109-9 ADDITIONAL GUIDELINES

Although the desk guides and templates are designed to inform staff about information they need to include in specific CANO Case Notes entries, the following sections provide additional guidelines to further clarify expectations for documentation in important areas affecting eligibility determination and benefit amount:

109-9 A     USING CANO Case Notes TITLES

Staff must always remember that CANO Case Notes titles should reflect what is in the body of the CANO Case Notes. Titles must be clear, descriptive and specific. Several recommendations and examples of CANO Case Notes titles are provided below.

Note:

When creating CANO Case Notes titles for applications and reapplications, staff must always include the program name, date of application, and action.

1. Title Formats, Keywords or Phrases

To easily locate information in a CANO Case Notes, the following wording or phrases must be included in titles:

• ROC- ADDR/EAIN/DEMH – case action
  

• ROC - Job Changed – case action
  

• ROC - New HH House Hold member – case action
  

• TA Temporary Assistance/FS Food Stamps/ME Medicaid Intake App – date of app – approved/pended/denied)
  

• TA Temporary Assistance/FS Food Stamps/ME Medicaid Recert – date of recert – approved/pended/denied)
  

• Information rec’d/date/action or still pended
  

• Fair Hearing Request with Finding
  

• Prehearing Conference with Action (forwarded/resolved)
  

• Fraud Referral
  

• ATAP Incapacity Determination
  

• Case Corrections for QA Review
  

• Type of Penalty Imposed/Lifted/Cured with date of action to occur
  

• Penalty Advanced to 75% with effective date
  

• Disqualification and Programs
  

• Trust Established

    * Initial Case Note; refer to ADLTC Medicaid MS 528-E

• Trust Information

    * For additional information received

• Medicaid (type) Trust (renewal)
  

• Transfer of Assets and Resources (effective date)
  

• Tax Refund Exempt (effective date to end date)
  

• TLIP Update  Request
  

• Spend-down (program type) (effective date)
  

• LOC, DDS and Qualis Determination (include agency name/date/favorable or denied)
  

• POA, Guardians and Payee
  

• ATAP Incapacity (name) (effective date to end date)
  

• Drug-related or Other Felony Convictions for (name)
  

• Unusual Alien Situations regarding (name)
  

• Intentional Program Violation
  

• Cold Call (# of attempt)

2. Examples of CANO Case Notes Titles

Some examples of good CANO Case Notes titles are provided below:

• ROC – EAIN/ADDR – PENDED
  

• ROC – ALERT/UIB  – BENEFIT CHANGE
  

• TA/FS/MED APP – 5/5/11 – APPROVED
  

• FS/ME REVIEW – 8/8/11 – PENDED
  

• FS/ME REVIEW CONT – 8/8/11 – DENIED
  

• FS/ME REVIEW – 8/24/11 – FS DENIED/MED AUTH
  

• INFORMATION REC’D 7/1/11 – STILL PENDED 
  

• WA PENALTY IMPOSED 8/1/11 – CHANGE OF BENEFITS
  

• PREHEARING CONFERENCE 8/4/11 -  RESOLVED
  

• FAIR HEARING – AGENCY UPHELD
  

• PENALTY ADVANCED TO 75%  - 8/1/11
  

• DISQUALIFICATION – FS 
  

• TRUST ESTABLISHED 8/2/11 (type – SNT/QIT/Pool)
  

• TRUST INFORMATION 8/24/11
  

• MEDICAID (type) TRUST – RENEWAL – 9/1/11
  

• TRANSFER OF ASSETS AND RESOURCES – 5/12/10 
  

• TAX REFUND EXEMPT - 1/11 THRU 1/12
  

• TLIP UPDATE REQUEST EFFECTIVE 6/1/11
  

• SPEND-DOWN (program type) 2/1/11 
  

• DDS DETERMINATION – 8/4/11 -  FAVORABLE
  

• POA, GUARDIANS AND PAYEE
  

• ATAP INCAPACITY (name) FROM 5/21/11 – 10/12/11
  

• DRUG-RELATED OR OTHER FELONY CONVICTIONS FOR JIMMY
  

• UNUSUAL ALIEN SITUATION REGARDING SALLY
  

• COLD CALL (#1)

109-9 B     USING ABBREVIATIONS AND ACRONYMS

Staff may use common abbreviations, acronyms and EIS Eligibility Information System Codes in CANO Case Notes documentation. They are generally used to shorten phrases in order to save space or to avoid awkward repetition of phrases. When using acronyms and abbreviations, follow this guideline:
 

1. •    Utilize the list of commonly used abbreviations and acronyms in DPA Division of Public Assistance (available as Addendum F).
     
