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ACES
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Revised October 28, 2009 |
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Purpose: |
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Eligibility Review/Recertification
Separate Eligibility Reviews for TANF/SFA Cash and TANF Related Medical
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ELIGIBILITY REVIEW/RECERTIFICATION What is the eligibility review/recertification process?
How does ACES support the eligibility review process?
How are eligibility reviews scheduled?
How is the eligibility review type determined?
How often is an eligibility review required?
How are certification periods determined?
How do I initiate an eligibility review?
How do I complete an eligibility review?
Can I initiate a review on a Spenddown Assistance Unit?
How do I complete an eligibility review after deadline but before the first of the following month?
What happens if an eligibility review is not initiated?
What happens if an eligibility review is initiated but not completed?
What is the eligibility review/recertification process?
· The eligibility review/ recertification process is to determine if a client is still eligible to receive continued assistance. It is the procedure by which a user:
o Initiates an eligibility review;
o Enters any changes with required verification based on the household's current circumstances; and
o Extends the certification period.
· For more information, see the following EAZ Manual Chapters:
o Eligibility Review/Food Assistance Recertifications – Process for Basic Food
How does ACES support the eligibility review process?
· ACES supports the eligibility review process by:
o Scheduling appointments. See Scheduling - Schedule an Eligibility Review / Recertification Appointment for a Client.
o Tracking the initiation and completion of eligibility reviews.
o Allowing on-line entry of eligibility review information.
o Initiating required interfaces and referral.
o Identifying required verifications.
o Sending alerts and letters.
How is the eligibility review type determined?
· Theeligibility review type is determined based on the valid value entered in the Next Review field on the MISC screen. There are three possible review types:
o M = Mail in Review
o O = Office Review
o T = Telephone Review
· When a new application is finalized, the Next Review field defaults to [O] – Office Review Type. The review type can be changed.
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How are eligibility reviews scheduled?
· Eligibility reviews are AUTO scheduled by ACES or manually scheduled by a user. See Scheduling - Schedule an Eligibility Review / Recertification Appointment for a Client.
How often is an eligibility review required?
· For cash and medical programs, see EAZ Manual – WAC 388-434-0005 Eligibility Reviews/Recertification’s For Cash and Medical Programs.
· For Basic Food, see EAZ Manual – WAC 388-416-0005 How long can I get Basic Food?
How are certification periods determined?
· See EAZ Manual Certification Periods.
· See ACES Certification Period Chapter.
How do I initiate an eligibility review?
· When an Eligibility Review form (14-078) has been received in Document Management System (DMS), ACES will AUTO update the MISC screen and display a [Y] in the Elig Rvw Rcvd field.
· To initiate an eligibility review take the following steps:
1. Select AMEN, Option N - Initiate Review, enter the [Client ID] for the head of household in the Client ID field, press <TRANSMIT>.
2. On the REVI screen, enter a [Y] in the SEL field next to each AU to be reviewed.
3. Press <TRANSMIT> to return to AMEN. | ||
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How do I complete an eligibility review?
· To complete an eligibility review take the following steps:
1. From the AMEN, enter Option R - Interim/Hist Change in the Selection field.
o Enter the [AUID or CLID] in the AUID or Client ID field for the head of household.
2. Update the case with information reported during the review, and re-enter all required verification codes. See EAZ Manual – WAC 388-406-0030 Do I need to submit other information after I apply for benefits?
3. Enter [Y] – Yes in the Elig Rvw Complete field on the MISC screen.
4. Commit the data.
· ACES generates Letter 027-01 (Cash/Medical/Food Recertification).
· The suspected of living above means (SLAM) indicator applies to cash and Basic Food AUs only and must be updated on the MISC screen at each eligibility review.
· In the SLAM Ind field, enter [Y] – Yes if you suspect the client(s) is living above their means. See <F2> help.
Can I initiate a review on a Spenddown Assistance Unit?
· If the spenddown AU for which the review is due is in [A] – active status, a review may be initiated on the following types of AUs:
o C99 (MN Hospice Svcs W/Spenddown),
o F99 (MN Children W/Spenddown),
o G99 (MN Alternate Living Facility W/Spenddown),
o K99 (MN Family LTC W/Spenddown) ,
o L99 (LTC MN W/Spenddown) ,
o P99 (Medically Needy Pregnancy) or;
o S99 (MN SSI Related W/Spenddown) the previous AU can be reopened.
