program review due date. And really, that’s just our batch doing a check, running to make sure we have everything we need, and if not, you’ll get a fallout task to let staff know they should go look at that as something may have happened with this person.

Does the HH individuals listed on the review shift depending on who is person level due for review at the time the program review is sent?

For clarity, you’re saying the individuals listed on the review form, is that going to change based off of when they’re a person level review is due if the whole program is due right? So, in this scenario, we’re actually going to let everybody in the household. That’s what we list on reviews and that’s how we will continue to list on reviews when we actually start sending those out, if that makes sense. It would just be in this scenario we’re going to pretend that Esther is actually also PLN. And if they did not return the review, then we would just bump them out and make Dylan our next one. But we would have listed both Esther and Dylan on the review, but because his CE is future (and he’s not technically due) we would bump him out.

Will batch still send out the review to SSI and other ‘continued coverages’ asking if the HH has any changes?

We’ll still send out the review to SSI and other continued coverage programs asking if the household has had any changes and that is what’s called a passive review, versus a super passive or an overview. SSI gets what’s called an overview, and so they actually will just get a NOA saying we’ve approved your coverage and it continues. A passive review would send out the form saying ‘Here’s what we counted. Is this still correct? Please return this if it’s not.’ I know it can be a little tricky getting into the different types but there is a difference between a passive and an overview.

Clarification on Becky’s question: If person is reviewed and it is determined that they are over income and closed for them. The person B will continue until their review month is run to be closed at time if they are still over income?

Yes Laura, their CE period will protect them in regard to being over income until their CE has ended. At which point we would send another review for that child to be determined.

I don’t understand how do you get the program level review due dates?

The program level review due date is what you all see, know, and love today.

Can you repeat what you just said?

You’re going to see their person level review due date stay the same, unless a review is turned in. OK, if a review is turned in and you’re able to run with RE and process, then yes, you are going to see that new one from the review being processed 12 months from that. If they do not turn it in, you’re then going to see that person kind of hand out and go to the program to adjust that person level.

Thoroughly understand that this topic Christie is covering right now (person level review due date) will absolutely be impacting what you were processing come Monday morning (11/21/22). This part right here is specific to even just processing an application. So it is not specific to when you’re processing a review, so help desk will be looking to see if anything is wrong come Monday from staff to report it. Which means it’s really important if staff understand when your person and program level review due dates update or when they’re updating when they shouldn’t so that you guys would know what to report to us if something isn’t working right when we get this turned on. So it’s really important everybody understands that this will be functionality that will be happening come Monday.

What happens if the reviews batch has already run and the review has been sent out before a change occurs that would have potentially changed the program level review due date?

We actually have a check that will see if the review due date has already had reviews sent and if so, will bump the review due date out one month to ensure the household receives the review as intended.

Rachelle hit that on the nose there and Jen K is right. So, for example, right now, I’ve already ran reviews for December. So if you’re running and EDBC and it says that the review should be do in December, you guys are actually going to see that review “bump out” to January, and going to be like, hold up that doesn’t make sense. That’s just how it is, the magic. If the reviews batch has already run and the review has been sent out before a change occurs, that would have potentially changed the program level review due date and my answer is great question. We have a check that we’ll see if the review due date has already had a review sent, and if so, we’ll bump the review due date out one month to ensure the household receives the review as intended.

Do we need to add both person and program level review dates in the journal?

Policy: When talking about journaling, there are already policies in place regarding case documentation, this will be formally sent to Operations for an answer as this is regarding the Journal Pro which is owned by the Technical Trainers at KDHE. Please revert to Operations/Business for additional information.

So does person level review dates effect ED coverages?

We’re now going to see what was always in the background for our elderly and disabled programs. We’re going to see a personal review of 12 months. When you all are adding MSP to a MDN coverage or something like that, you aren’t going to see a change. More often than not, we’re just going to see a flat out 12 months of coverage over and over again.

To make sure I understand, EDBC won’t send out a review until it is due for each consumer, correct?

That is correct, we’re actually going to send a review out when the program is due for a review. So in this example originally we would have sent a review in March when we closed Lucas. Now we recognize that the next program review is actually July and so we’ll send it in July. We’re going to see that program review adjust based off of when our next consumer has a review due. You are going to see less person level review adjustments and more program level based on when it’s due. Person lvl won’t change as much, but program lvl is where you will see this change.

