ADDENDUM 4 COCA Processing

ADLTC - Alaska Aged, Disabled and Long Term Care Medicaid Manual

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ADDENDUM 4

COCACost of Care PROCESSING

A. THE COCACost of Care SCREEN

The COCACost of Care Screen isIndividualized Supports used to calculate the amount of money a client is required to pay for the care he or she is receiving.

CF109-I NEW COCACost of Care AMT CALCULATED - PRESS ENTER TO CONFIRM - F9 TO CANCEL
EISEligibility Information System COCACost of Care		COST OF CARE SCREEN				020204 14:26
						WORKER B
CASE NAME: DOE, JOHN				CASE NUMBER: 00024573		MONTH: 0304
CLIENT: JOHN D				CLIENT NO: 0600055441

INCOME				EXPENSE
	SOC SECURITY (SS)	:	1200.00		PERSONAL NEEDS	:	1656.00
	SUPL SECURITY (SI)	:			INCOME TAXES	:
	SENIOR BENEFITS	:			CHILD SUPPORT GARNISH	:
	VETERANS ( VA )	:			SPOUSAL MAINTENANCE	:
	PENSION PERSPublic Employees Retirement System	:	1500.00		DEPENDENT MAINTENANCE	:
	ANNUITY	:			INSURANCE PREMIUM	:
					UNCOVERED MED EXPENSE	:	140.00
	EARNED INCOME	:			HOME MAINT (6 MO MAX)	:
	ADULT PUBLIC ASSISTANCE	:			EXPENSE ADJUSTMENT	:
	INCOME ADJUSTMENT	:
	TOTAL INCOME	:	2700.00		TOTAL EXPENSE	:	1796.00

Comments:

	NEW COST OF CARE LIABILITY AMOUNT:				904.00
							NEXT-->

B. DESCRIPTION OF FIELDS ON COCACost of Care SCREEN

FIELD	DESCRIPTION / USE
INCOME
SOC SECURITY (SS)	If the client receives Social Security (SSASocial Security Administration) income (RE, DI, etc), input the amount in this field.
SUPL SECURITY (SI)	If the client receives Supplemental Security Income (SSISupplemental Security Income), input the amount in this field.
SENIOR BENEFITS	If the client receives Alaska Senior Benefits Program (SBP) payments, input the amount in this field.
VETERANS ( VA )	If the client receives payments from the Department of Military and Veterans Affairs, input the amount in this field.
PENSION	If a client is receiving an employer pension, enter the amount in this field.
Open Field by PENSION	The field beside Pension opens and allows the caseworker to enter the source of the Pension (i.e. PERSPublic Employees Retirement System , Railroad, etc.)
ANNUITY	If a client is receiving an annuity from a private source, enter the amount in this field.
Open Field by ANNUITY	The field beside ANNUITY opens and allows the caseworker to enter the source of the annuity (i.e. SBS, Roth IRA, etc.)
Open Field between ANNUITY and EARNED INCOME fields	Use this field to enter any supplemental or additional income not otherwise specified.
EARNED INCOME	If a client has wages, enter the amount of gross earnings (including self-employment) in this field.
ADULT PUBLIC ASSISTANCE	If a client receives APAAdult Public Assistance benefits, enter the total amount of APAAdult Public Assistance benefits in this field.
INCOME ADJUSTMENT	Enter any amounts of offsetting income. (e.g. when an incorrect amount of income was used in determining the cost of care in a previous month.)
TOTAL INCOME	This field displays the total amount of countable income.
COMMENTS	This is a free form field for caseworkers to enter information regarding any of the data entry on the COCACost of Care screen. DO NOT DUPLICATE information that is recorded on the online Case Notes ( CANO ).

FIELD	DESCRIPTION / USE
EXPENSES
PERSONAL NEEDS	This amount is hard coded and is determined by the Medicaid subtype entered on the MEREMedical Reference screen.
INCOME TAXES	If a client pays taxes on any income (e.g. (retirement or annuity), enter the amount paid in this field.
CHILD SUPPORT GARNISH	If a client has any income garnished for child support during the month, enter the amount of the garnishment in this field.
SPOUSAL MAINTENANCE	Enter the amount allowed for spousal maintenance in this field.
DEPENDENT MAINTENANCE	Enter the amount allowed for dependent maintenance in this field.
INSURANCE PREMIUM	If a client pays an insurance premium for private insurance coverage, enter the amount of premium in this field.
UNCOVERED MED EXPENSE	Enter the amount for uncovered medical expenses in this field.
HOME MAINTENANCE	(6 MO MAX) If a client lives in a nursing home and intends to return to his or her private residence, enter the amount of maintaining the private residence in this field.
EXPENSE ADJUSTMENT	Enter any offsetting expenses in this field.
TOTAL EXPENSES	The total amount of allowed expenses will display in this field.
NEW COST OF CARE LIABILITY AMOUNT	Upon <ENTER> this field will display the clients new cost of care amount.