· If the AU is in [M] – Spenddown status, an eligibility review can be initiated when the ongoing month is the month after the current base period end month.
How do I complete an eligibility review after deadline but before the first of the following month?
· Reinstate both the ongoing and historical months. See Reinstatement. To ensure certification is set correctly, users should always process the oldest month first.
· Once the AU is active, take the following steps:
1. Select AMEN, Option N – Initiate Review. Enter the [CLID] in the Client ID field for the head of household.
2. The REVI screen displays and lists all AUs with the same head of household due for review.
3. Enter [Y] – Yes in the SEL field next to each AU to be reviewed. Press <TRANSMIT>.
4. Select AMEN, Option R – Interim Historical change.
5. Update the case information as needed.
6. Enter [Y] – Yes in the Elig Rvw Complete field on the MISC screen.
7. On the CAFI screen, the REV Begin Date will be the same as the ongoing month and the REV End Date will default based on program requirements. For most cases, this means the certification period includes one extra month.
8. Commit the data.
· When the review is received after the first day of the month following the month the review was due re-open benefits effective the date you determine they were eligible. See EAZ Manual – WAC 388-418-0020 How does the department determine the date a change affects my benefits?
· When the review is not received until after the month it is due, the review should be handled as a new application.
o See Screening – aces. online Re-Open.
o Follow the steps in Interview.
What happens if an eligibility review is not initiated?
· When an appointment has been scheduled through ACES, but the review is not initiated, Alert 312 – ER/Recert Sched on Previous Working day – Not Initiated is generated and displays the day after the appointment.
· If the review is not initiated before deadline in the month it is due, ACES:
o Closes the AU with Reason Code 235 – Review Not Complete.
o Generates Letter 026-04 (Termination for No ER), and Alert 351- AU TERMINATED/CLOSED OVERINIGHT.
What happens if an eligibility review is initiated but not completed?
· Basic Food AUs close at the end of the certification period.
· Cash or medical AUs will not close and will remain active until they are manually closed. | ||
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· If the eligibility review has been received in DMS but not initiated or completed:
o The MISC screen for that AU displays a Y in the Elig Rvw Rcvd field.
o At monthly issuance, the AU remains open with the current eligibility review end date.
o The MAID continues to be generated until the review is completed.
· The following medical programs are included in this functionality:
o C01 F01 F02 F03 F04 F05 F06
F07 G02 G03 I01 K01 L02 P02
S02 S03 S04 S05 S06 S08 S30
· When the eligibility review has been received in DMS but not initiated or completed:
o The MISC screen for that AU displays a Y in the Elig Rvw Rcvd field.
o The P02 does not trickle to P05 but remains P02 until eligibility is redetermined.
o If the P02 AU remains open at least one month past the original certification end date, ACES subtracts the number of extended months from the P05 certification period.
o If the client is not eligible for any other medical program, a recalculation on the P02 AU will cause a trickle to P05.
♦ To manually recalculate eligibility, on the MISC screen enter [Y] in the Calc Elig Ind field. Call DONE and commit the data.
What happens to a GAX (G02) cash AU when an eligibility review has been received in DMS but not initiated or completed?
· When the eligibility review has been received in DMS but not initiated or completed:
o The MISC screen for that AU displays a Y in the Elig Rvw Rcvd field.
o At monthly issuance, the AU will close with Reason Code 235 – Review Not Complete.
o The GA-G02 AU sprouts to an MA S02 AU and Alert 110 – ER/ RECERT PENDING and Alert 322 – MA AU CREATED DUE TO CASH AU TERMINATION generate in overnight batch.
o The S02 AU will retain the same “Eligibility Review Received” and expired review end date values as the closed G02 AU.
o The S02 MAID continues to be generated until the review is completed.
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SEPARATE ELIGIBILITY REVIEWS FOR TANF/SFA CASH AND TANF RELATED MEDICAL What is the difference between TANF/SFA cash and TANF related medical eligibility reviews?
How does ACES indicate an eligibility review has been received?
What happens to TANF related medical AUs when the review is initiated but not completed?
What happens to TANF related medical when the review has not been received?
