SUBJECT:
MEDICAID REINVESTIGATIONS FOR ACTIVE DEPARTMENT OF MENTAL HEALTH CLIENTS
DISCUSSION:
The Department of Mental Health (DMH) is partnering with the Family Support Division (FSD) to assist our staff with the completion of annual Medicaid reinvestigations for individuals whom we jointly serve. The FSD Training Unit has provided training, on the reinvestigation process, to staff from the Divisions of Comprehensive Psychiatric Services (CPS), Mental Retardation and Developmental Disabilities (MRDD), and Alcohol and Drug Abuse (ADA).
DMH staff will work on reinvestigations that are due three months in the future. This will allow time to request and obtain the necessary information for completion of the reinvestigation in a timely manner. Information obtained by DMH staff will be forwarded to the local county by the 7th of the month prior to the month the reinvestigation is due. Beginning October, 2005, DMH staff will begin working on reinvestigations due in December, 2005. If DMH staff are unable to obtain the necessary information needed to complete the reinvestigation, FSD staff remain responsible for obtaining the information and completing the reinvestigation by the due date.
REINVESTIGATIONS
An eligibility reinvestigation is conducted to review and re-verify all eligibility factors. When completing an eligibility reinvestigation, a new budget must be completed. Income documentation and the eligibility determination are to be recorded and the appropriate notices sent to the client.
A medical re-determination to validate continued disability is not necessary to complete an eligibility reinvestigation. The original disability determination continues until a new determination has been made. The Medical Review Team (MRT) decision regarding continued disability is completed outside of the eligibility reinvestigation process. Do not wait for the medical re-determination to complete the eligibility reinvestigation. These are two separate determinations.
NOTE: This applies to all cases that require a MRT disability determination, not just DMH cases.
EXAMPLES:
An eligibility reinvestigation (income, resources and all other eligibility factors for the program) and medical re-determination are both due in December, 2005. All verification is received to complete the eligibility reinvestigation and the worker is awaiting verification from doctors and hospitals to complete the medical re-determination. The caseworker should complete the eligibility reinvestigation and continue to work on obtaining medical information. When the medical information is collected, send to MRT for a determination of continued medical eligibility. If MRT states the individual is no longer disabled, the FSD caseworker will send an adverse action to close the case.
A medical re-determination is due in September 2005. The caseworker requests medical information in order to send to MRT for a determination of continued medical eligibility. In December 2005, an eligibility reinvestigation is due and the caseworker obtains all verification of eligibility. However, MRT has not made a decision of continued medical eligibility. Complete the eligibility reinvestigation and follow-up on the medical re-determination. The individual is considered to be continuously disabled unless/until MRT determines s/he is not.
COUNTY CONTACTS
A list of FSD contact names for each county has been provided to DMH. These individuals will serve as the point of contact for questions regarding the completion of reinvestigation forms and/or the reinvestigation process. Provide any necessary assistance to DMH case managers and assist them in locating the FSD caseworker assigned to work with the individual for whom a reinvestigation is being completed.
A list of DMH contacts containing the names and telephone numbers for each division assisting with reinvestigations is attached to this memorandum. FSD liaisons should use this list to determine the contact information for the DMH liaison.
CONFIDENTIALITY ISSUES
Health Insurance Portability and Accountability Act (HIPAA) and other confidentiality requirements will not be an issue when sharing information between FSD and DMH state employees due to the exemption of administration of public benefits. MRDD contacts are state employees and information can be shared freely with their case managers. Contacts for the other divisions are contracted providers and information can only be shared with the client’s permission. When the IM-2D (FSD/DMH) form is received at FSD and the form is signed by the individual listing the DMH agency as the collateral contact, information can be shared with the provider.
REPORTS
DMH will receive a file from FSD which lists the individuals whose cases are due for reinvestigation. DMH will match this list of recipients with their internal information in order to identify active DMH clients. To assist both DMH and FSD staff, the following reports will be produced:
- Listing of Medicaid Reinvestigations Due in the Next Three Months – This report will be produced monthly by DMH and will be sent to both DMH and FSD staff. The first list will contain reinvestigations due in October, November, and December, 2005. DMH will start with those individuals that have reinvestigations due in December. This will give DMH case mangers the month of October to have the form completed and obtain as much verification as possible. All information will be forwarded to the local FSD office by November 7, 2005. This allows FSD caseworkers the month of November to request any follow up verification and complete the actual eligibility reinvestigation timely for December.
- Listing of Closed Medicaid Cases - DMH case managers will receive a list of recently closed Medicaid cases (FSD will not receive this list). It will be used by DMH case managers to determine if the individual needs to reapply for Medicaid.
FORMS
The Family Support Division Reinvestigation-Eligibility Statement (IM-2D FSD/DMH) has been developed for use on this project. This is a combination of the IM-2D and the IM1U to simplify the reinvestigation process for DMH staff. This form will be printed on yellow paper to easily identify that the reinvestigation is being assisted by DMH. Completed forms will be sent to FSD with the FSD caseworker’s load number on the form and outside of the envelope.
DMH staff have been instructed to list the agency name and/or the DMH case manager’s name in the collateral section of the form. If questions arise and there is not a specific case manager’s name and phone number listed is this section, speak to the contact person for your county for that division or agency. If there is a case manager’s name listed, contact that individual for questions that arise. Collateral contacts are not routinely required for an eligibility reinvestigation, unless the claimant’s statement is questionable. However, this section is being completed to assist both agencies in the event that collateral contact is necessary.
Release of information forms, Financial Information Request (IM-7), Insurance and Prepaid Burial Letter (IM-9), Employment Information Request (IM-12), Veteran’s Administration Letter (IM-13) have been provided to DMH staff and contractors to assist FSD in obtaining necessary eligibility verification.
PROCESS
It is recommended that a meeting be conducted as soon as possible between local FSD and DMH staff to get acquainted, review the processes, and make any local decisions necessary to facilitate the success of this partnership.
When the reinvestigation form is completed and returned to FSD, review the information provided and compare to the case record. If the client previously claimed having a resource, property, etc. that is not reflected on the current reinvestigation, contact the DMH case manager and the recipient to request the verification. Send an IM-31A to the recipient and a copy to the DMH case manager; allow him/her 10 days to provide the requested verification.
If the reinvestigation form is completed and all verification is available, proceed with completing the eligibility reinvestigation and make all necessary computer entries. If the client is determined to no longer meet eligibility factors for Medicaid, an IM-80 and IM-33 will be provided to the client and a copy will be sent to the appropriate DMH staff person/agency.
If the reinvestigation form is not received in the county office by the 7th of the month prior to the month the reinvestigation is due, follow normal procedures to initiate the reinvestigation process.
NECESSARY ACTION:
- Review this memorandum with appropriate staff immediately.
- Meet with DMH staff to establish local procedures.
- Work with DMH staff to complete reinvestigations in a timely manner.