C. COCA PROCESSING EXAMPLES

Example 1:

John Doe is currently eligible for Medicaid under the Special Long Term Care category and is receiving HCBHome and Community-Based Waiver Services. He lives in his own home. His monthly income consists of $1200 in SS-RE and $1500 in PERSPublic Employees Retirement System retirement for a combined monthly income of $2700. He has a Qualifying Income Trust ( QIT ) that he deposits $1044 each month. He also incurs uncovered medical expenses and this month the total of uncovered medical expenses is $140.

Step 1:
Input all demographic and income information.

Step 2:
On the MEREMedical Reference :
" Input" the correct Medicaid Subtype and Eligibility Code.

Step 3:
On the APAAdult Public Assistance METHOD MEDICAID ONLY AUTHORIZATION ( APMM ) screen:
1. <TAB> to the UNEARNED INCOME field and enter the combined unearned income
2. <ENTER>
3. Input PCN and REVIEW DUE DATE
4. <ENTER>

APMMAPA Method Medicaid Only Authorization screen	APAAdult Public Assistance METHOD AUTHORIZATION ONLY				020204 13:50
					WORKER B
CASE NAME: DOE, JOHN			CASE NUMBER: 00024573		MONTH: 0304

ADJ GROSS EARNED INCOME	:	0.00		HOUSEHOLD TYPE	:	WAV
$65 AND 1/2 WORK INCENT	:	0.00		QMBQualified Medicare Beneficiaries / SLMB HH SIZE	:
ABAid to the Blind WORK DEDUCTIONS	:	0.00
NET EARNED INCOME	:	0.00		APAAdult Public Assistance NEED STANDARD	:	1656.00
UNEARNED INCOME	:	2700.00		COUNTABLE EARNED INCOME	:	2700.00
$20 DISREGARD	:	0.00
NET UNEARNED INCOME		2700.00


PENDED?	:			INFORMATION ONLY
AUTHORIZATION	:
DENIAL/CLOSURE REASON	:			COUNTABLE RESOURCES	:	0.00
				INSTITUTIONALIZED?	:


BENEFIT ISSUANCE	:	R

REVIEW DUE DATE	:	0105

Step 4:

Upon <ENTER> the COCACost of Care screen will appear. On the COCACost of Care screen:

1. In the SOC SECURITY field input the SS-DS payment of $1200

2. <TAB> to the PENSION field, beside the PENSION field enter the source of the pension

3. In the PENSION field input the PERSPublic Employees Retirement System pension of $1500.00

4. <TAB> to the UNCOVERED MED EXPENSE and enter the allowed $140 deduction

5. <TAB> to the COMMENTS field and enter any comments (optional step)

6. <ENTER> to calculate the New Cost of Care Liability amount

7. If correct<ENTER> again to confirm

EISEligibility Information System COCACost of Care		COST OF CARE SCREEN				020204 14:03
						WORKER B
CASE NAME: DOE, JOHN				CASE NUMBER: 00024573		MONTH: 0304
CLIENT: JOHN D				CLIENT NO: 0600055441

INCOME				EXPENSE
	SOC SECURITY (SS)	:	1200.00		PERSONAL NEEDS	:	1656.00
	SUPL SECURITY (SI)	:			INCOME TAXES	:
	SENIOR BENEFITS	:			CHILD SUPPORT GARNISH	:
	VETERANS ( VA )	:			SPOUSAL MAINTENANCE	:
	PENSION PERSPublic Employees Retirement System	:	1500.00		DEPENDENT MAINTENANCE	:
	ANNUITY	:			INSURANCE PREMIUM	:
					UNCOVERED MED EXPENSE	:	140.00
	EARNED INCOME	:			HOME MAINT (6 MO MAX)	:
	ADULT PUBLIC ASSISTANCE	:			EXPENSE ADJUSTMENT	:
	INCOME ADJUSTMENT	:
	TOTAL INCOME	:	2700.00		TOTAL EXPENSE	:	1796.00

Comments:

	NEW COST OF CARE LIABILITY AMOUNT:				904.00
							NEXT-->

Example 2:

Jane Doe is currently eligible for Medicaid under the Special Long Term Care category and is receiving HCBHome and Community-Based Waiver Services. She lives in an assisted living home. Her monthly income consists of $1200 in SS-RE and $300 from an annuity for a combined monthly income of $1500. She has no expenses.

Step 1:

Input all demographic and income information

Step 2:

On the MEREMedical Reference :

"Input" the correct Medicaid Subtype AS and Eligibility Code

Step 3:

On the APAAdult Public Assistance METHOD MEDICAID ONLY AUTHORIZATION ( APMM ) screen:

1. <TAB> to the UNEARNED INCOME field and enter the combined unearned income

2. <ENTER>

3. Input PCN and REVIEW DUE DATE

4. <ENTER>

Step 4:

Upon <ENTER> the COCACost of Care screen will appear. On the COCACost of Care screen:

1. In the SOC SECURITY field input the SS-DS payment of $1200

2. <TAB> to the ANNUITY field, beside the ANNUITY field enter the source of the annuity

3. In the ANNUITY field input the $300.00

4. <TAB> to the COMMENTS field and enter any comments (optional step)