     

   • When using a word or phrase that is not on the list, spell the phrase out and follow it with the abbreviation or acronym in parentheses. This ensures the reader clearly understands the meaning of the abbreviation or acronym and what it is being used for. This rule applies to each new CANO Case Notes that staff creates.
     
     

109-9 C    CREATING CANO Case Notes FOR REVIEWS AND RECERTS

The CANO Case Notes format is pertinent to both intake and maintenance processing.  The purpose of conducting a review or recertification is to determine continued eligibility and establish a new certification period. The CANO Case Notes for a review or recert CANO Case Notes should address much of the same information addressed in the documentation supporting a determination made on an initial application.

109-9 D    DOCUMENTING INCOME INFORMATION AND CALCULATIONS

Clear documentation of income calculations is critical for every eligibility determination.  Document all income, how it was verified, and calculated for each budget month.

If a pay stub is missing or if there is unusual pay stub that exists, staff need to seek clarification from the employer and this information must be followed-clearly explained. Additional guidance on documenting income is explained in Addendum A.

109-9 E    DOCUMENTING DISABILITY INFORMATION

The subject of disability is pertinent to all programs (incapacity for ATAP Adult Temporary Assistance Program, exemption for FS Food Stamps, disability for APA Adult Public Assistance / IA Interim Assistance, CAMA Chronic and Acute medical Assistance, and Medicaid). Staff must determine if disability exists in the home and document it accordingly.

Staff must not include sensitive information such as medical diagnosis or condition in CANO Case Notes. Refer to MS 109-3 for additional information on documenting sensitive information.

109-9 F     DOCUMENTING RIGHTS AND RESPONSIBILITIES

Program rules require staff to discuss rights and responsibilities with all applicants and complete the documentation process. Supervisors and case reviewers cannot assume that staff discussed the Rights and Responsibilities form (GEN 51 Your Rights and Responsibilities) with the client. Staff must document that rights and responsibilities were discussed with the client and note any other relevant information about the discussion.

If the interview was conducted by a fee agent, document that fee agent has discussed rights and responsibilities to the client and given the client a copy of the GEN 51 Your Rights and Responsibilities as indicated in the fee agent checklist.

109-9 G    DOCUMENTING TPL CODES

Documenting Third Party Liability (TPL Third Party Liability) for Medicaid cases is necessary to assist Health Care Services in billing the appropriate agency. When TPL Third Party Liability exists in a case, the following information must be included in the CANO Case Notes entry:

• the insurance code

• the name of the primary insured person and their place of employment if available

• the date the insurance began

• If the worker verifies insurance has ended, the date it ended should be annotated and how verified

109-9 H     DOCUMENTING CASE CORRECTIONS FOR QA Quality Assurance ERRORS

Clear, concise documentation is required for every case correction made as a result of a QA Quality Assurance error finding. Staff in the Program Integrity and Analysis Unit checks EIS Eligibility Information System to ensure the case corrections are completed. When documenting case corrections for QA Quality Assurance errors staff must:
 

1. •     Use standardized CANO Case Notes title to assist Program Integrity &Analysis in easily finding the case information, e.g., Case Corrections for QA Quality Assurance Review # ______.
     
     

   • Include a brief description of the error finding, the amount and months of the overpayment or underpayment, and an explanation of how it was calculated.  
      

The same documentation guidelines apply when submitting a fraud referral as a result of a QA Quality Assurance error and when closing a case after the household fails to cooperate with the QA Quality Assurance review.

109-9 I  DOCUMENTING RETURNED MAIL
 

DPA Division of Public Assistance applicants and recipients are responsible for providing accurate and updated addresses when applying for and receiving benefits. When DPA Division of Public Assistance offices receive returned mail, staff must follow certain guidelines to process the document and document the action. Refer to MS 103-4 for further guidance on processing returned mail. To document the receipt of returned mail, staff must include in the documentation the following information:

• Reason for the return. Some examples of language used by the postal service include: undeliverable as addressed, unclaimed, unable to forward, attempted not known, no forwarding address, no mail receptacle, attempted – not known, insufficient address, etc.

• Action: this may include action taken to verify the address was incorrect or if a new address exists or any case determination made.

• Notice of action sent to the household.