There are some situations where a Penalty Period may not be established for the correct months. When one of these situations occur the steps below will walk the user through the process of updating the Penalty Period so that the correct information displays.
Historical Penalty Periods that have already been served. If staff identify a case where a penalty has been served, but KEES is denying eligibility and establishing a penalty for the same delinquent period (or the same delinquent amount if the delinquent period is not known).
Penalty Periods that started between March 1, 2016 and May 1, 2016. If staff identify a case where a penalty began between March 1 and May 1and the penalty record has not already been added to KEES.
Processing reviews where a consumer goes from Medicaid to CHIP and has a premium delinquency.
NOTE: In all instances, EDBC should have been Accepted and Saved and the CHIP children Denied/Discontinued.
Click the View Details button in the appropriate Medical Programs block.
Click the View Penalty History button in the Program Information block on the Medical Program Detail page. The Premium Penalties History page displays.
Click the Edit button for the penalty period that needs to be updated. The Penalty Period Detail page displays.
Update the following information as is necessary:
Penalty Start / Penalty End - These fields reflect the start and end date of the three-month penalty period. Use the <mm/dd/yyyy> format or the calendar icon and always reflect the first day or last day of the month.
Penalty Amount - This is the amount that the household was delinquent at the time the penalty was imposed.
Delinquent Month Starts / Delinquent Month Ends - These fields reflect the benefit months for which the premiums were not paid. Use the <mm/dd/yyyy> format or the calendar icon and always reflect the first day or last day of the month.
NOTE: If the delinquent months are not consecutive then the Delinquent Month Starts field should reflect the start of the first month and the Delinquent Month Ends field should reflect the end of the first month. The Is there a break between Delinquent Months? field should be used to start another month.
Is there a break between Delinquent Months? - This field is used to indicate a break between the delinquent months.
Example: The first delinquent month is January 2016 and the second delinquent month is March 2016. These display as 01/01/2016 - 01/31/2016 and then a second line of 03/01/2016 - 03/31/2016. The delinquent months could also span a larger time frame.
Example: Delinquent from January 2014 - May 2014 and then December 2014 - March 2015. These display as 01/01/2014 - 05/30/2014 and then a second line of 12/01/2014 - 03/31/2015.
Leave the Status as Active.
Click the Save and Return button to return to the Premium Penalties History page. If the Penalty Period was updated to reflect a historical penalty (served penalty), proceed to STEP 7; otherwise the process is complete.
If the record was updated to reflect a historical penalty, then the Update Penalty Period for Non-Delinquent Premiums Batch picks the case up and updates the status to Served. It also updates the Delinquent CHIP Premiums indicator to ‘No’ and clears out the Delinquent Amount field.
Rescind the CHIP Denial/Discontinuance and delete the system generated NOA.
The case (task) needs to be placed on Hold until the next business day so the Batch can make the updates.
When the case (task) is picked back up for processing, any CHIP approvals that had to wait for the Batch to run will require a CHIP Start Date override at EDBC, to backdate CHIP eligibility to account for the Batch to run.
Example: Today’s date is Monday 4/25/2016. I process the case as far as I can and update the CHIP Penalty Period. I place my task on Hold until tomorrow. When I run EDBC, the CHIP Start Date will be set to 4/26/2016. The CHIP Start Date should be overridden to 4/25/2016.