5. <ENTER> to calculate the New Cost of Care Liability amount

6. If correct<ENTER> again to confirm

EISEligibility Information System COCACost of Care		COST OF CARE SCREEN				090204 14:03
						WORKER B
CASE NAME: DOE, JANE				CASE NUMBER: 00024573		MONTH: 1004
CLIENT: JANE D				CLIENT NO: 0600055441

INCOME				EXPENSE
	SOC SECURITY (SS)	:	1200.00		PERSONAL NEEDS	:	1396.00
	SUPL SECURITY (SI)	:			INCOME TAXES	:
	SENIOR BENEFITS	:			CHILD SUPPORT GARNISH	:
	VETERANS ( VA )	:			SPOUSAL MAINTENANCE	:
	PENSION PERSPublic Employees Retirement System	:			DEPENDENT MAINTENANCE	:
	ANNUITY	:	300.00		INSURANCE PREMIUM	:
					UNCOVERED MED EXPENSE	:
	EARNED INCOME	:			HOME MAINT (6 MO MAX)	:
	ADULT PUBLIC ASSISTANCE	:			EXPENSE ADJUSTMENT	:
	INCOME ADJUSTMENT	:
	TOTAL INCOME	:	1500.00		TOTAL EXPENSE	:	1396.00

Comments:

	NEW COST OF CARE LIABILITY AMOUNT:				104.00
							NEXT-->

D. THE COCB SCREEN

The COCB screen provides a history of the cost of care for the case. This screen displays all months of benefits, including months that have auto-rolled. The only instance where the COCB will not show a benefit month is if a worker accidentally passed through the COCACost of Care screen without making any entries. To access the COCB screen:

<NEXT> to the COCB from the COCACost of Care or any EISEligibility Information System menu

Caseworkers can access a specific COCACost of Care screen directly from the COCB screen by:

1. Placing an X in the SEL (select) field by the benefit month

2. Pressing <ENTER>

IE002-I END OF DATA
EISEligibility Information System COCB		COST OF CARE BROWSE				020204 14:06
						WORKER B
CASE NAME: DOE, JOHN			CASE NUMBER			0002457

SEL	BEN MONTH	COCACost of Care AMOUNT	INCOME AMOUNT	EXPENSE AMOUNT	COMMENTS
	03/04	904.00	2700.00	1796.00
	02/04	844.00	2700.00	1856.00
	03/00	712.83	1240.00	527.17
	02/00	1713.98	2291.87	577.89
						NEXT -->

Note:

When the COCACost of Care displays from the COCB, the NEXT field will automatically display COCB.

E. MAKING RETROACTIVE COCACost of Care ADJUSTMENTS

Example 3:

Retroactive Adjustment due to Reported Uncovered Medical Expense

It is March 3, 2004 and Mr. Doe has submitted a podiatrist bill for $75 for services received on February 19, 2004.

Step 1:

Access the 0404 COCACost of Care screen and input the $75 in the Expense Adjustment field and <ENTER>

Step 2:

Upon <enter> EISEligibility Information System will update the COCACost of Care liability

Step 3:

Send notice to Mr. Doe explaining that his COCCost-of-care for 0404 has been reduced due to the uncovered medical expense occurred in 0204.

Step 4:

Access the 0504 COCACost of Care screen and remove the $75 from the Expense Adjustment field and <ENTER>

Step 5:

Upon <ENTER> the COCACost of Care screen will update the COCCost-of-care amount

Step 6:

Send a second notice to Mr. Doe explaining that his COCCost-of-care liability will increase in 0504.

Example 4:

Retroactive Adjustment due to Increased Income

Mr. Doe receives Social Security Retirement. It is January 10, 2004 and the caseworker has just realized that the COCCost-of-care was not adjusted with the increase in Social Security due to the cost-of-living adjustment. Mr. Does Social Security increased from $1200 to $1226.

Step 1:

Access the 0204 COCACost of Care screen and enter the new SS-RE amount of $1226.00 in the SOC Security field.

Step 2:

Enter the $26 of the missed Social Security for 0104 in the INCOME ADJUSTMENT field and <ENTER>

Step 3:

Send the COCCost-of-care notice informing Mr. Doe that his 0204 COCCost-of-care liability has increased due to Social Security adjustment

Step 4:

Access the 0304 COCACost of Care screen and delete the $26 from the INCOME ADJUSTMENT field and <ENTER>

Step 5:

Send a second notice explaining what the new COCCost-of-care liability amount is beginning with 0304 benefits.

F. CONTACTING THE HELP DESK

If COCCost-of-care adjustments cannot be made within a four-month timeframe, contact the EISEligibility Information System Helpdesk to adjust the COCACost of Care for earlier months.

When contacting the Help Desk to make a change to the Cost of Care Liability, provide the following information for each month to be corrected:

All income information

All expense information

The corrected liability amount

The Help Desk will email Policy to determine if the request is valid and can be approved. If the request is denied, the Help Desk will email the ET who requested the correction.

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		MC #53 (04/20)