(Regarding pages 39-41 of the webinar PDF) Your due date is what you see today, it’s not necessarily new. I think this is just the first time that we’ve ever explain to you guys how it gets determined. In the background, when y’all can see there was personal review due dates the whole time, and for those members who are CE aid code, it was easy to kind of picture; ok, that’s their CE. That is of course when they’re “personal review” would be due right, we can kind of see that relationship between how CE might impact our review due date. It’s actually what you guys see today. From our PLT kid (page 41 webinar PDF): right here in KEES today if y’all had the scenario and I know we’re in PHE, but you know, we’re getting out of that. Ok, we’ve added kids at different times, right. You guys will see this; then all of a sudden we’ve got another kid coming in. So they have varying CE dates. And the reason why I’m going to talk in CE form is because you all can see it and make that correlation. So here we have Lucas with the CE date of 03/2023. When you have a CE aid code, that is actually what your person level review date is equal to. Ok, so when we see person level review due date of 03/2023, that’s also Lucas’ CE; and when we add Caden, we see his CE as 07/2023. Now, we’re also going to see that as his personal review due date. So right now in KEES IF WE WERE TO CLOSE Lukas where the program level review due date, the review due date that you all see was equal to 03/2023 because that was our next CE. If you were to close Lucas now, it would stay that date and that’s not actually correct because we don’t have anyone on the program that ha a CE equal to them. Kaden is good till 07/2023. So how KEES previously worked is that we would send them a review in March of 2023 when they didn’t actually have anybody that needed to be reviewed; and at what point we could review them, they turn it in. That’s all fine and great, but then if they didn’t then we would leave Kaden open and send him another review due in July, when the actual review was due. So now what KEES is doing is it’s saying we’re going to not only show you all of our review due dates for everyone that was always behind the scenes. We’re now going to adjust this to always make sure that we are aligning this little guys’ review with our next review due date. So we’ve kind of made EDBC smarter and more consumer friendly at this point. Also economically friendly, because then we’re not sending out 20 page review forms to these consumers every few months, even though they shouldn’t really have a review due. Does that help, kind of explain, what’s happening?

Regarding pg 45 of Nov 2022 Webinar PDF: So I know normally we say that the 19 year old we are not going to match the review due date to the 19 year old and I would like to give an explanation to that and the explanation is actually that if everyone else in the household has a CE later than the 19 yo when we run the CH turns 19 batch, we'll send that child their own application letting them know that they do need to apply on their own behalf. And so we would like to let the rest of our household continue to receive benefits until the end of their normal CE period without anextra hoop to jump through, and so the CH turns 19 batch would typically close that child on their program and send them an application letting them know they need to apply on their own behalf; that's typically why we don't consider a 19 yo when determining the programs review due date. There is an exception to that and that, and this happens to be if the 19 yo CE date does not match the month they're considered 19. Then we will consider that person's CE period or review due date when determining the program review due date. So, for example, this PHE where we've had to override the CE to allow our 19 yo's to continue toreceive beneefits. Another example would be if they happen to be pregnant. I mean, so we have a pregnant 19yo continuining to receive thier postpartum period for the additional 12 months and that is another one that we will consider there review as the next possible review due date. so I don want to point that out; that if the 19 yo for some reasion is receiving coverage beyond their 19th birthday, then we are not g oing to see that review, then we will see that review due date considered.

PHE & KEES

Will consumers be given notice when PHE is ending?

Policy: There will be some sort of program review/redetermination post PHE when the official word comes out PHE is ending. Anyone who is currently receiving benefits through Kansas Medicaid will go through some sort of redetermination post pH when The Health and Human Services Secretary has officially declared the PHE over. And at that time they will, they will get a some sort of a renewal/redetermination depending on how you are used to hearing it. And at that time we will determine if they are either eligible for continued benefits or if they will be discontinued at that time. So they will get some sort of notice. Now if you're asking specifically for just going to send them a notice saying hey, the public health emergency is over, I have not heard of anything like that in the works but, As we all know, the the PHE continues to roll on and our leadership is continuing to work with policy systems and even CMS to issue guidance to all States and the consumers as information is known. So that's kind of that in a nutshell. Does that answer your question? I got a thumbs up, so that's the policy response on that one.

Rescind without Review

Would she still have to turn in the review or fill our a new application?

It's probably going to be best you know to give an example of what this would be. Let’s say a review was due and we happen to also get a request like a niece/nephew has moved into the household or something like that; and I would like to put a disclaimer here. Yes, majority of the time, if somebody is going to give us a request for new coverage and that happens to be somebody who's part of their IBU, we would get enough information that we should process the review. I'd like to put that disclaimer out there. If for some reason, though, the request for coverage is happens to be separate, it's not the same IBU. We don't require the same information. This functionality would allow us to go ahead and process the request. For the new person, provided we do not need the information that we would have needed to process that review or a paper application of some sort does not come in. That could count as the review. So this is truly one of those scenarios where then we can still protect our other people and allow them an oppportunity to still get that information turned in. Does that help?

Clarification follow up: So you're saying that we that Maya doesn't have to turn in the review or a new application? Just provide us with the information we would need to add Medicaid for her pregnant sister. But we would just be doing that for the pregnant sister, but if Maya and her child wanted it. They'd have to turn in the review.

