RedeterminationModule

Updated 12/02/2013

Redetermination

Objectives

• Locate and Monitor cases due for Redetermination

• Schedule an early Redetermination

• Log in a Redetermination packet

• Perform the Redetermination

• Process Overdue and Not Logged Redeterminations

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Redetermination

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How to Take this Training

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Redetermination

The RedeterminationThe Department of Human Services must periodically redetermine an individual’s eligibility for active programs. The redetermination process includes a thorough review of all eligibility factors.

A complete redetermination is required at least every 12 months. Bridges sets the redetermination date according to benefit periods; see Eligibility Decisions in BAM 115.

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An ex parte review is required before Medicaid closures when there is an actual or anticipated change, unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 calendar days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories; see BAM 115 and BAM 220.

Redetermination

Redetermination Periods

* If a CDC group is active for other programs, Bridges will set the CDC redetermination date to be the same redetermination date as the other program if 12 months or less.

** A ex parte review must be completed before closing an individ ual in one of these categories if the closure is for any reason other than total ineligibility for any MA (such as moved out of state or death). The ex parte review must consider eligibility in all other FIP and SSI related MA categories.

3 - month 6 - month 12 - month 24 - month No Redetermination

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Redetermination

Redetermination Period Exceptions

Group 2 Persons Under 21 - If a member will reach age 21 before the month the case is scheduled for redetermination, an ex parte review should begin at least 90 days prior to the date the member turns 21; see BAM 210.

Newborn MA - Newborn cases must be scheduled for redetermination no later than the month of the child’s first birthday; see BEM 145.

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Redetermination

SchedulingBridges generates a redetermination packet to the client three business days prior to the negative action cut-off date in the month before the redetermination is due. Bridges schedules required redetermination appointments in the first 10 business days of the redetermination month.

• Redetermination/review form.• Notice of review as determined by policy. • Interview date.• Interview type.• Place and time.• Required verifications.• Due date.• Return envelope.

The packet includes the following as determined by the TOA to be redetermined:

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Redetermination

Redetermination Forms

Redetermination forms may include:

DHS-574, Redetermination Telephone Interview (FIP and FAP - Bridges only form)

DHS-1010, Redetermination (all TOA).

DHS-1046, Semi-Annual Contact Report (FAP).

DHS-1171, Assistance Application (all TOA).

DHS-2240-A, Mid-Certification Contact Notice (MA and FAP).

DHS-2063-B, Continuing Your Food Assistance Benefits (FAP).

DHS-4574, Medicaid Application for Long-Term Care.

DCH-0373-D, MI Child and Healthy Kids Application.

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Redetermination

Scheduling Early

Redetermination of an active program may be scheduled up to three months before the review date. Redetermination of active programs may be necessary for one of the following reasons:

• A case is found to be error-prone as a result of supervisory case reading, quality assurance data or quality enhancement data.

• Specialist’s schedule requires early redetermination of active program.

• Align dates to simultaneously process redeterminations for multiple programs. Bridges does this automatically for all programs except certain MA programs such as TMA.

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Redetermination

Scheduling EarlyStep-by-Step Instructions to Schedule an Early Redetermination:

1. On Left Navigation, select Redetermination.2. Select Initiate Redetermination.3. The Redetermination Ready page displays.4. Enter the case number.5. Click Search.

The Redetermination Details displays at the bottom.

6. Review the redetermination details to make sure you have retrieved correct case.

7. Click the Schedule Early box for each TOA you want to schedule early.

8. Click Submit.

Submitted Successfully message displays at the top.

You must complete the above steps at least 4 business days prior to the Negative Action Cut-Off Day the month prior to the month of the early redetermination.

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Redetermination

Scheduling Early

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Here is the Bridges page where you can select the EDG you wish to schedule early. Notice that only one of the boxes is not “grayed out”. That is the box for the FAP EDG, and in this example, it is the only program that meets the criteria for scheduling early.

Redetermination

Scheduling Early

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Select “Schedule Early” for the FAP EDG.

Redetermination

Scheduling Early

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CLICK on the“Submit” button

Redetermination

Scheduling Early

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You will see a green message under the page title that states: “Submitted Successfully” and the “Schedule Early” box for the FAP EDG will now be grayed out.

The “Revert” button in the next column will allow you to change your mind about rescheduling the review early, until the date the packets have been sent.

Redetermination

Redetermination Statuses

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• As your case moves through the various stages of a Redetermination, Bridges will assign it a status.

• You can check the status of your Redeterminations by going to

Left Navigation>Redetermination>Initiate Redetermination.

• This is the same path you would take to schedule an Early Redetermination.

Redetermination

Redetermination Statuses

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Once Bridges has sent the packet and/or scheduled the appointment, Bridges will update the redetermination status to Redetermination Packet and/or Appointment Sent. This indicates that the redetermination process has been started. If this status remains and the redetermination packet and/or appointment are never updated to being received and/or shown, Bridges will automatically close the program based on policy.

Bridges will update to Redetermination Completed once the data has been updated, EDBC has been run, and the programs have been certified.

Redetermination

Redetermination Statuses

Send Redetermination Packet and/or Appointment

Redetermination Packet and/or Appointment Sent

Redetermination Initiated

Redetermination Complete

Bridges will set this status when the redetermination due date is approaching.

Once the Redet packet has been sent and/or the appointment has been scheduled, Bridges will update to this status. This indicates the review process has been started.

