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Redetermination Module

Redetermination Module. Updated 12/02/2013. Objectives. Locate and Monitor cases due for Redetermination Schedule an early Redetermination Log in a Redetermination packet Perform the Redetermination Process Overdue and Not Logged Redeterminations. How to Take this Training.

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Redetermination Module

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  1. RedeterminationModule Updated 12/02/2013

  2. Objectives • Locate and Monitor cases due for Redetermination • Schedule an early Redetermination • Log in a Redetermination packet • Perform the Redetermination • Process Overdue and Not Logged Redeterminations

  3. How to Take this Training In order to access the hyperlinks in this PowerPoint, you will need to view it in Slide Show mode. If it opens from within PowerPoint (in Edit mode), please follow these steps to play the slide show: • On the bottom status bar, click the Slide Show icon. • If you cannot see the bottom status bar, click Slide Show on the top menu, and then click From Current Slide or From Beginning. • If you cannot see the PowerPoint interface, you may be viewing the presentation in Slide Show mode already.

  4. The Redetermination The Department of Human Services must periodically redetermine an individual’s eligibility for active programs. The redetermination process includes a thorough review of all eligibility factors. An ex parte reviewis required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 calendar days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories; see BAM 115 and BAM 220. A complete redetermination is required at least every 12 months. Bridges sets the redetermination date according to benefit periods; seeEligibility Decisions in BAM 115.

  5. Redetermination Periods 24 - month No Redetermination 3 - month 6 - month 12 - month * If a CDC group is active for other programs, Bridges will set the CDC redetermination date to be the same redetermination date as the other program if 12 months or less. ** A ex parte review must be completed before closing an individ­ual in one of these categories if the closure is for any reason other than total ineligibility for any MA (such as moved out of state or death). The ex parte review must consider eligibility in all other FIP and SSI related MA categories.

  6. Redetermination Period Exceptions Newborn MA - Newborn cases must be scheduled for redetermination no later than the month of the child’s first birthday; see BEM 145. Group 2 Persons Under 21 - If a member will reach age 21 before the month the case is scheduled for redetermination, an ex parte review should begin at least 90 days prior to the date the member turns 21; see BAM 210.

  7. Scheduling Bridges generates a redetermination packet to the client three business days prior to the negative action cut-off date in the month before the redetermination is due. Bridges schedules required redetermination appointments in the first 10 business days of the redetermination month. The packet includes the following as determined by the TOA to be redetermined: • Redetermination/review form. • Notice of review as determined by policy. • Interview date. • Interview type. • Place and time. • Required verifications. • Due date. • Return envelope.

  8. Redetermination Forms Redetermination forms may include: DHS-574, Redetermination Telephone Interview (FIP and FAP - Bridges only form) DHS-1010, Redetermination (all TOA). DHS-1046, Semi-Annual Contact Report (FAP). DHS-1171, Assistance Application (all TOA). DHS-2240-A, Mid-Certification Contact Notice (MA and FAP). DHS-2063-B, Continuing Your Food Assistance Benefits (FAP). DHS-4574, Medicaid Application for Long-Term Care. DCH-0373-D, MI Child and Healthy Kids Application.

  9. Scheduling Early Redetermination of an active program may be scheduled up to three months before the review date. Redetermination of active programs may be necessary for one of the following reasons: • A case is found to be error-prone as a result of supervisory case reading, quality assurance data or quality enhancement data. • Specialist’s schedule requires early redetermination of active program. • Align dates to simultaneously process redeterminations for multiple programs. Bridges does this automatically for all programs except certain MA programs such as TMA.

  10. Scheduling Early Step-by-Step Instructions to Schedule an Early Redetermination: On Left Navigation, select Redetermination. Select Initiate Redetermination. The Redetermination Ready page displays. Enter the case number. Click Search. The Redetermination Details displays at the bottom. Review the redetermination details to make sure you have retrieved correct case. Click the Schedule Early box for each TOA you want to schedule early. Click Submit. Submitted Successfully message displays at the top. You must complete the above steps at least 4 business days prior to the Negative Action Cut-Off Day the month prior to the month of the early redetermination.

  11. Scheduling Early Here is the Bridges page where you can select the EDG you wish to schedule early. Notice that only one of the boxes is not “grayed out”. That is the box for the FAP EDG, and in this example, it is the only program that meets the criteria for scheduling early.

  12. Scheduling Early Select “Schedule Early” for the FAP EDG.

  13. Scheduling Early CLICK on the “Submit” button

  14. Scheduling Early You will see a green message under the page title that states: “Submitted Successfully” and the “Schedule Early” box for the FAP EDG will now be grayed out. The “Revert” button in the next column will allow you to change your mind about rescheduling the review early, until the date the packets have been sent.

