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Effective: March 1, 2009 |
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08.25.05ar3 - Processing MA and GAMC Renewals (Archive) |
Archived: July 1, 2009 |
There are some similarities between processing renewals for MA/GAMC and processing them for MinnesotaCare (MCRE). However, there are also differences. This section provides information on processing an MA/GAMC renewal.
MA/GAMC Renewal Processing Steps.
Clients must provide the following to consider the renewal complete and ready to be processed for eligibility:
l A completed MHCP Renewal Form (DHS-3418). For more information about the DHS-3418 and other requirements, see Renewal Forms.
l A signature for all people required to sign. See Renewal Signature for specific policy on who must sign the renewal form.
l Required verifications and any information needed to redetermine eligibility must be received.
Accept and process faxed renewals.
MA/GAMC Renewal Processing Steps
Follow these steps to process an MA/GAMC renewal:
1. Process renewals in the order they are received. Give priority to processing renewals to avoid a gap in coverage.
l Process the renewal before the 10-day cutoff date to ensure continuous coverage if possible.
l Do not require an in-person interview as part of the renewal process for MA/GAMC.
2. Review the renewal form.
l Review the renewal for missing data, verifications and the following:
n Required signatures.
n Household member changes. See Adding a Household Member and Removing a Household Member.
n Pregnancy reported. Request verification. Consider the woman to be a pregnant woman when the pregnancy has been verified.
n Insurance changes. Request new insurance information.
n Assets.
n Assets allocations for LTC spouses. See Asset Assessments for more information on asset allocations.
n Income. Request verifications.
n Changes in parental status and medical support. Follow required steps.
n Managed care status changes.
l Contact the enrollee to obtain any missing information or verifications.
Note: County agencies may request the reimbursement officer to obtain information necessary to renew the eligibility of Regional Treatment Center residents.
l Set the client’s renewal status to ’r;I’ (incomplete) on the REVW screen if information is missing.
3. Update MAXIS with the new information.
4. Redetermine MA/GAMC eligibility.
l If the client has completed the renewal and sent in all required information and verifications timely and:
n The client remains eligible, approve the renewal.
Note: Add a worker comment to the approval notice if MA-EPD is closing but the client remains eligible under another basis of eligibility or under another health care program. Include notice that MA-EPD is closing, the effective date of the close and the reason it is closing.
n The client is no longer eligible, close eligibility for the end of the month before the renewal month using the appropriate closing reason.
m Share or transfer the renewal with MCRE Operations if the county agency is not a MCRE enrollment site.
Exception: Do not transfer the renewal to MCRE Operations or process MCRE eligibility at the county if eligibility is closed solely due to failure to provide asset verification. See MA Asset Verification Denial/Closure for more information.
m Add a worker comment to the closing notice if MA-EPD is closing. Include in the notice that MA-EPD is closing, the effective date of closure and the reason it is closing.
l MAXIS will generate a closing notice on 10-day cutoff in the month before the renewal month if information and verifications are incomplete (renewal status of ’r;I’) or the renewal has not been received (renewal status of ’r;N’).
Note: If the household turns in the renewal form before the last day of the certification period but after 10-day cutoff, and it is incomplete or the agency does not have time to act on the form before the end of the month, the case will remain closed.
Reinstate coverage if the household completes the renewal process during the renewal month and the agency determines that eligibility continues.
A renewal is late if it is returned after the end of the certification period.
Process the renewal as a new application.
l Do not require the household to complete a new application form if they submit the DHS-3418 as the renewal.
l Require a new application if the household submits a Renewal for People Receiving Long-Term Care or Elderly Waiver Services (DHS-2128).
Example:
Margaret’s renewal month is February. She submits a completed renewal form on January 2 but does not include verification of income.
Action:
Request the income verification and enter an ’r;I’ in the review status field on the MAXIS REVW screen.
Margaret has not returned the income verification by 10-day cutoff in January.
Action:
MAXIS generates a closing notice.
Margaret returns the income verifications on February 2, indicating she has been on vacation visiting her mother in Florida for the past month.
Action:
Redetermine Margaret’s eligibility. Reinstate eligibility for February if she remains eligible. If she is not eligible, code MAXIS to send a closing notice with the reason for ineligibility.
Example:
Herbert’s renewal month is April. The renewal form has not been received as of 10-day notice cutoff in March. The review status field remains coded ’r;N’.
Action:
MAXIS generates a termination notice effective April 1.
Herbert returns the renewal form on April 5.
Action:
Process the renewal as a new application because it was returned after the renewal determination month.