Yes, exactly.

Policy: For add member requests received during the COVID-19 PHE, please refer to PC0222-02-01.

Run without Review

Would she still have to turn in the review or fill our a new application?

It's probably going to be best you know to give an example of what this would be. Let’s say a review was due and we happen to also get a request like a niece/nephew has moved into the household or something like that; and I would like to put a disclaimer here. Yes, majority of the time, if somebody is going to give us a request for new coverage and that happens to be somebody who's part of their IBU, we would get enough information that we should process the review. I'd like to put that disclaimer out there. If for some reason, though, the request for coverage is happens to be separate, it's not the same IBU. We don't require the same information. This functionality would allow us to go ahead and process the request. For the new person, provided we do not need the information that we would have needed to process that review or a paper application of some sort does not come in. That could count as the review. So this is truly one of those scenarios where then we can still protect our other people and allow them an oppportunity to still get that information turned in. Does that help?

Clarification follow up: So you're saying that we that Maya doesn't have to turn in the review or a new application? Just provide us with the information we would need to add Medicaid for her pregnant sister. But we would just be doing that for the pregnant sister, but if Maya and her child wanted it. They'd have to turn in the review.

Yes, exactly.

Policy: For add member requests received during the COVID-19 PHE, please refer to PC0222-02-01.

Run without Review

(Example from Pg 14 of Nov 2022 Webinar PDF): So this would be the run reason used for the previous example?

That is correct. It means (for this example), that when adding Ella we would use run without review because we have not received her review yet for Mia & Max, we have Ella who is pending because she's pregnant and needs coverage and she's not in Mia & Max's IBU. And we've also rescinded Max's program block using rescind without review. Excellent question.  

EDBC & Negative Action Error Messages

In which data base is the list of error's in and what exactly is the page called? KEES UM, KanShare, etc.

This list will be in the KEES UM.

It will be the EDBC Warnings page in the KEES UM.

Is the Customer Reporting Record the same as the Review and IR/12 Month Reporting List page in KEES? My worker has not heard that term before.

That is correct.

NOA's

What does NOA stand for?

Notice of Action

What does RE stand for?

Review

When it comes to the NOA's right now, since we aren't doing reviews, do we need to amend or edit the NOA to get rid of the review info?

No, we should not edit the NOA to remove that.

Do we know when the Rights and Responsibilities will be included in the NOA's again?

Yes.

Helpdesk: I wasn't aware that they weren't in the NOA. I'll need to look into that. Are we sure you mean NOA's and not Forms? Just want to be clear.

Program Level & Person Level Review due Dates

I am guessing the MAGI cases see more person level review dates than E&D cases will?

Actually everybody will see a person level review due date. They are not synonymous with CE dates.

If you happen to have a CE period that goes with it, then yes, your CE end date would match your person level review due date, but everyone would have a person level review due date except for SOBRA which is at the bottom of the slide here, they'll handle it a little bit different. So even your E&D cases will have a person level review due date. It's typically just going to be set to for your 12 months; typically TB gets your 6 months.

Follow up from previous question: Even SSI?

You're correct, there is no CE period that is set for SSI. However, SSI folks that aid code does get a person level review due date and a program level review due date. We just don't actually send out reviews for SSI recipients they received what's called a no review review, but they do still get picked up by your reviews batch.

Do our AGO consumers still get a CE set for them? As we all know they get coverage until their 26th birthday, is there anything in the works to set those out for their 26th birthday month?

Helpdesk: Yes, but it has not been corrected yet. So we haven't corrected the age piece of it yet but once Christie gets a little bit further here she'll tell you how the person level review will work with any of those folks where you have to do an override on.

After this build will show, do we use the PHE date or the Review due date in our journal?

Policy: You'll follow Journal Pro; Policy doesn't have a specific requirement for how to journal the review period.

So why would the person level review date be different than the program review date?

On your LTC type cases where you only have 1 person on the program, the person level review will always match the program level review.

(Surrounding example on page 34 of PDF): Even though there are 2 different review dates, they can send them both in by the first date, correct? Even though Donald and his son are showing different review due dates?

Say they sent a complete review in 04/2023, KEES will automatically try to do a review for both of them. So let's say Donald qualifies for the exact same coverage or better coverage than Donald, KEES will actually go ahead and review at that time with Adam. When you use the RE run reason, it will actually then sync the two of them together if they both qualify for coverage again so that they don't have two different review due dates. However, if Donald does not qualify for at least as good a coverage as he's currently getting, then a review won't actually be processed on Donald. Donald will just stay status quo. We'll keep the 06/2023 person level review and CE because you can't change benefits to something worse before that CE period ends.

So the program level review date matches her program level review date?

Yes.

This is an example of something you'll expect to see today when you have a person who's open and active. There's already a program level review due date set to January. You get a request to add a person to a program. You add them in, they get a 12 month CE period set for them and nothing else changes. So this would be exactly like it would be today.