What happens to a TANF/SFA AU if an eligibility review has not been received in DMS or initiated?
What happens to TANF/SFA AUs with Office/Telephone interviews if a review is not completed?
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What is the difference between TANF/SFA cash and TANF related medical eligibility reviews?
· TANF/SFA cash AUs (F01) require an interview every 12 months.
· TANF related medical (F04, and Children’s Medical programs F06, and F07) only require that an eligibility review be completed.
· See EAZ Manual – WAC 388-434-0005 How often does the department review my eligibility for benefits?
How does ACES indicate an eligibility review has been received?
· ACES updates the Elig Rvw Rcvd field on the MISC screen with a [Y] – Yes the day after one of the following documents are scanned in DMS (Document Management System):
o Eligibility Review (14-078)
o Eligibility Review for Long Term Care Benefits (14-416)
What happens to TANF related medical AUs when the review is initiated but not completed?
· The AU will remain active and benefits issue until the review is completed.
· The AU continues to show the same certification period.
· Letter 026-04 (Termination for No ER) will NOT be generated.
· Alert 110 – ER/RECERT PENDING generates in overnight batch.
What happens to TANF related medical when the review has not been received?
· Letter 026-04 (Termination for No ER) generates 15 days prior to the end of the month.
· At monthly issuance, the AU will close for Reason Code 235 – Review Not Complete and generate Letter 026-04 (Termination for No ER).
· If the eligibility review has been received but not initiated or completed:
o At monthly issuance, the AU will close with Reason Code 235 – Review Not Complete.
o The TANF F01 AU sprouts to an MA F04 AU and Alert 110 – ER/ RECERT PENDING and Alert 322 – MA AU CREATED DUE TO CASH AU TERMINATION generate in overnight batch.
o The F04 AU will retain the same “Eligibility Review Received” and expired review end date values as the closed F01 AU.
What happens to a TANF/SFA AU if an eligibility review has not been received in DMS or initiated?
· If the eligibility review has not been received:
o At monthly issuance, the AU will close with Reason Code 235 – Review Not Complete and the TANF F01 AU will not sprout.
o Alert 268 – OPEN PREGNANCY MEDICAL generates if the AU contains an active client who is pregnant.
o Alert 269 – OPEN NEWBORN MEDICAL generates if the AU contains an active child who is less than 1 year of age.
What happens to a TANF/SFA AUs with Office/Telephone interviews if a review is not completed?
· Letter 026-04 (Termination for No ER) generates in overnight batch on the day of the scheduled review.
· If the eligibility review has been received but not completed:
o At monthly issuance the AU will close with Reason Code 235-Review not completed.
o The TANF F01 AU sprouts to an MA F04 AU.
o Alert 110 – ER/RECERT PENDING and Alert 322 – MA AU CREATED DUE TO CASH AU TERMINATION generate in overnight batch.
o The F04 AU will retain the same “Eligibility Review Received” and expired review end date values as the closed F01 AU.
· If the Eligibility review has not been received:
o At monthly issuance the AU will close with Reason Code 235 – Review not complete.
o The TANF F01 AU will not sprout.
o Alert 268 – OPEN PREGNANCY MEDICAL generates if the AU contains an active client who is pregnant.
o Alert 269 – OPEN NEWBORN MEDICAL generates if the AU contains an active child who is less than 1 year of age.
· If the eligibility review has been received but not completed:
o Letter 26-04 (Termination for No ER) will not be generated. o At monthly issuance, the AUs will remain active.
o The AU retains the same “Eligibility Review Received” and expired review end date values.
o Alert 110 – ER/RECERT PENDING generates in overnight batch.
· If the eligibility review has not been received:
o Letter 026-04 (Termination for No ER) generates 15 days prior to the end of the month.
o At monthly issuance the AU will close for Reason Code 235 – Review not Complete.
o Alert 268 – OPEN PREGNANCY MEDICAL generates in overnight batch if the AU contains an active client who is pregnant.
o Alert 269 – OPEN NEWBORN MEDICAL generates in overnight batch if the AU contains an active child who is less than 1 year of age. | ||
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MID–CERTIFICATION REVIEW Who is required to complete a mid-certification review?
What is the mid-certification review?
When is a mid-certification review generated?
Will the system match up the mid-certification review cycle for related AUs?
