These instructions work if the incorrect base is accepted, starting in the wrong month.
NOTE: These instructions do not apply if the incorrect base period has already been updated to KMMS. If the incorrect base period is already in KMMS and needs to be changed, please contact the KEES Help Desk.
Reminder: Staff should remember to check the spenddown base period dates in KMMS prior to setting up a new spenddown base period.
Example: The consumer has a spenddown base period from 03/2024-08/2024. The user Runs EDBC for 10/2024 in error and sets a spenddown of 10/2024 to 04/2025. The spenddown base period begins 09/2024 and runs through 02/2024. The worker confirms that the incorrect base period has not been updated to KMMS yet. Complete the steps below (under User Sets a Spenddown Starting with the Wrong Month) to correctly set the spenddown base period.
For all scenarios in the table below, start at STEP 3 (found below under User Sets a Spenddown Starting with the Wrong Month).
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Scenario 1:
A child (CH) active on Poverty Level Child or Newborn (PLN) is now eligible for Social Security (SSA) starting in 02/2024 and needs to be placed on a spenddown. CH was receiving PLN coverage, which ended in the Kansas Modular Medicaid System (KMMS) on 02/29/2024. Medically Needy (MDN)/Spenddown coverage does not begin in the month of application, 02/2024. MDN/Spenddown coverage begins in 03/2024 because the CH is active on PLN coverage in the Family Medical (FM) program block. The 6-month base period is approved based on the first month of eligibility (03/2024 - 08/2024). Any month before 03/2024 (including the month of application) is denied due to already received coverage (PLN that ended 02/29/2024). |
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Scenario 2:
A 6-month spenddown is approved on 10/12/23 for 11/2023-04/2024, and the case is closed due to failure to return review on 10/19/23. The case is rescinded on 12/23 for the month of 11/23 because the review is late. Because coverage for 11/2023 was not sent to KMMS, the expected result when running 11/2023 is the spenddown matching 11/2023-04/2024 (which was approved when EDBC ran on 10/12/2023). If KEES is attempting to set any other spenddown, a Help Desk ticket needs to be submitted. |
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Scenario 3:
A consumer is released from Long Term Care (LTC) in 02/2024, but the change is not processed until 08/15/2024. A spenddown needs to be determined in month following the discharge date (03/2024 - 08/2024). The months that overlap with full Medicaid are paid months (due to untimely processing). The full 6-month spenddown amount begins in the first unpaid month (09/2024). Please see the KDHE Processing Deadlines Code Card to determine the first unpaid month. A new 6-month base period begins 09/2024 - 02/2025. |
NOTE: If the spenddown is already established in KMMS and the EDBC result does not match for the month EDBC is run, contact the KEES Help Desk. If directed by the Help Desk, start the override at STEP 3.
Using a Negative Action, Run EDBC to Discontinue the program for the month the spenddown started in error. Accept and Save the EDBC result to close the case. Delete the Discontinuance NOA.
Rescind the application.
Select the View Details button in the Program Block.
Select the Edit button.
Click the Rescind button in the Program Persons section for the individual who needs to be rescinded.
Select a Rescind Reason of Rescind Disc/Deny.
Click the Save and Return button twice to return to the Case Summary page.
Run EDBC for the correct month in which the spenddown begins.
For Scenario 3 above, Run EDBC for all months (except come-up month) with the following:
Timely Notice Exception: Yes
Reason: LTC Late Change
Click the Medical hyperlink with a Run Status of Not Accepted on the EDBC List page. The Medical EDBC Summary page displays.
Click the Medically Needy hyperlink to check the spenddown base period dates.
If the spenddown base period dates are correct, click the Close button to return to the Medical EDBC Summary page. Skip to STEP 15.
If the spenddown base period dates are incorrect, the spenddown Begin and End Dates need to be overridden to the correct base period. Continue to the next step.
Click the Close button. The Medical EDBC Summary page displays.
Click the Override Medical Summary button at the bottom right corner of the page. The Medical EDBC Override List page displays.
This allows the user to manually set the correct spenddown amount and base period Begin and End Dates.
Click the Override button for the Medically Needy Test Category. The Medical EDBC Override Detail page displays.
If the amount is incorrect, enter the correct spenddown amount in the Premium/LTC Liability/Spenddown field.
Enter the first day of the first month of the correct Spenddown Base Period in the Start Date field using the <mm/dd/yyyy> format or the calendar icon.
Enter the last day of the last month of the correct Spenddown Base Period in the End Date field using the <mm/dd/yyyy> format or the calendar icon.
Click the Save and Return button. The Medical EDBC Override List page displays.
Select EDBC Override Reason of Administrative Decision; then click the Save and Return button. The Medical EDBC Summary page displays.
Click the Medically Needy hyperlink. Check the spenddown base period dates. Click the Close button. The Medical EDBC Summary page displays.
If the result is correct, click the Accept button. The EDBC List page displays.
Click the Save and Continue button. The Case Summary page displays.
Run EDBC for each month through the come-up month, following STEPS 3-16. Save the results.
Send the appropriate NOA/Form and create a Journal entry.