LOW INCOME SUBSIDY (LIS)
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LOW INCOME SUBSIDY (LIS)


Revised March 25, 2011



LOW INCOME SUBSIDY (LIS)

What is the Low Income Subsidy interface?

 

How often is the LIS file received?

 

How do I access the LIS screens?

 

How do I access the LIS application information in aces.online?

 

What information is received from SSA on the LIS file?

 

How am I notified when there is a discrepancy between the information in ACES versus what is sent on the LIS file?

 

When is a client considered matched between ACES and the LIS file?

 

What happens when there is an exact match between ACES client data and the LIS file?

 

What happens when ACES does not auto-screen a S03?

 

What if the client’s name, DOB and gender matches, but the SSN does not match?

 

What happens if the LIS beneficiary is not known to ACES?

 

When does the system auto-deny a S03 AU auto-screened?

 


 

What is the Low Income Subsidy interface?

 

·         This interface was developed to comply with Public Law 110-275 section 113 Eliminating Barriers to Enrollment under the Medicare Improvements Patients and Providers Act (MIPPA). The Low Income Subsidy (LIS) program is federally funded assistance for the Medicare Part D program. The LIS interface provides information from the Social Security Administration (SSA) regarding clients who have applied for LIS.

 

How often is the LIS file received?

 

·          Effective 01/01/2010, SSA will start sending the LIS file on a daily basis.

 

How do I access the LIS screens?

 

·         To access the LIS application file take the following steps:

 

1.    From the WMEN, select option L – File Inquiry.

 

2.    On the LMEN screen, select option J – LIS Application.

 

3.    <TRANSMIT> and the LIS1 screen displays.

 

o    The LIS1 screen displays the client’s demographics data and the LIS approval details.

 

o    To access the LIS2 screen enter function key <F14>.

 

o    The LIS2 screen displays the earned income, unearned income and resources of the client and the spouse as reported to SSA.

 

·         The LIS Application data can also be accessed from the following two client level screens:

 

o    From the UNER screen, enter <F20> and the LMEN displays, select option J – LIS Application and enter the client id if it has not auto populated.  <TRANSMIT> to display the LIS1 screen and <F20> to access the LIS2 screen.

 

o    From the EARN screen enter <F20>, and the LMEN displays, select option J – LIS Application and enter the client’s Social Security Number if it has not auto populated and <TRANSMIT> and the LIS1 screen displays. To access LIS2 enter function key <F14>.

 

How do I access the LIS application information in aces.online?

 

1.    From the Welcome Back page of aces.online, use the Quick Navigation section to do the following:

 

o    In the Select a Type of ID drop down box, click Client.

 

o    Enter the Client ID in the Enter an ID field.

 

o    In the Select a Page drop down box, click LIS Application.

 

o    Click Go and the Client >> Income >> LIS Application page displays.

 

What information is received from SSA on the LIS file?

 

·         The LIS interface file contains the demographics, income and partial resource information pertaining to clients who are just becoming eligible for Medicare.

 

·         Clients reaching the 24th month of disability and MSP clients moving into the State and have completed an LIS application.

 

How am I notified when there is a discrepancy between the information in ACES versus what is sent on the LIS file?

 

·         Alerts are generated to the worker of record unless the client ZIP Code is out of state or does not match the ACES ZIP Code database. These AUs will be assigned to CSC 128 – District 2 and the default user (unit supervisor for first unit type 88).

 

·         When there is a discrepancy in the Social Security Number, Name or Date of Birth between the LIS Application file and ACES, a two-tier discrepancy Alert 430 – LIS MATCH DISCREPANCY – REVIEW FOR MSP PROGRAM generates.

 

·         When ACES receives a record with a date of death for a spouse, a two-tier discrepancy Alert 431 – SPOUSE IN THE LIS FILE DECEASED PER ACES generates and spouse will not be added to the pending S03 AU.

 

When is a client considered matched between ACES and the LIS file?

 

·         A client is considered a match when all of the following criteria are identical between the client’s ACES case and the LIS file:

 

o    Social Security Number

 

o    Date of Birth

 

o    Name

 

What happens when there is an exact match between ACES client data and the LIS file?

 

·         The system screens or adds in a pending S03 AU.

 

·         The application date will be set to the date the client applied for LIS through the Social Security Administration.

 

·         The Standard of Promptness (SOP) count begins from the date ACES processes the LIS file.

 

o    This is the only program where the SOP count begins from the date we receive the LIS input file from SSA.

