MEMORANDUM

DATE:                  September 20, 2004

TO:                        All Medical Assistance Manual Holders

FROM:                  Policy and Program Development Team

                               Ellie Fitzjarrald, Chief

SUBJECT:           Medical Assistance Manual Change #28

This manual change incorporates revisions to bring our policy manual up-to-date with changes that have occurred over the last few months.

It includes clarifications, examples, and new subsections in the Transitional Medicaid Section.  These improvements are the result of findings and recommendations of the Quality Assessment Review Committee ( QARC Quality Assurance Review Committee ).  

This manual change also removes Part E – Medicaid Covered Services since the Division of Health Care Services now publishes and distributes the Medicaid Recipient Services Handbook, which is also available online.

The changes included are outlined below.  If you have any questions, please contact any member the Policy and Program Development Team at 465-3347 or email us at dpapolicy@health.state.ak.us.

OVERVIEW OF CHANGES

5002 – General Medicaid Provisions

• Changes the name of the Primary Care Program to the Medicaid Lock-In Program.

• Reflects that administration of the Lock-In program has been contracted to the state’s fiscal agent, First Health Services Corporation.

• Incorporates Medicaid policy for recipients placed into Lock-In that was announced by broadcast on June 17, 2004.  First Health will assign a provider and the recipient will no longer be able to choose their provider.

• Instructs caseworkers to contact First Health if a Medicaid coupon is requested for a recipient who is in the Lock-In program.

• Removes provision for the Recipient Identification card being sent to an authorized representative.  This provision is added to Section 5075.

• Adds the internet address (URL) for the Alaska Medicaid Recipient Handbook, which provides information on Medicaid covered services, and is now available on-line from the Division of Health Care Services.

5035 – Residents of Public and Penal Institutions

• Adds Definitions of inmate and institutional status.

• Changes the definition of a Pioneer’s Home from a public (non-medical) institution to a public “medical institution”.  Incorporates policy that Medicaid is available to a Pioneer’s Home resident that was announced by broadcast on June 29, 2004.  

• Updates the Division of Juvenile Justice contact list for verifying the release date of an incarcerated child.

5075 – Medicaid Recipient Identification Card

• Revised to incorporate current practices and issuances of the Medicaid and Denali KidCare Recipient Identification Cards.

5220 – Transitional Medicaid

• Moves Definitions to beginning of section.

• Clarifies eligibility for Transitional Medicaid is not automatic, and requires a separate eligibility determination.

• Includes a new subsection with guidance on when to begin the first month of Transitional Medicaid, and when backdating may be necessary.  Also adds an example.

• Includes a new subsection regarding verification of employment and earnings.

• Clarifies countable months that qualify for Transitional Medicaid when determining if the household meets the three of the last six months requirement.

• Changes “Child Support Enforcement Division” ( CSSD Child Support Services Division ) to the Division’s new name of “Child Support Services Division” ( CSSD Child Support Services Division ).

• Includes reference to Addendum – 2 for the Federal Poverty Guidelines for Alaska.

• Identifies the appropriate EIS Eligibility Information System notices to send under the notice requirement subsection.

• Adds an example for reinstating Transitional Medicaid during a dual eligibility period.

• Adds a section to explain the need for a redetermination of potential Medicaid eligibility in another category at the end of the Transitional Medicaid period.

MANUAL CHANGE FILING INSTRUCTIONS