When will the system not match up the mid-certification review cycle for related AUs?
How will I know if an AU is a mid-certification reviewer?
How do I process a mid-certification review no change report with verifications?
How do I process an incomplete mid-certification review or a report with changes?
When is LTR 033-03 (Non-Receipt of Change Report Form) generated?
What happens at monthly issuance if the mid-certification review is incomplete?
What happens at monthly issuance if the mid-certification review has not been received?
Can an AU be manually closed for an incomplete mid-certification review?
What do I do if an application is received after an AU closed for no mid-certification review?
Who is required to complete a mid-certification review? · Most cash and Basic Food assistance units with certifications periods greater than 6 months are required to report changes on a mid-certification review. See EAZ Manual WAC 388-418-0011 What is a mid-certification review, and do I have to complete one in order to keep getting benefits?
· The reporting requirements are the same for all assistance units (AUs) related by head of household (HOH) and are based on what types of benefits the household receives.
What is the mid-certification review?
· The mid-certification review (Mid-Certification Review Form 022-07) is a letter that is auto populated with client information.
· Clients are required to return the report indicating if any circumstances have changed. See EAZ Manual WAC 388-418-005 How will I know what changes I must report?
· ACES creates the mid-certification review using static and conditional text to confirm circumstances and ask questions necessary to determine ongoing eligibility and benefits for the benefits clients receive.
· If a question is not relevant to the benefits a client receives, ACES will not add the question to the mid-certification review.
When is a mid-certification review generated?
· The mid-certification review is auto generated the day after monthly issuance (deadline) in the 5th month from the begin date.
· The Mid-Certification Review is due back by the 10th day of the 6th month.
Will the system match up the mid-certification review cycle for related AUs?
· If cash, family related medical or Basic Food is approved in different months and matching the cash or family medical end dates to the end date for Basic Food will give the cash or family medical a review end date of at least 6 months, the system will match up the mid-certification review cycle.
· A single report will be sent at the end of the 5th month of the Basic Food AU certification period to be completed and returned in the 6th month).
When will the system not match up the mid-certification review cycle for related AUs?
· If matching the cash or family related medical AU end dates to the end date for Basic Food will give the cash or family medical a review date of less than 6 months, the system will not match up the 6-month review cycle.
· The cash/family medical AU will receive a separate mid-certification review.
· The user has the option of initiating a review on the Basic Food AU which will match up the mid-certification review cycle to the newly opened cash or family medical AU.
· Processing the related application will be will be considered a completed mid-certification review and no LTR 022-07 will be mailed.
· The system will consider the mid-certification review as complete and automatically update the Report Cmplt field on the MISC screen to <C> (Complete) to prevent the termination of the related AU.
How will I know if an AU is a mid-certification reviewer?
· Mid-certification reviewers are identified on the STAT screen in the Rpt Stat field. This field will only appear on the STAT screen if the AU is a mid-certification reviewer (indicator ‘S’) or a quarterly reporter (indicator ‘Q’). See <F1> Help.
· The Rpt Stat field will always appear on the CAFI, MAFI, and/or FSFI screens. See <F1> Help.
· The exempt reason field on the CAFI, MAFI, and/or FSFI screen will be automatically updated by ACES to identify the reason an AU is a non-reporter. See <F1> Help.
How do I process a mid-certification review no change report with verifications?
· Mid-certification reviews returned with no reported changes and all required verifications are processed in aces.online using the 6 Month No Change Report function. This function can be accessed in two ways: 1. From the Welcome Back page in aces. online, use the Quick Navigation section to do the following:
o Enter a Client ID number in the Enter an ID box.
o From the Select a Page drop down box, click on the 6 Month No Change Report option.
OR
o From the Client Summary page, select the Case Maintenance link and then click 6 Month No Change Report.
2. When the 6 Month No Change Report option is selected, a pop-up page, ACES Update, appears and lists all AUs that the client is the HOH for and that have a Mid-Certification Review due.
3. If there are no related AUs with a mid-certification review due or the client is not a Mid-Certification Reviewer, the error message “No related AUs qualify to process for Simplified Review” will appear.
4. The date field defaults to the current date. A new date can be entered in the space provided or selected from the calendar.
