IM-68      06/30/06

SUBJECT:

ROLLING CALENDAR IMPLEMENTATION FOR CHIP PREMIUM CASES; MPNI UPDATES

DISCUSSION:

The Division of Medical Services (DMS) is implementing the Rolling Calendar for CHIP Premium cases. Effective July 1, 2006, CHIP Premium cases will be based on a 30-day payment cycle, with the start date of the cycle determined by the date the initial payment is received. For LOC 2 children (gross income over 150% FPL up to and including 225% FPL), failure to pay the Recurring Invoice timely will result in continued open eligibility, with coverage ending at the end of the 30-day cycle. Coverage resumes upon the date any subsequent payment is received (considered an “Initial” payment) and extending for 30 days. (See IM Memorandum IM-52, 05/12/2006 for additional information.)

The second stage of MPNI screen updates are effective July 1, 2006. The MPNI screen is revised to accommodate CHIP changes and to assist the worker in a clearer understanding of the payment and coverage cycles of the program.

The MPNI screen has become a two-screen inquiry system. The first screen is accessed using the current procedure (MPNI, space, case type, case DCN). This first screen lists the invoice history, with additional supportive information. The second screen is a detail screen, providing the listing of notices sent out for a particular invoice. Following are examples of the two screens and the information available on them.

MPNI Initial Screen

The Initial Screen displayed below is an example of a CHIP Premium screen. The MA Spenddown screen displays most of the same information. Differences will be noted later in this memo.

Case Information Section:

CASE-ID

Case ID and DCN

NAME

Case DCN Name

STATUS

Status of Case:

• Pending - Invoices have been created but have either not been paid or bills have been presented
• Active - Invoices have been created, premium/spenddown has been paid or bills have been presented
• Closed - No longer receiving invoices as case is either closed due to worker action, non-premium level of care change, or failure to pay initial invoice.
  
  Note: If a case is active, closed, then reopened, the case status will be pending until another invoice is paid or bills are presented.

PGM

Program - CHIP (CHIP Premium Cases) or SPND (MA Spenddown)

CYCL-STR

Cycle Start Date - The date the “Rolling Calendar” monthly cycle begins. As of July 1, 2006, all cases that are sent a Recurring Invoice will have 07/01/06 as the start date. If a case is closed for non-payment or other action that closes coverage, but not eligibility, no start date will display. Once a payment is received on a case with open eligibility, the start date will display the date the payment was received and will be the start date for the Rolling Calendar coverage periods.

LOC

Level of Care - Displays a “2” or “3” for a CHIP case. No entry is displayed in this field for MA Spenddown cases.

LAST-UPD

The date the most recent entry is made on MPNI.

OPER

Operator ID - Used by DMS.

Invoice Information Section:

SEL

Select field - Enter any character in this spot to access the Detail Screen for the selected invoice.

PG

Program - Displays “CH” for CHIP program, “SP” for MA Spenddown program.

TYPE

Invoice Type:

• I - Initial
• R - Recurring
• N - No invoice mailed due to six months of no activity (payment not received, bills not submitted)
• A - Spenddown case needing to submit bills for coverage, payment not accepted.

NUMBER

Invoice Number

DATE

Status Date - This field displays the date of the status of the invoice. Example: Status field shows “Closed”, Date field shows “08-15-06” - invoice was closed August 15, 2006 because of reason indicated on LAR field.

STATUS

Status of Invoice - This field displays the status of the invoice, and may be used in conjunction with the LAR field to clarify the case or repayment status of a premium. The Status field will display the one of the following:

• PAID - Invoice has been paid. LAR will display method of payment.
• CLOSED - Invoice is closed. LAR will display reason for closed status.
• INSUFF - Invoice payment is insufficient. Either the payment received was less than the invoiced amount, or there was not enough in the client's account to pay the check or the Automatic Withdrawal.
• OPEN - The invoice has not been paid yet and coverage may still be purchased.

PREM

Premium - The CHIP Premium amount or MA Spenddown amount owed to receive coverage.

NX-NTC/DT

Next Notice Type/Date - The next notice type and the date it will be mailed. The Notice Types are described on the Detail Screen.

COVG-STR

Coverage Start Date - The coverage begin date for the invoice. The date will display for CHIP Premium Recurring Invoices only. MA Spenddown cases will not display a coverage start date as Spenddown payments cover the whole calendar month.

COVG-STP

Coverage Stop Date - The coverage stop date for the invoice. The date will display for CHIP Premium Recurring Invoices only. MA Spenddown cases will not display a coverage end date as Spenddown payments cover the whole calendar month.

LAR

Last Action Received (on the A/R - Accounts Receivable) - The field displays the last action on the CHIP Premium invoice/account. MA Spenddown cases will not contain information in this field at this time. The actions are as follows:

• CHK - Invoice paid by check. The Status field will show “Paid.”
• CSH - Invoice paid by cash. The Status field will show “Paid.”
• EFT - Invoice paid by Automatic Withdrawal from client's bank account. The Status field will show “Paid.”
• NSF - Insufficient funds. The client is given additional time to “make good” on the payment. Coverage will resume on the date the insufficient payment is paid by money order, if paid within the time given by DMS.
• NPR - No payment received. Either the client did not make a payment, or the insufficient payment was not paid timely. The Status field will show “Closed.”
• NPI - Non-Payment of Initial (Invoice). The Initial Invoice was not paid and the client will need to reapply. The Status field will show “Closed.”
• LOC - Level of Care Change. All of the children on the case have gone from a premium level of care to a non-premium level of care. Paid premiums will be reimbursed based on the date of the level of care change.
• SCL - State Closed. Case has been systems-closed due to policy changes, etc. The Status field will show “Closed.”
• WCL - Worker Initiated Closing. Case has been closed by the worker (examples: moved out of state, access to affordable insurance, death). The Status field will show “Closed.”
• ORC - Outstanding Receivable Corrected. The premium/Spenddown amount has been adjusted due to a worker error or budget adjustment.
• MAN - Manually closed. The invoice generated in error has been closed manually.

MPNI Detail Screen

The MPNI Detail Screen displayed below is an example of a CHIP Premium Detail screen. The MA Spenddown Detail Screen displays the same information. Access the Detail Screen by placing a character in the Select Field next to an invoice on the MPNI Initial Screen and hitting “Enter.” The Detail Screen lists all notices sent to the client for the selected invoice.

This screen can only be accessed through the MPNI Initial Screen. To return to the MPNI Initial Screen, hit “Enter.”

Case Information Section:

This section displays the same information as on the MPNI Initial Screen.

Invoice Information Section:

This section displays the invoice selected from the MPNI Initial Screen.

Notice Information Section:

This section displays all the notices sent on the case for the selected invoice, the date the notice was added to the system and the actual mail date of the notice. See IM Memorandum IM-52 05/12/2006 for information regarding notice types.

MPNI Initial Screen for MA Spenddown Cases:

The MPNI Initial Screen below is an example of a MA Spenddown screen.

The few differences between the MA Spenddown and the CHIP Premium are as follows:

• There are no coverage stop and start dates as Spenddown payments are for the calendar month.
  
  
• A COMMENTS field is included to add information related to Federal Poverty Level (FPL) adjustments.
  
  
• The LAR field will not contain information at this time. This field will be used later when MA Spenddown changes are updated.

Future Screen Updates

MPNI and MCII screens will be updated in the near future to include Help Screens to assist workers with abbreviations, acronyms and code definitions.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

LH