Come In If You Dare !!

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Come In If You Dare !!
Medicaid

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Welcome to Medicaid!!!
Betty Dumas-Beasley, Chief, Medicaid Eligibility
Unit Ena Lightbourne, Program coordinator Pam
Cooper, Policy Consultant
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Whats new, changed or may come..

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Haitian Family Reunification Parole Program (HFRP)

• Implemented by U.S. Citizenship and Immigration
  Services (USCIS).
• An Immigration petition that offers a Principal
  Beneficiary and Derivative Beneficiaries (spouses
  and unmarried children under 21) the opportunity
  to be reunited with family in the United States.
• The program is intended to expedite family
  reunification, by increasing avenues for legal
  migration from Haiti, and help Haiti continue to
  recover from the devastation and damage suffered
  in the January 12, 2010 earthquake.
• Only U.S. petitioners who receive invitations
  from the National Visa Center (NVC) will be
  eligible to apply.
• Approved beneficiaries will enter the US as
  parolees.

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Medicaid Eligibility

• Once paroled into the United States, the parolee
  will meet the definition of Cuban/Haitian
  entrants under section 501(e)(1) of the Refugee
  Education and Assistance Act of 1980, and will be
  a Qualified Alien.
• Follow sections MA-2504 and MA-3330 Alien
  Requirements to determine Medicaid eligibility.

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Non-Emergency Medicaid Transportation(NEMT)

• The North Carolina Medicaid program provides
  non-emergency medical transportation services to
  and from medical appointments for Medicaid
  beneficiaries.
• Currently, NEMT is arranged and provided by the
  local county departments of social services.
  Each county contracts with vendors to provide
  transportation. The County DSS pays the vendors
  for the cost of the trip and seeks reimbursement
  from DMA.
• The Affordable Care Act (ACA) requires that
  professionals providing services under the state
  plan (Medicaid) or waiver of the plan to be
  enrolled as participating providers. This
  provision applies to NEMT vendors.
• Once enrolled, the NEMT vendor will be allowed to
  bill for services through NCTracks just like any
  other Medicaid provider.

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NEMT Continued..

• Since NEMT vendors will be able to bill through
  NCTracks, there must be a way to verify the
  following
• The vendor is contracted with the County DSS
• A billed trip was authorized by the county
• The trip occurred
• The cost of the trip
• Essentially, we would need to create a prior
  approval process.

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Prior Approval ProcessProposal 1

• The transportation coordinator will enter travel
  information into NCFAST.
• This information will include
• MID of individual transported.
• Date and time of trip.
• Name of vendor.
• Destination address.
• Medicaid provider name.
• NCFAST will send a daily file containing this
  information to NCTracks. The information will be
  compared to the NEMT providers claim in
  NCTracks. NCFAST data must match provider claim
  data in NCTracks, completing a prior approval
  process. This will allow NCTracks to pay the
  claim.

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Prior Approval ProcessProposal 2

• The transportation coordinator will enter travel
  information directly into NCTracks.
• Data must match provider claim data in NCTracks,
  completing a prior approval process.
• This will allow NcTracks to pay the claim.

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Keep in Mind.

• Although NEMT vendors will be enrolled Medicaid
  providers, they will still be required to
  contract with the local county department of
  social services.
• The County DSS is still responsible for
  assessments and arranging transportation.
• More information is forthcoming.

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Eastern Band of Cherokee Indians (EBCI)

• N.C. General Assembly approved legislation
  allowing the EBCI to establish and operate as a
  separate social services entity. The EBCI will
  be responsible for determining Medicaid
  eligibility and case maintenance. They will take
  on this role for people living on tribal lands.
• The EBCI is a sovereign nation however for
  system functionality purposes they will be
  considered County 10X.
• The Qualla Boundary lies within the counties of
  Jackson, Swain, Graham, Cherokee, and Haywood.

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EBCI Functions and Responsibilities

• Responsible for intake and processing for
  Medicaid applications face to face, by mail or
  electronically.
• Subject to all eligibility determination rules
  and regulations.
• Responsible for completing annual reviews.
• The EBCI will utilized NCFAST and electronic
  verifications to determine eligibility.
• Subject to program integrity guidelines and
  procedures.
• NEMT compliance
• Subject to case audit review requirements
• Alexander Audit
• Perm/MEQC
• Single Audit
• Quality Assurance
• Monitoring and Oversight

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Hearings Process

• A Beneficiary has the right to appeal an action
  if he/she disagrees with the decision. A local
  hearing must be held at the EBCI DSS office for
  all appeals except those involving a disability.
  Appeals involving disability are held at the
  state level.
• A Beneficiary has the right to a state appeal if
  he/she disagrees with the local appeal decision,
  or if the appeal involves a determination of a
  disability.
• EBCI and the state will maintain the hearing
  process for any cases appealed regarding actions
  taken by the EBCI.

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Resources

• EBCI will be included in Listserv messages
• Access to state Medicaid manuals for guidance and
  reviews
• Access to Dear County Director Letter and State
  Administrative letters and other state
  communications
• EBCI will be present on the DSS Director Board
• EBCI will be invited to join the Economic
  Benefits sub-committee, which reviews draft
  policy for comments
• Receive webinar policy training periodically as a
  county DSS office
• More information forthcoming

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Asset Verification System (AVS) Clarifications

• AVS is an automated system that obtains
  electronic financial information for individuals
  applying or subject to redetermination for Aged,
  Blind and Disabled Medicaid.
• Here are some clarifications on how the AVS
  system works
• AVS is not a verification in the sense a
  caseworker should expect a response from known
  banks for the purpose of verification.
• The AVS system is designed to identify
  undisclosed accounts, not validate/verify what is
  already known.
• All financial institutions in North Carolina are
  eligible to receive requests.

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Asset Verification System (AVS) Clarifications
(cont.)

• The caseworker should proceed with the manual
  verification process for all known accounts and
  not to wait to receive a response. 
• If the caseworker gets a response prior to
  receiving verification from the client or the
  bank, use it to confirm the information received.
  Move forward with processing the
  application/recertification.

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REVIEW

• Title IV-E Adoption
• IV-E children that move to North Carolina from
  another state.
• NC covers IV-E children up to age 18, however
  many states cover them up to age 21. Changes to
  regulations require states/NC to cover all IV-E
  children through the age stated in the IV-E
  agreement in the originating state.
• Policy is forthcoming. In the interim call
  DMA/MEU _at_ 919-855-4000
• Proposed bill
• NC G.S. 108-A-55.55(b) Verification of State
  Residency for Medical Assistance.
• A document issued by the Mexican consular or
  other foreign consulate verifying the applicants
  intent to live in North Carolina permanently or
  for an indefinite period of time or that the
  applicant is residing in North Carolina to seek
  employment or with a job commitment from state
  residency verification.

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• Proposed bill
• Senate Bill 14
• NC State Auditor Language back in bill that
  state auditors will be auditing the counties to
  ensure they are implementing policy accurately
  and timely.

• County Recertification