psychiatric indigent inpatient program (pii)
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psychiatric indigent inpatient program (pii)


Revised December 13, 2011



What is PII and who is eligible for PII?

 

How long is the certification period for PII?

 

How do I screen in a PII (M99) AU?

 

How do I process a PII (M99) AU?

 

How do I enter medical expenses to meet the PII EMER and spenddown?

 

How do I assign medical expenses and authorize spenddown?

 

Do I need to list the expenses used to meet the PII EMER and spenddown on the approval letter?

 

How do I process Involuntary Treatment Act (ITA) clients?

 


 


What is PII and who is eligible for PII?

 

·         The Psychiatric Indigent Inpatient (PII) program became effective July 1, 2003 to provide emergent medical care to indigent individuals who voluntarily admitted themselves for inpatient psychiatric treatment with Regional Support Network (RSN) approval.

 

·         For more information about the PII program and who is eligible for PII, see EAZ Manual – WAC 388-865-0217 Psychiatric Indigent Inpatient Program.

 

How long is the certification period for PII?

 

·         Clients are allowed one 3-month certification period on PII per 12-month base period. The PII client also has a $2,000.00 Emergency Medical Expense Requirement (EMER) for every 12-month base period.

 

·         Clients applying for additional voluntary admissions to a psychiatric hospital within their original 12-month base period are subject to an Exception to Rule process. 

 

·         If the client is approved for PII for an additional 3-month certification period with an Exception to Rule, the client will not have to meet an additional $2,000.00 EMER.

·         For more information on certification periods, see EAZ Manual EMERGENCY ASSISTANCE – PSYCHIATRIC INDIGENT INPATIENT (PII).

 

How do I screen in a PII (M99) AU?

 

·         To screen a PII (M99) AU, take the following steps:

 

1.    From the Welcome Back page in aces.online, click the Screen New Application link at the top of the page. The Applicant page displays in a new window.

 

2.    In the Applicant page, enter the applicant’s information and continue with the screening process until you reach the Programs page.

 

3.    From the Programs page, select Medical and click Next.

 

4.    Continue the screening process until you get to the Finalize page.

 

5.    For an adult applicant under age 65 without a dependent child, the system will default to SSI Related Categorically Needy – Disabled (S02 D). If your applicant is over age 65 without a dependent child, you will need to select the PII program by clicking on the Specify Program button.

6.    From the Program drop down menu, select Medical Assistance (MA).

 

7.    From the Medical Coverage Group drop down menu, select Psychiatric Indigent Inpatient Spenddown (M99), and click Next.

8.    You will then be back at the Finalize page where the Psychiatric Indigent Inpatient (PII) program will have a green check mark next to it.

 

9.    Enter the date of application in the Application Date field which should be the same date as the applicant’s admittance to the psychiatric inpatient facility. Click Commit.

10. From the Commit Status page, click the Exit Screening button. 

 

How do I process a PII (M99) AU?

 

·         To process a pending PII (M99) AU, take the following steps:

 

1.    From the AMEN, enter Option O – Interview in the Selection field.

 

2.    On the AREP screen, enter the hospital where the applicant has received voluntary psychiatric inpatient treatment as the Authorized Representative (AREP) using type [HO] – Hospital Representative, Receives Letters – Use for MA.

 

o   If an AREP type [HO] is not entered the user will encounter Edit 2184 – PII/M99 REQUIRES HOSPITAL (HO) AS THE AUTHORIZED REPRESENTATIVE on the APP2 screen and will not be able to finalize the PII AU in Option Q – Finalize until an AREP type [HO] is added.

 

3.    The STAT screen will only allow one [RE] – Recipient.

 

4.    The only enterable financial responsibility codes for PII are:

 

o   [IP] – Ineligible Person.

 

o   [PN] – Applicant for the person applying.

 

o   [SC] – Child of SSI Related Parents/Child used to determine household size for dependent children living with the applicant.

 

o   [SP] – Ineligible Spouse for spouse of applicant.

 

o   [NM] – Non Related and Not financially Responsible to the Applicant.

 

w  [RE] – Recipient and [SI] – SSI Parent cannot be entered on STAT screen but may be changed by the system to these values during eligibility processing.

 

5.    On the ALAS screen, in the Psychiatric Indigent Inpatient Section:

 

o    Enter [RV] – RSN Authorization, Voluntary or [NO] – No RSN Authorization in the Rsn Cd field.

 

o    Enter the [9 digit authorization number] provided by the hospital in the Rsn Number field. See Worker Responsibilities under EAZ Manual – WAC 388-865-0217 Psychiatric indigent inpatient program for more information.

 

o    The Admit Date field is auto-populated with the application date.

 

o    Enter the [appropriate code] in the Exception Cd field. Entry of [N] will result in a denial.

 

    The Exception Cd field is a mandatory field when the client has received RSN approval for Voluntary Admission and reapplies more than once during a 12-month period.

 

    An Exception to Policy code must be re-entered for multiple extensions.

 

6.    On the MISC screen, enter the actual date the application was received by the CSO in the Appl Override Date field. This will identify applications that are submitted greater than three months after the admit date.