So it doesn’t acknowledge the SSI no review?

When the reviews batch runs and sees that Dylan's CE is in the future and that Esther has SSI, it actualy going to determine a most comprehensive review type of likely super passive and it's going to run EDBC and go ahead and give them until Dylan's review period. But actually, that's how it's worked all along. Now what's it's going to do is see if Esther and Dylan are still eligible and align them to be 12 months when we run with RE through the review batch. So it does see the SI no review, just not right then because we're still going to do the no review type when we run the reviews batch in January of 2023. I hope that answers a little bit.

When adding this to the journal would Dylan's CE date be 06/2022-05/2023 or through 01/2023?

Right, so his CE is 05/2023 if you notice, that's not his person level review. That's the program level review and you can only have one program level review. You can have multiple person level reviews. Every single person on your program block is going to have their own person level review, but then it's going to take the shortest of those to figure out what your program level review is. so the CE periods weren't touched with this.

Is this unless it gives Dylan a lower coverage than his current coverage?

Yes, that is correct; and then he would just stay on his 05/2023 CE. Great callout.

Why would Dylan's Program review due date be 01/2023?

Think of the reviews as little Russian dolls. So you've got the program review and it just has all the little people reviews inside. That's a good metaphor for it.

So would we do a Review in January and then another review in 05/2023?

So would we do a review in January and then another review in five of 2023, it is possible that yes, that could happen. Johnny brought up a good point and that's why I wanted to call it out if when the reviews batch goes to run in January of 2023 and it determines for some reason Dylan is no longer eligible or perhaps their income has changed enough that he is now PLT, his CE is going to kick in and protect him and keep him with the CE period of 05/2023. At which point then the next program review would be 05/2023. This is actually how KEES works today. That is not a change, it's just that we are now showing you how we're figuring out what that review due date is.

(Regarding scenario on page 40 of PDF): Why on Lukas, it's 03/2022-03/2023, but on Kaden it's 08/2022-07/2023? Do you use the same month (like 3) or the month earlier (like 7 instead of 8) on the slide before this one?

That's because he's PLT. That's why you're actually seeing it from 03/2022-03/2023, because they need to get 12 full months of coverage. So it appears that's it's 13 months, but it's not.

What if Lukas has a change in coverage?

I would like to remind you guys if they are a CE aid code their person level review due dates follow their CE. So if their change in  circumstances resulted in a new CE period with a different set of dates being created then yes, we would see his person level review due date change.

Will the new review display on the case summary?

Yes, this new review due date, we're actually going to see not only on the case summary, but in the EDBC result. So we're going to see it as the person level review due date and the EDBC program level review due date. This date will display in the upper left corner of your program block as well as when you open the caret to expan the program block coverage details.

So I hope this makes sense to everybody. We have just kind of made EDBC smarter and do a little bit more of the intuitive thinking for y'all. The point here is to make sure that we are getting the most accurate and correct review for this program based on when these people need to be reviewed so that we can e inline with MEQC guidelines as well as CMS.

GREAT QUESTION FROM 1ST SESSION: What happens if the reviews batch has already run for that month and we already sent the reviews out befor this occurs?

All the time today it falls on a spreadshet for me to deal with and it's annoying; so never happeir when KEES can now account for it. So what actually is going to happen is if KEES has already mailed a review for March, KEES is going to see that. It's going to say "BOOP, Did we already run reviews batch?" and if that  answer is yes, it's going to say I can't set to this date and it's going to bump them out one month.

Since the premiums were paid timely/quickly there's no gap in coverage correct?

That is correct because they paid the premiums before the actual end of the month they were discontinued. So in that scenario, we had actually discontinued them effective 10/31 and she made the payments 10/28. We're able to negate the premium penalty and reinstate her coverage without an application.

Why not just put them on their own case and notate somewhere that they are related to each other like the relationship page?

Well because the 2 slides beforfe this, we explained to you guys that we wouldn't consider 19 yo's when determining our program review. That's because they're going to be picked up by the CH turns 19 batch. We are only going to consider the 19 year old exception. I guess that's what I'll call it, a 19 year old exception when the CE period is equal to the month that the consumer is turning 19. This will allow us to be able to apply policy as needed. So in these scenarios where they need to continue past their 19th birthday then we know, oh, we actually do need to consider them. Let's take an example where perhaps we have an 18 year old who's actually a parent and their CE is going to be based off of getting a caretaker aid code versus a child aid code that we need to consider. You guys can think of all the different examples when a 19 year old is not actually considered a 19 year old in terms of turn 19 and losing eligibility, and so we do consider their personal review as the next one if their CE is not equal to the month they turn 19.

What about an existing program block that is not in use?

Please see the Usable Program Block - Medical page in the KEES UM for additional information.