MEMORANDUM

2014 Memorandums

IM-#50     10/01/14

DEPARTMENT OF SOCIAL SERVICES
FAMILY SUPPORT DIVISION
P.O. BOX 2320
JEFFERSON CITY, MISSOURI
TO:
ALL COUNTY OFFICES
FROM:
ALYSON CAMPBELL, DIRECTOR
SUBJECT:
NEWBORN EX PARTE PROCESS AND PRE-CLOSING REVIEW (IM-80PRE) FORM REVISION

DISCUSSION:

The purpose of this memorandum is to provide instructions to coordinate the completion of ex parte reviews for newborns turning age one. This memorandum introduces the process for completing ex parte reviews for newborns who have turned one, or who will be turning one, along with revisions to the Pre-Closing Review (IM-80PRE) form.

The Family Assistance Management Information System (FAMIS) no longer registers system applications for Newborns turning age one; therefore, ex parte reviews for newborns now require manual processing by staff. Effective September 1, 2014, Regional Administrators will receive a monthly listing from program and policy of newborns who have turned one, or will be turning age one. Regional Administrators will assign the cases to be processed and other necessary action required.

This memorandum includes:

Screening and processing instructions for the Newborns over age one and turning age one report

Upon receiving the monthly listing of cases MAGI processing center management staff must ensure that the report is screened and processed. Staff who screen and process the cases will utilize the following procedures to complete the ex parte process:

  1. The DCN of the child and mother must be screened in the Missouri Eligibility Determination and Enrollment System (MEDES) to see if an active Product Delivery Case (PDC) or Application Case (AC) exists.
    1. If there is an active PDC staff must first review the Integrated Case (IC) to see if the newborn is a household member. If the child is a household member, but they were not marked as an applicant the following instructions must be utilized:
      1. From the IC select the Application Details evidence for the newborn, and toggle open the evidence to select the Edit option from the list menu actions icon.
      2. Update the Received Date to the date the ex parte is processed.
      3. Leave Case Review as the Change Reason, and enter the ex parte review date to the Effective Date of Change field. 
      4. Mark the child as an Applicant, and show the Application Date as the date of the ex parte review.
      5. Follow the Adding/Editing Evidence job aid to enter in Citizenship and ID Details evidence for the newborn.
      6. Apply the changes to the IC and review the PDC determinations tab to ensure the newborn was added as of the date of the ex parte review. MEDES will use the existing evidence to add the child to the PDC.
    2. If the IC does not have the newborn listed use the job aid Adding a Participant to an Integrated Case to add the newborn. Use the existing MEDES evidence to process the ex parte review.
    3. If there is a pending AC staff must ensure that the newborn is on the AC and marked as an applicant on the application details evidence. If the newborn is not on the AC utilize the job aid Adding a Participant to an Application Case .
    4. When the MEDES determination is complete and the Newborn is age one or older, close the FAMIS newborn case using Instructions for closing the FAMIS Newborn cases .
    5. When the MEDES determination is complete and the Newborn has not yet turned age one, leave the Newborn case open until the child’s birthday then close the case using Instructions for closing the FAMIS Newborn cases .

    NOTE:  When adding a Newborn to a pending AC the Eligibility Specialist (ES) must review notes in MEDES prior to authorizing the case to determine if they need to coordinate with the ES who last worked on the AC.

  2. If the mother or child is not known to MEDES, review FAMIS to see if there is an active MO HealthNet for Families (FAM) or MO HealthNet for Children (MHK) case.
    1. Review the MEDES Queues in the FSD Work Site for any MEDES application or review. If there is an application or review this must be processed with the newborn ex parte.
    2. If there is no application or review in the FSD Work Site staff must register the head of household from the active FAMIS case in MEDES.
    3. Register a new application in MEDES and process the case as an annual review.
    4. The household will be considered non tax filers to complete the review.
    5. Follow the MAGI guidelines established in Income Maintenance Memorandum IM-43 dated August 25, 2014.

    NOTE: Staff must follow instructions from Email Memorandum IM-34 dated April 11, 2014 in processing the reviews. Staff must pay special attention to follow the process for review cases going from non premium to premium level of care.

  3. If the mother or child is not known to MEDES, and there is no other active MHF or MHK case in FAMIS, or application or review in the FSD Work Site, mail the IM-80PRE to the last known address.
    1. Allow 10 days for the family to respond to the IM-80PRE.
    2. If no response is received within 10 days, check the FSD Work Site, the Integrated Tracking and Reporting System (ITrackRS), and MEDES to see if the family has applied for MHF or MHK. Review FAMIS for any call center notes regarding an application being mailed to the family. If this comment exists allow another 10 days then review step 3b once more.
    3. If an application has been received complete the MEDES determination.
    4. If there has been no response to the IM-80PRE follow the Instructions for closing the FAMIS Newborn cases.

    NOTE: Enter a comment in FAMIS about the IM-80PRE that was mailed out as part of the Ex Parte process, and scan the IM-80PRE to the virtual file room. Follow the scanning and indexing instructions on E-mail Memorandum IM-4 dated January 23, 2014.

    NOTE: Staff must ensure that a notice is sent to the household informing them of the decision made from the ex parte process.

Instructions for closing the FAMIS Newborn cases

If a child who has turned age one is approved or denied in MEDES, refer to the FAMIS User Guide Worker Initiated Close for the process to remove the child from Newborn coverage.

If a child under age one is approved or denied in MEDES, do not close the Newborn case until their first birthday. Follow the FAMIS User Guide Worker Initiated Close for the process to remove the child from Newborn coverage.

NOTE: The Newborn program is time limited; therefore, an adverse action notice is not required. Use a Worker Initiated Closing (WICL) action with a reason code of Child is 1-Not Eligible For Newborn Coverage (A01).

If no application is received, or there was no response to the IM-80PRE, enter an adverse action worker close (AAWC) in FAMIS with reason code COO (failed to cooperate).

NOTE:  The ES must confirm the child on Newborn coverage has turned age one prior to expiration of the adverse action.

Instructions for Children who need a MO HealthNet for Disabled Children (MHDC) Determination

If it is determined that a MHDC decision is necessary during the ex parte review send these cases via email to DSS.FSD.GreeneCo@dss.mo.gov for a determination.

NECESSARY ACTION:

ATTACHMENT:

AC/ns/mks/df

2014 Memorandums