  15. Redetermination Statuses • As your case moves through the various stages of a Redetermination, Bridges will assign it a status. • You can check the status of your Redeterminations by going to Left Navigation>Redetermination>Initiate Redetermination. • This is the same path you would take to schedule an Early Redetermination.

  16. Redetermination Statuses Once Bridges has sent the packet and/or scheduled the appointment, Bridges will update the redetermination status to Redetermination Packet and/or Appointment Sent. This indicates that the redetermination process has been started. If this status remains and the redetermination packet and/or appointment are never updated to being received and/or shown, Bridges will automatically close the program based on policy. Bridges will update to Redetermination Completed once the data has been updated, EDBC has been run, and the programs have been certified.

  17. Redetermination Statuses

  18. Scheduling Early Example Mrs. Imma Worker checks her future redeterminations in Bridges and notices she has 83 redeterminations in August 2013. Mrs. Worker decides to send some of her August redeterminations out early to balance her caseload. She decides to schedule15 August redeterminations in May and 20 August redeterminations in June. To schedule 15 of Mrs. Worker’s August redeterminations in May, by what day will she have to schedule them early? Negative Action Cut Off Days: March = 03/18/2013 April = 04/19/2013 May = 05/20/2013 June = 06/17/2013 04/15/2013 is correct! To schedule 20 of Mrs. Worker’s August redeterminations in June, by what day will she have to schedule them early? 05/14/2013 is correct!

  19. Impact of Scheduling Early If the client is found eligible, a new redetermination date for the EDG is set based on the month you processed the redetermination. The client’s new benefit period begins the month following the month you processed the redetermination. • Healthy Kids Exception: • If the client is found to be ineligible, the Redetermination Due Date will revert to the original date. • You will have to perform the review again at the regularly scheduled time. • FAP Exception: • When a redetermination is scheduled early, FAP benefits cannot be terminated prior to the end of the benefit period for failure to complete the redetermination process.

  20. Redetermination Interview Requirements No Interview Required Interview Required Telephone In-Person If both a telephone and in-person interview are acceptable choose the method that is more convenient for the client. Conduct an in-person interview if the client requests one or fraudulent information is suspected. For more information on who can be interviewed for each program see BAM 210.

  21. Monitor Your Upcoming Redeterminations • Bridges Left Navigation > Inquiry > Case Load Search. • Change the Level to EDG and the Status to Approved. • You can choose Redetermination Due Date On or Before or leave the date blank.

  22. Monitor Your Upcoming Redeterminations • Bridges Left Navigation > Inquiry > Case Load Search. • Change the Level to EDG and the Status to Approved. • You can choose Redetermination Due Date On or Before or leave the date blank.

  23. Monitor Your Upcoming Redeterminations • Bridges Left Navigation > Inquiry > Case Load Search. • Change the Level to EDG and the Status to Approved. • You can choose Redetermination Due Date On or Beforeor leave the date blank.

  24. Monitor Your Upcoming Redeterminations • Bridges Left Navigation > Inquiry > Case Load Search. • Change the Level to EDG and the Status to Approved. • You can enter a Redetermination Due Date On or Before dateor leave the date blank.

  25. Log Packets Received DHS-1010/1171 DHS-2240-A DHS-1046 To log the redetermination packet in as received: Bridges Left Navigation > Redetermination > Packet Received

  26. Failure to Log In Packet

  27. Perform Reviews After you have logged in the redetermination packet as received you can proceed with the redetermination. Go to Bridges Left Navigation > Data Collection > Initiate Interview. What Case Action will you use? For annual redeterminations, use the Redetermination Case Action. You must update all information that has changed or requires re-verification at Redetermination (income, assets, and medical/support/ dependent care expenses). Forsemi-annualormid-certificationcontacts,usetheCaseChangeCaseAction.Youmustupdateall information thathaschangedorrequiresre-verification(income,childsupportexpense,etc.). Bridges will update the review dates for a program ONLY if the redetermination has been initiated.

  28. New Redetermination Due Date Established • After you have certified the results of the review, you can check to verify that a new Redetermination due date has been established: • Go to Left Navigation>Inquiry>Case. • Click the EDG# hyperlink on the Case Search/Summary page. • View the new Redetermination Date on the EDG Search/Summary page..

  29. Overdue Redetermination • A redetermination is considered “overdue” when: • The client returned the redetermination packet, and • The client kept the interview (if required) and • The specialist did not completed the redetermination in Bridges by the end of the redetermination month.

  30. Client fails to return Packet

  31. Any Questions?

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