 

·         Populate the following screens with the information received in the LIS interface file:

 

LIS1

o    Client Name

 

o    SSN

 

o    Medicare claim number (HICN)

 

o    DOB

 

o    Gender

 

o    Spouses Name

 

o    Spouses SSN

 

o    Spouses Medicare claim number (HICN)

 

o    Spouses DOB

 

o    Mailing Address

 

o    Phone Number

 

o    Household Size

 

o    Application date

 

o    Subsidy Approval/Denial Information

 

o    Subsidy Denial Reason

 

LIS2

o    Level of Resources

 

o    Income Used for Determination

 

o    Income as % of FPL

 

o    Clients:

 

    Bank A/Cs   Stock/Bond  Cash   Real Estate

 

    Soc Sec Bnft   Rail Rd Bnft   VA Bnft   Pensions/Annuities    Other

 

    Wage   Self Empl   Net Losses   Burial Exp

 

o    Spouse:

 

    Wage   Self Empl   Net Losses   Burial Exp

 

·         On the ADDR screen, ACES enters the following:

 

o    Primary Language Code is set to EN – English

 

o    LIS address lines one and two will be used to populate the first and second address lines in ACES, unless the client is the head of household on an active or pending AU, then the system retains the address in ACES.

 

o    City

 

o    State

 

o    ZIP

 

    The ZIP code from the LIS input file is used to determine the Customer Service Center (CSC) and user of record for the AU. If the zip code is not valid in ACES, the AU defaults to CSC 128 and the default user (unit supervisor for first unit type 88).

 

    If the client is the head of household on an active/pending AU, the system compares the address data from the LIS file to the data already existing in ACES and if different retains the address entered in ACES.

 

·         On the AREP  screen, if appropriate ACES enters the following:

 

o    The Authorized Representative data on any active or pending medical AUs is copied over to the auto-screened QMB AU.

 

·         On the DEM1 screen, ACES enters the following:

 

o    SSN

 

o    First Name, Middle Initial, Last Name

 

o    Date of Birth

 

o    Sex

 

o    Race Code will be set to 999 – Unreported.

 

·         On the DEM2 screen, ACES enters the following:

 

o    Equal Access Question will be set to P – Not Present.

 

·         Generate Letter 023-02 (General Request for Information or Action) with the appropriate conditional text block.

 

What happens when ACES does not auto-screen a S03?

 

·         An S03 AU is not auto-screened under the following conditions:

 

o    If there is a discrepancy in the client’s name, date of birth or Social Security Number between ACES and the LIS file.

 

    Alert 430 – LIS MATCH DISCREPANCY – REVIEW FOR MSP PROGRAM is generated. The second line of this alert identifies the discrepancy for the worker to review and take the appropriate case action.

 

o    If the client is deceased per ACES coding.

 

o    If the client is active or pending on a QMB AU.

 

·         When auto-screen is not possible, S03 should be manually screened if appropriate.

 

·         If the LIS file contains a spouse or other household members that are not already known to ACES, Alert 247 – SDX SHOWS CLIENT IS MARRIED, ACES DOES NOT is generated to the user of record to review household composition.

 

What if the client’s name, DOB and gender matches, but the SSN does not match?

 

·         The system compares the Social Security Number number-by-number and if seven of nine match and if it is not federally verified.

 

o    The client’s SSN will be updated in ACES and the client will be considered known to ACES.

 

o    If not it the appropriate alert is generated to the worker of record.

 

What happens if the LIS beneficiary is not known to ACES?

 

·         The system will take the same steps as in What happens when there is an exact match between ACES client data and the LIS file? client is known to ACES and is not active on or pending on a MSP program in addition to the following:

 

·         A new S03 AU with a new client ID for beneficiary and/or spouse is auto screened.

 

·         The application date is set to the LIS application date in the LIS interface file.

 

·         The information received from the LIS interface file will populate the following ACES fields:

 

·         On the ADDR screen, ACES enters the following:

 

o    Primary Language Code will be set to EN – English

 

o    LIS address lines one and two will be used to populate the first and second address lines in ACES, unless the client is the head of household on an active or pending AU, then the system retains the address in ACES.

 

o    City

 

o    State

 

o    ZIP

 

    The ZIP code from the LIS input file is used to determine the Customer Service Center (CSC) and user of record for the AU. If the ZIP code is not valid in ACES, the AU defaults to CSC 128 and the default user (unit supervisor for first unit type 88).

 

·         On the DEM1 screen, ACES enters the following:

 

o    SSN

 

o    First Name, Middle Initial, Last Name

 

o    Date of Birth

 

o    Sex

 

o    Race Code will be set to 999 – Unreported.

 

·         On the DEM2 screen, ACES enters the following:

 

o    Equal Access Question will be set to P – Not Present.

 

When does the system auto-deny a S03 AU auto-screened?

 

·         The pending S03 AU auto denies after 30 days if an interview has not been initiated on the PEND screen. The S03 AU auto- denies with Reason Code 230 – Verification and Letter 004-05 (General Denial – No Information) generates.

Modification Date: March 25, 2011