MEMORANDUM

DATE: September 9, 2003

TO: ALL CAMAChronic and Acute Medical Assistance MANUAL HOLDERS

FROM: Program & Policy Development

SUBJECT: CAMAChronic and Acute Medical Assistance Manual Change #1

This manual change includes policy clarifications and substantial coverage changes due to large reductions in the CAMAChronic and Acute Medical Assistance appropriations.  Effective September 20, 2003, CAMAChronic and Acute Medical Assistance no longer covers any inpatient hospitalization, nursing home services, or transportation expenses.  Effective October 1, 2003, prescription drug coverage is restricted to three approved prescriptions per recipientAn individual who is receiving a public assistance program. within a calendar month.  Medical supplies will only be reimbursed if they are related to the administration of a drug product needed to treat one of the covered conditions and may not exceed a 30 day supply.

If you have any questions about this manual change, please contact the Policy and Program Development Team at 465-3347 or email dpa_policy@health.state.ak.us.

OVERVIEW OF CHANGES

900 – Introduction and General Provisions

1. • Removes coverage for inpatient hospitalization, nursing home care and transportation.

910 - 1 – Applying for CAMA

1. • Removes language about using the Med 4 application form for nursing home coverage.

910-3 – Verification and Documentation

1. • Removes the physician assistant signature from being accepted on the Med 11 form, and removes the need for Division of Health Care Services (formerly DMA ) approval for nursing home admission.

910-4 – MED 11 Processing Instructions

1. • Removes language about the client signing the release of information in the Patient Identification section.  The Med 11 form has been revised with HIPAAHealth Insurance Portability and Accountability Act approved language.

940-1 – CAMA Household

1. • Clarifies a legally responsible relative must be both categorically and financially eligible as a “potential” cash assistance program recipientAn individual who is receiving a public assistance program. to exclude their needs, income, or resources from counting for the applicant’s CAMAChronic and Acute Medical Assistance eligibility - example added.

940-4 – Determining Month Net Income

1. • Fixes a misplaced paragraph that was adding confusion on when to apply a standard 20% deduction from gross income.

950 – Covered Medical Services

1. • Removes coverage for major medical careNon-elective inpatient hospital services that cannot be performed on an outpatient basis and are certified as necessary by the professional review organization under contract with the Division of Health Care Services., impatient physician services, transportation, nursing home services, and laboratory and X-ray services.

950 -2 - Major Medical Care , 950-3 - Transportation, and

950-4 - Nursing Home Care

These subsections are removed.

960 –1 – Period of Eligibility

1. • Removes paragraph regarding eligibility for nursing home cases.

960-2 - Reviews

1. • Updates policy that a new Med 11 form must be completed by the recipient’s physician or advanced nurse practitioner for verification that the recipientAn individual who is receiving a public assistance program. still has a qualifying chronic condition, cancer, or terminal illness.

970 - The CAMA Authorization (COUPON)

1. • Removes the paragraph about approval needed from Qualis HealthThe professional provider review organization on contract with the Division of Medical Assistance. for inpatient services.