After you log in the redetermination packet and/or the appointment has been marked as “Show”, Bridges will update to this status. This status will keep Bridges from automatically taking negative action against the client.

This status will appear after the data in Bridges has been updated, EDBC has been run, and the programs have been certified.

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Redetermination

Scheduling Early Example

Mrs. Imma Worker checks her future redeterminations in Bridges and notices she has 83 redeterminations in August 2013. Mrs. Worker decides to send some of her August redeterminations out early to balance her caseload. She decides to schedule15 August redeterminations in May and 20 August redeterminations in June.

Negative Action Cut Off Days:

March = 03/18/2013 April = 04/19/2013May = 05/20/2013June = 06/17/2013

To schedule 15 of Mrs. Worker’s August redeterminations in May, by what day will she have to schedule them early?

04/15/2013 is correct!

To schedule 20 of Mrs. Worker’s August redeterminations in June, by what day will she have to schedule them early?

05/14/2013 is correct!

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Redetermination

Impact of Scheduling EarlyIf the client is found eligible, a new redetermination date for the EDG is set based on the month you processed the redetermination. The client’s new benefit period begins the month following the month you processed the redetermination.

Healthy Kids Exception:

• If the client is found to be ineligible, the Redetermination Due Date will revert to the original date.

• You will have to perform the review again at the regularly scheduled time.

FAP Exception:• When a redetermination is scheduled early, FAP

benefits cannot be terminated prior to the end of the benefit period for failure to complete the redetermination process.

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Redetermination

Redetermination Interview Requirements

No Interview Required Interview Required Telephone In-Person

If both a telephone and in-person interview are acceptable choose the method that is more convenient for the client. Conduct an in-person interview if the client requests one or fraudulent information is suspected. For more information on who can be interviewed for each program see BAM 210.

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Redetermination

Monitor Your Upcoming Redeterminations

1. Bridges Left Navigation > Inquiry > Case Load Search.2. Change the Level to EDG and the Status to Approved. 3. You can choose Redetermination Due Date On or Before or

leave the date blank.

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Redetermination

Monitor Your Upcoming Redeterminations

1. Bridges Left Navigation > Inquiry > Case Load Search.2. Change the Level to EDG and the Status to Approved. 3. You can choose Redetermination Due Date On or Before or

leave the date blank.

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Redetermination

Monitor Your Upcoming Redeterminations

1. Bridges Left Navigation > Inquiry > Case Load Search.2. Change the Level to EDG and the Status to Approved. 3. You can choose Redetermination Due Date On or Before or

leave the date blank.

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Redetermination

Monitor Your Upcoming Redeterminations

1. Bridges Left Navigation > Inquiry > Case Load Search.2. Change the Level to EDG and the Status to Approved. 3. You can enter a Redetermination Due Date On or Before

date or leave the date blank.

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Redetermination

Log Packets ReceivedDHS-1010/1171 DHS-2240-A DHS-1046

To log the redetermination packet in as received: Bridges Left Navigation > Redetermination > Packet Received

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Redetermination

Failure to Log In Packet

Program What happens in Bridges if the packet is received but not logged in?

Cash, CDC,and FAP

The program will close automatically on the Negative Action Date (Cash/CDC) or the Redetermination Due Date (FAP). You will have to reinstate the program. You can use the Redetermination case action to do this. First, mark the packet as received by going to Left Navigation > Redetermination > Packet Received.

MA and Medicare Cost Sharing

The programs will remain approved until you complete the redetermination.

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Redetermination

Perform Reviews

For annual redeterminations, use the Redetermination Case Action. You must update all information that has changed or requires re-verification at Redetermination (income, assets, and medical/support/ dependent care expenses).

After you have logged in the redetermination packet as received you can proceed with the redetermination. Go to Bridges Left Navigation > Data Collection > Initiate Interview.

For semi-annual or mid-certification contacts, use the Case Change Case Action. You must update all information that has changed or requires re-verification (income, child support expense, etc.).

What Case Action will you use?

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Bridges will update the review dates for a program ONLY if the redetermination has been initiated.

Redetermination

New Redetermination Due Date Established

After you have certified the results of the review, you can check to verify that a new Redetermination due date has been established:

1. Go to Left Navigation>Inquiry>Case.

2. Click the EDG# hyperlink on the Case Search/Summary page.

3. View the new Redetermination Date on the EDG Search/Summary page..

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Redetermination

Overdue Redetermination

A redetermination is considered “overdue” when:•The client returned the redetermination packet, and•The client kept the interview (if required) and •The specialist did not completed the redetermination in Bridges by the end of the redetermination month.

Program What happens in Bridges when the redetermination is overdue?

FAP The program will remain approved, but benefit issuance will stop until the redetermination is completed.

Cash, CDC, MA and Medicare Cost Sharing

The programs will remain approved and benefits will be issued (if appropriate) until you complete the redetermination.

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Redetermination

Client fails to return Packet

Program What happens in Bridges if the client didn’t return the redetermination packet?

Cash The program will close automatically on the Negative Action Date in the month the review is due.

CDC The program will close automatically on the Negative Action Date in the month the review is due.

FAP The program will close automatically after the Redetermination Due Date passes.

MA and Medicare Cost Sharing

Bridges will not close the program automatically. You must go to Left Navigation > Redetermination > RD MA Redetermination Packet Overdue to mark the program as ready for closure. The program will automatically close on the next negative action date.

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Redetermination

Any Questions?

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