5. Once completed, click on the “Save” button for the system to process the entered date.
6. A second pop-up page appears with links to Additional Functions View Case Narrative and Take me to Letters List.
· This process automatically updates the Date Report Rec’d and Report Complt fields on the MISC screen in ACES.
· The ACES narrative is automatically updated with the following entry:
o “Mid-Certification Review form received. Client states circumstances have not changed. Case processed and finalized. Letter 010-01 sent."
· ACES generates one LTR 010-01 (No Change in Benefit) for all related AUs.
How do I process an incomplete mid-certification review or a report with changes?
· Mid-certification reviews returned incomplete or with changes are processed in ACES.
· For information on required verifications for the mid-certification review, see Clarifying Information in the EAZ Manual – WAC 388-418-0011 What is a mid-certification review and do I have to complete one in order to keep getting benefits?
· To process a mid-certification review in ACES, take the following steps:
1. From AMEN, access the AU via Option R – Interim/Hist Change.
2. If changes have been reported, enter the information as required on the appropriate screens.
3. On the MISC screen, enter date in the Date Report Recd field and update the Report Cmplt field with the appropriate code. See <F1> Help.
o When mid-certification review is processed through Option R – Interim/Hist Change, the MISC screen will need to be updated for each AU separately.
o When a returned mid-certification review is processed as incomplete, ACES generates LTR 023-02 (General Request for Information or Action) to request more information from the client.
4. Enter [DONE] in the Screen ID field in the upper right corner, update the NARR screen and <TRANSMIT>.
When is LTR 033-03 (Non-Receipt of the Change Report Form) generated?
· LTR 033-03 serves as 10-day Notice and the Termination Letter. It is generated on or about the 18th of the month in the 6th month if the MISC screen Report Cmplt field displays the following valid values:
o S - Report Sent Not Returned
o I - Report Returned Incomplete
o W - Report Ret Incomplete-Missing WAGE/Income Verification What happens at monthly issuance if the mid-certification review is incomplete?
· If the Report Cmplt field on MISC screen indicates the report is still incomplete at monthly issuance of the 6th month:
o TANF/SFA will close at monthly issuance for Reason Code 142 Incomplete mid-certification review. TANF/SFA will sprout a F04 medical AU. Alert 115 - MID-CERT REVIEW INCOMPLETE: REDETERMINE ELIGIBILITY will be generated.
o GA and Basic Food will close at monthly issuance for Reason Code 142 Incomplete mid-certification review.
o F04 AUs marked incomplete will not close at monthly issuance Alert 115 -MID CERT REVIEW INCOMPLETE: REDETERMINE ELIGIBILITY will be generated.
What happens at monthly issuance if the mid-certification review has not been received?
· TANF/SFA, Basic Food, GA and medical AUs will close for Reason Code 141 – Mid-certification review not returned.
Can an AU be manually closed for an incomplete mid-certification review?
· Yes, an AU can be manually closed for Reason Code 542 – Incomplete mid-certification review.
· When an AU is closed for Reason Code 542, the AU will not trickle or sprout.
What do I do if an application is received after an AU closed for no mid-certification review?
· When a client submits a new application after their case closed for failing to return a mid certification review (Reason code 141 or 142) the client has the choice of either completing the application, or withdrawing the application and completing the 6-month report. See EAZ Manual – WAC 388-418-0011 What is a mid-certification review, and do I have to complete one in order to keep receiving benefits?
· When you receive a new application in this situation, take the following steps:
1. Screen a new AU for the application. See Screening a Client.
o Do not re-open the AU that closed for Reason Code 141 or 142, you will need to use this AU if the client chooses to complete the 6-month report. 2. Contact the client to offer them the choice of withdrawing this application and completing the six-month report or completing the application process.
3. If the client chooses to complete the application:
o Complete the interview following the instructions in Interview.
o Process the application following the instructions in Process Application Months.
o Finalize the application following the instructions in Finalize Application.
4. If the client chooses to withdraw the application and complete the 6-month report, take the following steps only when you have all the necessary information/verification to complete the 6-month report:
o Reinstate the AU(s) that closed for non-receipt of the 6-month report (Reason Code 141 or 142). See Reinstatement.
o Process the 6-month report following the steps in How do I process a 6-month no change report with verifications? Or How do I process an incomplete 6-month report or a report with changes?
o Deny the pending AU screened from the application.
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