 

7.    Complete Option O – Interview. See Interview chapter.

 

8.    Process all months through Option P – Process Appl Months. See Process Application Month chapter.

 

9.    Complete Option Q – Finalize Application. See Finalize Application chapter.

o   If a PII AU is added to a case that already includes an active Cash or Medical AU, the client’s financial responsibility code on the PII AU changes to [OS] – CL Inc/Assets/Exp Treated as Recipient but Active in Another AU in finalize and will deny with Reason Code 245 – No Eligible Household Members.

 

o   If a PII AU is in [M] or [A] status, a related cash or medical AU can be added. If the related cash or medical AU becomes active and then the PII AU goes to active, the PII AU will close in overnight batch with Reason Code 245 and the financial responsibility code changes to [OS] – CL Inc/Assets/Exp Treated as Recipient but Active in Another AU.

 

o   If the applicant entered Washington State specifically to obtain medical care, the user should use the value [T] – Temporary Resident for Medical Tx in the Washington Resident field on the DEM1 screen. The PII AU will deny for Reason Code 210 – Failed Residency Requirement in finalize.

 

o   Inmates of a federal or state prison are coded on DEM1 with [PR] – State/Federal Prison in the Living Arrangement field. This will cause the PII to close/deny with Reason Code 201 – Living Arrangement.

 

How do I enter medical expenses to meet the PII EMER and spenddown? 

 

·         For steps on how to enter medical expenses for the applicant’s spouse or child(ren), see Spenddown – How do I enter medical expenses?.

 

·         To enter medical expenses for the applicant on a PII AU, take the following steps:

 

1.    In aces.online, from the Client >> Spenddown Medical Expenses page, click the Add link and the Client Spenddown Medical Expenses – Add box opens.

 

2.    On the Client Spenddown Medical Expenses – Add box, complete the following fields:

 

o   Expense Type: Enter Psychiatric Hospitalization (PH)

 

o   Current Indicator: When Expense Type PH is chosen, the Current Indicator field opens.

 

w  Check No if the expense is a prior PH bill. The PH expense marked as No displays as PH in the Expense Type field and is deducted first to meet the EMER.

 

w  Check Yes if the expense was incurred during the base period. The PH expense marked as Yes displays as PH/C in the Expense Type field and is used next to meet the EMER.

 

o   Expense Amount: Enter the expense amount.

 

o   Verification: Select the appropriate verification code from the drop down menu.

 

o   Date Incurred: The date format is MM/DD/YYYY or users can click on the electronic calendar to select a date.

 

o   TPL Amount: Enter the amount of the expense covered by another source such as other health insurance.

 

o   Expense Paid: Click the radio button to indicate Yes or No.

 

o   Provider Name: Enter the name of the provider, such as the hospital, clinic’s or pharmacy’s name.

 

3.    To add more than one medical expense, click the Add More box.

 

4.    Click the Submit button.

 

5.    After expenses have been added, follow the steps in Spenddown - How do I assign medical expenses and authorize spenddown?

 

How do I assign medical expenses and authorize spenddown?

 

·         For information on the order in which medical expenses reduce the spenddown liability, see EZ Manual WAC 388-519-0110 Spenddown of excess income for the medically needy program.

 

·         To assign medical expenses and authorize spenddown, take the following steps:

 

1.    On the Assistance Unit >> Spenddown page, if the ongoing month is not part of the spenddown period, select a benefit month within the spenddown base period. The Benefit Month selection is at the top right hand corner of the page.

 

2.    From the Assistance Unit >> Spenddown page, at the bottom, click the Start the Assign/Authorize Process button.

 

3.    On the Assistance Unit >> Spenddown Assign/Authorize Review page:

 

o   Review the Spenddown Details and Liability section to make sure eligibility calculations are correct.

 

o   Click the Next button.

 

4.    On the Assistance Unit >> Spenddown Assign/Authorize page, all the spenddown medical expenses entered for all household members are listed in priority order.

 

o   To select a medical expense to assign, click the check box next to the medical expense.

 

o   Click the Next button.

 

5.    On the Assistance Unit >> Spenddown Assign/Authorize Confirm page:

 

o   If the spenddown liability has been met, the Eligibility Begin Date field in the AU status section displays the medical approval date. The date is based on the assigned medical expenses.

 

o   On the Assistance Unit >> Spenddown Assign/Authorize Confirm page, click the Confirm button.

 

·         When the client is approved for PII, Letter 002-31 (Approval for PII) generates.

 

·         A copy of Letter 002-31 is also sent to the hospital identified with the AREP value code of [HO].

 

Do I need to list the expenses used to meet the PII EMER and spenddown on the approval letter?

 

·         Letter 002-31 (Approval for PII) auto fills with the expenses that were used to meet the PII EMER and spenddown liability.

 

How do I process Involuntary Treatment Act (ITA) clients?

 

·         Coverage is provided to individuals who are involuntarily admitted for inpatient psychiatric treatment under the Involuntary Treatment Act (ITA). ITA’s are not currently supported in ACES. Payment is made for involuntary psychiatric treatment services directly to the providers from Health and Recovery Services Administration (HRSA).

Modification Date: December 13, 2011