Waivers
When do you add a waitlist?
With a valid PFOC!
found in the "Help sheet" from Isabel
Do applicants pay a Patient Pay Amount for retroactive months?
No
The applicants do not pay a Patient Pay Amount for Retro Months - Ask who found this and where
Is a LOC required when the individual is in a Facility (acute hospital/hospital)?
No
Institutional Care MA and Waiver MA - Version 2.5[10487].pdf
For a waiver edge to build, do you have to select a MAD 381 aged blind disabled application type from the application form type drop down box?
Yes
App Reg pp
Can a client be eligible for IC Medicaid while receiving MA-SSA Medicaid?
No
IC App Reg Flow chart from Marizol
Must a client register for a waiver - before applying for that benefit?
Yes, there are several steps to apply for a waiver.
App Reg Waiver pp
What does PACE stand for?
Program of All-Inclusive Care for the Elderly
Where was this found?
What is a medical assessment that determines the extent of care a customer is expected to receive?
LOC
Found in Modified IC-Waiver training word doc
You must register a PACE case with the MCO of choice?
No
Where did you get this answer?
Can you verify a negative?
Nope, not now not ever....
IC pp
What is a (PFOC) Primary Freedom of Choice form used for?
This type of allocation is used to register aged and disabled waivers this allocation, and it comes from (MAD) Medical Assistance Division
IC/W APP REG pp
What do you do if you receive a PFOC but aren't sure if allocation is valid?
Send an email to HCA-ISD-Institutional-Care-and-Waiver@hca.nm.gov with case# or Task# and ask them if they can help you verify that allocation is still Valid. (Found in the HUB Chat)
If no LOC is in the inquiry, But you just received an LOC. What should you do?
You need to send (escalate) to Merit for them manually enter the LOC
HUB
If you receive a MAD381 and applicant states in app that they do live in a facility, you must get a PFOC.
FALSE.
PFOC's are only needed for waivers.
Do we reinstate closed or denied Institutional Care cases?
No.
Resource-ICW FAQ sheet.
Are DD waiver and Supports waiver the eligibility criteria? And same amount of coverage for an individual?
yes, the eligibility criteria is the same. Supports waiver is offered to individuals waiting for the DD waiver.
Where was this found?
If you receive a MAD381 and applicant left all assets completely blank (no slash, no N/A, NOTHING) how would you proceed?
Pend all assets Per Job Aid 61.
(Found in Processing notes Cassandra sent us through email)
Who is responsible for sending the approved or denied LOC via the interface back to ISD
The MCO
LOC pp
We must count parents income for a minors case, if they send in their assets on the application.
No, only if both parent and Childs name is on the bank account that's when you'll need verification of assets.
Resource- ICW FAQ sheet.
If you need to register a case through case change action and they have an existing MAGI COE is it essential to update the individual program request date to avoid late approval?
Yes.
According to the Institutional Care PowerPoint it is ESSENTIAL to update the individual program request date to avoid the late approvals.
What are home and community-based services
HCBS provide opportunities for Medicaid beneficiaries to receive their services in their home or community rather than institutions or other isolated settings, we call these waivers
App Reg Waivers pp
What COE only services applications in Bernalillo, Sandoval and Valencia County?
PACE
Found in Modified IC-Waiver training word doc
Is it imperative to have the right MCO for the LOC to be entered correctly?
Yes, otherwise the correct MCO may NOT receive the right information and the case may be denied incorrectly.
Aspen and LOC pp
Working IC/W App Reg case easier than Recerts?
Sure…….. if juggling chainsaws blindfold it is easy for you to do
For an IC-Disabled request to be ran correctly, what age would the client need to be under, and does the disability screen need to be filled out?
Under age 65, and yes.
IC pp